Riding the wave into wellbeing: A qualitative evaluation of surf therapy for individuals living with acquired brain injury

Abstract

Nature has long demonstrated the capacity to facilitate wellbeing. Interventions involving the natural environment such as surf therapy, are increasingly being used to facilitate aspects of wellbeing in clinical populations. However, explorations of how nature-based interventions such as surf therapy may be used to promote wellbeing in the context of neurorehabilitation are missing from the peer-reviewed literature. Here we characterize the experience of a five-week surfing intervention involving fifteen adults living with the psycho-social and cognitive sequelae of acquired brain injury. Insights were analysed using reflexive thematic analysis, which highlighted the importance of seven overarching themes, including: 1) Connection to Nature, 2) Facilitating Trust and Safety, 3) Managing and Accepting Difficult Emotions, 4) Facilitating Positive Emotion, Meaning and Purpose, 5) Building Community through Social Connection, and 6) Positive Change. Barriers and opportunities (theme 7) were also identified as components on which clinical services may be improved. We present a theoretical model for the benefits of surf therapy in people living with acquired brain injury (ABI) based on these themes and reflections on findings from the wider literature. Findings emphasise the importance of leveraging community partnerships to augment the holistic model of neurorehabilitation and potential implications for service redesign are discussed, focusing on recent developments in wellbeing science.

The ‘Rippling’ Waves of Wellbeing: A Mixed Methods Evaluation of a Surf-Therapy Intervention on Patients with Acquired Brain Injury

“…There were no significant differences between baseline and post-intervention HADS depression and anxiety scores, nor connectedness (visual analogue scale rating), and no significant change in HRV measures. The improvement in participants' self-reported wellbeing is coherent with previous qualitative findings on Surf-Ability, in which participants reported holistic improvements across a range of interconnected wellbeing-promoting factors [58]. In addition, an REM session was conducted with a small sub-sample of participants at 6-10 months follow up.…”

“…There are an extensive number of third-sector and community organisations across the world providing opportunities for people to flourish, but it requires substantial confidence for patients to approach these spontaneously without support. Whilst it can be practically and financially challenging for neurorehabilitation services to attend community projects with patients, the present evaluation demonstrates that this goal can be achieved via collaborative partnerships between neurorehabilitation services and local community third-sector organisations [58,93]. Bridging the gap between healthcare and community projects can help overcome barriers for individuals with ABI who feel unable to access the community independently and thus are at risk of become marginalised [11].…”

“…The surf-therapy intervention was designed to facilitate the key determinants of wellbeing, as defined by the GENIAL model, whilst utilising the natural environment as a treatment opportunity [11,43,44]. A qualitative service evaluation was previously conducted using individual interviews from participants immediately after completing surf therapy [58]. The evaluation revealed seven central themes, including: (1) connection to nature, (2) facilitating trust and safety, (3) managing and accepting difficult emotions, (4) facilitating positive emotion, meaning and purpose, (5) building community through social connection, (6) positive change and (7) barriers and opportunities.…”

The Complex Construct of Wellbeing and the Role of Vagal Function

“…The science of wellbeing has given rise to new opportunities including interventions designed to improve wellbeing in people living with chronic conditions (e.g., Tulip et al, 2020 ; Wilkie et al, 2021 ; Gibbs et al, 2022 ), for whom interventions have typically focused on reducing illbeing. Wellbeing in chronic conditions may be promoted through efforts to tackle wellbeing at multiple levels of scale for system-wide change, consistent with a systems-informed positive psychology (Kern et al, 2020 ).…”

“…Wellbeing in chronic conditions may be promoted through efforts to tackle wellbeing at multiple levels of scale for system-wide change, consistent with a systems-informed positive psychology (Kern et al, 2020 ). For instance, we found that a group-based surf therapy intervention for people with acquired brain injury involving a partnership across academia, healthcare and community-based organizations may facilitate a cascade of mechanisms supporting positive change (Wilkie et al, 2021 ; Gibbs et al, 2022 ). This provides a concrete example of how our GENIAL model has been applied, taking into consideration individual, community, environment and behavior change while tackling entrenched socio-structural barriers (e.g., financial constraints, disciplinary silos) (see also Kemp and Fisher, 2022 ).…”