Trial of Surf and Hike Therapy for Major Depressive Disorder

A Randomized Controlled Trial of Surf and Hike Therapy for Active-duty Service Members With Major Depressive Disorder

This study uses a randomized controlled trial design to compare the psychological effects of surf therapy to hike therapy in active duty service members who have been diagnosed with major depressive disorder.

Study Overview

• Status: Completed
• Conditions: Major Depressive Disorder
• Intervention / Treatment: Behavioral: Physical Activity-based Interventions

Detailed Description

This prospective, longitudinal randomized controlled trial will enroll up to 86 active duty service members with major depressive disorder who are seeking surf or hike therapy as part of their standard medical care. Participants will be randomly assigned to receive 6 weeks of either surf or hike therapy. Assessor-administered and self-report measures will be completed at pre- and post-program, as well as three months following program completion. Participants also will complete brief, self-report assessments before and after each program activity session.

• Study Type: Interventional
• Enrollment (Actual): 110
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • California
    • San Diego, California, United States, 92134
      • Naval Medical Center San Diego

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: No

Description

Inclusion Criteria:

• Be a military service member seeking surf or hike therapy as part of the Wounded, Ill, and Injured Wellness program at Naval Medical Center San Diego;
• Have medical clearance to participate in these programs;
• Have a current diagnosis of Major Depressive Disorder based on DSM-5 criteria.

Exclusion Criteria:

• Service members who are currently receiving surf or hike therapy (i.e., have already started attending program sessions);
• Service members who are currently pregnant

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Treatment
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Surf Therapy; Participants receive a physical activity-based intervention, which in this arm is surf therapy. Each service member is paired with a surf instructor who typically works with them each week for the length of the program.	Behavioral: Physical Activity-based Interventions; Participants will be randomized to one of two physical activity-based interventions, surf or hike therapy.
Active Comparator: Hike Therapy; Participants receive a physical activity-based intervention, which in this arm is hike therapy. During hike therapy, service members may hike together or at a self-selected pace.	Behavioral: Physical Activity-based Interventions; Participants will be randomized to one of two physical activity-based interventions, surf or hike therapy.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Montgomery-Asberg Depression Rating Scale (MADRS)	The MADRS is a widely used, semi-structured, clinical-interview assessment of depression symptom severity that is intended to be sensitive to change following an intervention.	5 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
PTSD Checklist (PCL-5)	The PCL-5 is a self-report instrument assessing PTSD symptom severity.	5 months
Generalized Anxiety Disorder (GAD-7)	The GAD-7 is a self-report instrument that assesses the presence and severity of generalized anxiety disorder.	5 months
Short Form Health Survey - 36 Item, Version 2 (SF-36)	The SF-36 is a widely used questionnaire that assesses functioning physical and mental health based on eight summary measures.	5 months
Positive and Negative Affect scales (PANAS)	PANAS is a self-report instrument that measures the extent of 20 feelings and emotions experienced within the past few hours.	5 months
Insomnia Severity Index (ISI)	The ISI is a 7-item self-report measure that assesses the nature, severity, and impact of insomnia.	5 months
Patient Health Questionnaire (PHQ-9)	The PHQ-9 is a self-report instrument that assesses the presence and severity	5 months

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
Pain Rating Scale (PRS)	The PRS is a self-report measure that assesses current level of pain. It consists of one item rated on an 11-point scale from 0 (no pain) to 10 (worst possible pain).	5 months

Collaborators and Investigators

• Sponsor: United States Naval Medical Center, San Diego
• Collaborators: Naval Health Research Center
• Investigators: Principal Investigator: Cynthia J. Thomsen, Ph.D., Naval Health Research Center

Publications and helpful links

General Publications

• Walter KH, Otis NP, Glassman LH, Ray TN, Michalewicz-Kragh B, Kobayashi Elliott KT, Thomsen CJ. Comparison of surf and hike therapy for active duty service members with major depressive disorder: Study protocol for a randomized controlled trial of novel interventions in a naturalistic setting. Contemp Clin Trials Commun. 2019 Aug 21;16:100435. doi: 10.1016/j.conctc.2019.100435. eCollection 2019 Dec.
• Walter KH, Otis NP, Ray TN, Glassman LH, Beltran JL, Kobayashi Elliott KT, Michalewicz-Kragh B. A randomized controlled trial of surf and hike therapy for U.S. active duty service members with major depressive disorder. BMC Psychiatry. 2023 Feb 17;23(1):109. doi: 10.1186/s12888-022-04452-7.
• Otis NP, Walter KH, Glassman LH, Ray TN, Kobayashi Elliott KT, Michalewicz-Kragh B. Comorbidity of depression and posttraumatic stress disorder: Outcomes from a randomized controlled trial of surf and hike therapies among service members. Psychol Trauma. 2024 Jul 8. doi: 10.1037/tra0001673. Online ahead of print.
• Glassman LH, Otis NP, Kobayashi Elliott KT, Michalewicz-Kragh B, Walter KH. Gender Differences in Psychological Outcomes Following Surf versus Hike Therapy among U.S. Service Members. Int J Environ Res Public Health. 2024 Feb 19;21(2):241. doi: 10.3390/ijerph21020241.
• Walter KH, Otis NP, Miggantz EL, Ray TN, Glassman LH, Beltran JL, Kobayashi Elliott KT, Michalewicz-Kragh B. Psychological and functional outcomes following a randomized controlled trial of surf and hike therapy for U.S. service members. Front Psychol. 2023 Jun 8;14:1185774. doi: 10.3389/fpsyg.2023.1185774. eCollection 2023.

Helpful Links

• Link to outcomes manuscript

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2018
• Primary Completion (Actual): September 1, 2020
• Study Completion (Actual): September 1, 2020

Study Registration Dates

• First Submitted: October 2, 2017
• First Submitted That Met QC Criteria: October 4, 2017
• First Posted (Actual): October 5, 2017

Study Record Updates

• Last Update Posted (Actual): November 15, 2024
• Last Update Submitted That Met QC Criteria: November 13, 2024
• Last Verified: November 1, 2024

More Information

Terms related to this study

• Keywords: randomized controlled trial; major depressive disorder; military; surf therapy; hike therapy
• Additional Relevant MeSH Terms: Mental Disorders; Behavioral Symptoms; Mood Disorders; Depression; Depressive Disorder; Depressive Disorder, Major
• Other Study ID Numbers: NMCSD.2017.0007

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No