Using surf therapy to deal with toxic stress

Waves for Change (W4C) fuses the rush of surfing with evidence-based mind/body therapy to provide a child-friendly mental health service to under-served children and young people in South Africa. In 2017, W4C embarked on a research study with The New School for Social Research in New York, mainly to pilot measures (other than self-report surveys) to collect data on the efficacy of surf therapy on children.

The study incorporated 3 data collection measures, i.e. self-report surveys, physiology (heart rate variability [HRV]), and computerized behavioral tasks. HRV is seen by researchers as a reliable marker for resilience, self-regulation, and behavioural flexibility. It is a promising biomarker of mental health resilience, as well as an index of flexibility and ability to adapt to stress. Analysis and findings were completed in May 2020.

We know that children and young people grow up in chronic poverty in South Africa, and toxic stress subsequently becomes a recognised pandemic for these children. On average, children living in the communities W4C partner with experience at least 8 traumatic/adverse events per year, in comparison to those in more developed settings that experience, on average, 5 traumatic events in their entire childhood.

Toxic stress results in exaggerated, repeated, and prolonged bottom up activation of the sympathetic nervous system (SNS) and the hypothalamus-adrenal (HA) axis. In the shorter term, toxic stress affects children’s ability to control their behaviour, emotions, and thoughts in pursuit of longer-term goals. In the longer term, it significantly increases risk for a wide range of adult-onset illness such as substance addiction, anxiety, and depression.

The study’s main objective was to answer the following questions:

1. If children referred to W4C experience toxic stress, alongside the subsequent effect this has on their overall well-being, why do our self-report surveys always show high scores across items like self-esteem?
2. Are there other ways/measures we can use to more accurately measure items like self-esteem, stress and self-regulation at baseline (when children join W4C)?
3. Does surf therapy help children deal with chronic adversity/trauma, and if so, how? Are children that have been through surf therapy better able to identify and regulate their emotions?

The evaluation yielded the following main observations:

1. Self-report measures, alone, may not be accurate to collect data from child participants. Self-report surveys largely did not converge (at least at baseline) with the other two measures, and may not always be highly accurate in this target group (as an only measure). As such, incorporating other measures, such as physiology (e.g. HRV), to triangulate and compliment self-report data, may strengthen the understanding of programme participants and programme impact.
2. HRV was found to be a suitable measure for children aged 11-14 years old, growing up in multidimensional poverty in South Africa, and the most appropriate/practical to continue with at W4C, to complement self-report data.
3. Surf therapy appeared to have a positive impact on children. Following exposure to W4C’s surf therapy, it appeared that children found a ‘happy medium’; those that ‘shut down’ were encouraged to ‘feel more’ and ‘risk more’, while those that are in constant ‘fight or flight’ learnt to ‘take 5’, ‘breath’ and respond to adversity more calmly.
4. The above positive programme effects seemed to occur after 8 weeks and were sustained thereafter. This was an important finding for mental health and prevention programmes. We’ve learnt that our 10-month programme shouldn’t be shorter, but rather that it is long enough to give children time to ‘become available’ for learning and able to retain information, and then have ongoing engagement and participation - to ‘cement’ positive changes.

Click here to access the full study learning brief.