A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder

Abstract

Background Major depressive disorder (MDD) is the most prevalent mental health disorder worldwide, including among U.S. service members. In addition to evidence-based treatments, activity-based approaches have been shown to effectively treat depressive symptoms, particularly when they occur in the natural environment. Methods This study compared two activity-based interventions, Surf Therapy and Hike Therapy, on depression outcomes among 96 active duty service members with MDD. Participants were randomized to 6 weeks of Surf or Hike Therapy. Clinician-administered and self-report measures were completed at preprogram, postprogram, and 3-month follow-up. A brief depression/anxiety measure was completed before and after each activity session. Results Multilevel modeling results showed that continuous depression outcomes changed significantly over time (ps < .001). Although service members in Hike Therapy reported higher average depression scores than those in Surf Therapy, the trajectory of symptom improvement did not significantly differ between groups. Regarding MDD diagnostic status, there were no significant differences between the groups at postprogram (p = .401), but Surf Therapy participants were more likely to remit from MDD than were those in Hike Therapy at the 3-month follow-up (p = .015). Limitations The sample consisted of service members, so results may not generalize to other populations. Most participants received concurrent psychotherapy or pharmacotherapy, and, although statistically accounted for, results should be interpreted in this context. Conclusions Both Surf and Hike Therapies appear to be effective adjunctive interventions for service members with MDD. Research is needed to examine the effectiveness of these therapies as standalone interventions. Trial registration Clinical trials registration number NCT03302611; First registered on 05/10/2017.

The effectiveness of the National Veterans Summer Sports Clinic for veterans with probable posttraumatic stress disorder

“…The Surf and Hike Therapy programs were conducted locally on a weekly basis for 6 consecutive weeks whereas the NVSSC was a week-long program in San Diego that typically required participants to travel. Unlike findings from the current study that showed a rebound in symptoms at the 3-month follow-up, results at 3 months following Surf and Hike Therapy demonstrated continued gains in depression outcomes for active duty service member participants ( Walter et al, 2023 ). While these findings cannot be directly compared, together they may suggest that programs with longer duration, more regular sessions, occur locally, or provide opportunities for continued engagement following the program period may facilitate sustained psychological improvements (e.g., Babyak et al, 2000 ; Mota-Pereira et al, 2013 ).…”

“…Across all psychological outcomes and both diagnostic groups, scores rebounded to preprogram levels at 3-month follow-up, suggesting that gains were not maintained. Walter et al (2023) used similar assessment methodology to this study to evaluate the duration of psychological effects following a randomized trial of surf and hike therapy. The Surf and Hike Therapy programs were conducted locally on a weekly basis for 6 consecutive weeks whereas the NVSSC was a week-long program in San Diego that typically required participants to travel.…”

Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members

“…Results were consistent with prior research reporting postprogram improvements in psychological and functional outcomes for outdoor exercise and recreation programs (Lundberg et al, 2011;Duvall and Kaplan, 2014;Rogers et al, 2014;Bennett et al, 2017;Crawford, 2017;Townsend et al, 2018;Walter et al, 2019Walter et al, , 2021Walter et al, , 2023. Though, in the current study, improvements in negative affect and social functioning were contingent on the number of sessions attended, with a greater number of sessions yielding stronger effects.…”

“…The NMCSD program offered an optional yoga practice for participants prior to the start of each Surf Therapy session (data were collected and analyzed). Further information on the Surf Therapy and Hike Therapy programs has been published elsewhere (see Walter et al, 2019Walter et al, , 2023. In early 2020, the NMCSD WII Wellness Program was forced to cancel all in-person group activities due to the COVID-19 pandemic.…”

“…The current study examined the effects of Surf and Hike Therapies on psychological and functional outcomes among US active duty service members with MDD. Results from the parent study demonstrated that service members who received either Surf or Hike Therapy reported statistically and clinically significant reductions in depression symptom severity and MDD diagnosis ( Walter et al, 2023 ). The current work extends these findings by evaluating whether service members who received either Surf or Hike Therapy also reported improvements in secondary outcomes, including positive and negative affect, pain, anxiety, resilience, and physical and social functioning.…”