Gender Differences in Psychological Outcomes Following Surf Therapy Sessions among U.S. Service Members

Lisa H Glassman, Nicholas P Otis, Betty Michalewicz-Kragh, Kristen H Walter, Lisa H Glassman, Nicholas P Otis, Betty Michalewicz-Kragh, Kristen H Walter

Abstract

Surf therapy is increasingly being used as an intervention to address various health problems, including psychological symptoms. Although recent research supports the positive impact of surf therapy on psychological outcomes, it is unclear whether these outcomes differ between men and women. This study compared changes in depression/anxiety (Patient Health Questionnaire-4), positive affect (Positive and Negative Affect Schedule), and pain (Numerical Pain Rating Scale) between U.S. service men and women (N = 74) during six weekly surf therapy sessions. Overall, participants reported decreased depression/anxiety (p < 0.001) and increased positive affect (p < 0.001), but no change in pain rating following each session (p = 0.141). Significant gender differences were found in the magnitude of changes in depression/anxiety (B = -1.01, p = 0.008) and positive affect (B = 4.53, p < 0.001) during surf sessions, despite no differences in pre-session scores on either outcome. Women showed greater improvements in depression/anxiety and positive affect compared with men-an important finding, given that surfing and military environments are often socially dominated by men. Future research is needed to replicate these findings in other samples, extend this research to other underrepresented populations, and identify barriers and facilitators of the sustainable implementation of surf therapy across populations.

Keywords: affect; anxiety; depression; exercise; gender differences; military; pain; physical activity; sex differences; surf therapy.

Conflict of interest statement

The authors declare no conflict of interest.

References

    1. Benninger E., Curtis C., Sarkisian G.V., Rogers C.M., Bender K., Comer M. Surf therapy: A Scoping Review of the Qualitative and Quantitative Research Evidence. [(accessed on 1 February 2021)];Glob. J. Community Psychol. Pract. 2020 11:1–26. Available online:
    1. Walter K.H., Sarkisian G.V., Martínez G., Ward P.B. Surf Therapy Practice, Research, and Coalition Building: Future Directions. [(accessed on 1 February 2021)];Glob. J. Community Psychol. Pract. 2020 11:1–11. Available online:
    1. Department of Defense Mental Health Disorder Prevalence among Active Duty Service Members in the Military Health System, Fiscal Years 2005–2016. [(accessed on 1 February 2021)];2017 Available online: .
    1. Dickstein B.D., Vogt D.S., Handa S., Litz B.T. Targeting self-stigma in returning military personnel and veterans: A review of intervention strategies. Mil. Psychol. 2010;22:223–236. doi: 10.1080/08995600903417399.
    1. Sharp M.L., Fear N.T., Rona R.J., Wessely S., Greenberg N., Jones N., Goodwin L. Stigma as a barrier to seeking health care among military personnel with mental health problems. Epidemiol. Rev. 2015;37:144–162. doi: 10.1093/epirev/mxu012.
    1. Walter K.H., Otis N.P., Ray T.N., Glassman L.H., Michalewicz-Kragh B., Powell A.L., Thomsen C.J. Breaking the surface: Psychological outcomes among U.S. active duty service members following a surf therapy program. Psychol. Sport Exerc. 2019;45:101551. doi: 10.1016/j.psychsport.2019.101551.
    1. Caddick N., Smith B., Phoenix C. The effects of surfing and the natural environment on the well-being of combat veterans. Qual. Health Res. 2015;25:76–86. doi: 10.1177/1049732314549477.
    1. Crawford R., Spitzer S., Aragon N., Shelton D. Ph.D. Thesis. Grand Canyon University; Phoenix, AZ, USA: 2016. The Impact of Ocean Therapy on Veterans with Posttraumatic Stress Disorder.
    1. Rogers C.M., Mallinson T., Peppers D. High-intensity sports for posttraumatic stress disorder and depression: Feasibility study of ocean therapy with veterans of operation enduring freedom and operation iraqi freedom. Am. J. Occup. Ther. 2014;68:395–404. doi: 10.5014/ajot.2014.011221.
    1. Otis N.P., Walter K.H., Glassman L.H., Ray T.N., Michalewicz-Kragh B., Thomsen C.J. Effects of PTSD and MDD Comorbidity on Psychological Changes during Surf Therapy Sessions for Active Duty Service Members. [(accessed on 1 February 2021)];Glob. J. Community Psychol. Pract. 2020 11:1–23. Available online:
    1. Booth D. From bikinis to boardshorts: “Wahines” and the paradoxes of surfing culture. J. Sport Hist. 2001;28:3–22.
    1. Booth D. Surf lifesavers and surfers: Cultural and spatial conflict on the Australian beach. In: Bale J., Vertinsky P., editors. Sites of Sport: Space, Place Experience. Routledge; London, UK: 2004. pp. 115–131.
    1. Comley C. “We have to establish our territory”: How women surfers ‘carve out’ gendered spaces within surfing. Sport Soc. 2016;19:1289–1298. doi: 10.1080/17430437.2015.1133603.
    1. Olive R., McCuaig L., Phillips M.G. Women’s recreational surfing: A patronising experience. Sport Educ. Soc. 2013;20:258–276. doi: 10.1080/13573322.2012.754752.
    1. Brennan D. Surfing like a girl: A critique of feminine embodied movement in surfing. Hypatia. 2016;31:907–922. doi: 10.1111/hypa.12293.
    1. Waitt G. ‘Killing waves’: Surfing, space and gender. Soc. Cult. Geogr. 2008;9:75–94. doi: 10.1080/14649360701789600.
    1. Godfrey C., Devine-Wright H., Taylor J. The positive impact of structured surfing courses on the wellbeing of vulnerable young people. Community Pract. 2015;88:26–29.
    1. De Bourdeaudhuij I., Sallis J. Relative contribution of psychosocial variables to the explanation of physical activity in three population-based adult samples. Prev. Med. 2002;34:279–288. doi: 10.1006/pmed.2001.0979.
    1. Edwards E.S., Sackett S.C. Psychosocial variables related to why women are less active than men and related health implications. Clin. Med. Insights Women’s Health. 2016;9:47–56. doi: 10.4137/CMWH.S34668.
    1. Marshall J., Ferrier B., Ward P.B., Martindale R. “When I was surfing with those guys I was surfing with family.” A grounded exploration of program theory within the Jimmy Miller Memorial Foundation surf therapy intervention. [(accessed on 1 February 2021)];Glob. J. Community Psychol. Pract. 2020 11:1–19. Available online:
    1. Archer E.M. The power of gendered stereotypes in the US Marine Corps. Armed Forces Soc. 2013;39:359–391. doi: 10.1177/0095327X12446924.
    1. Jeffreys S. Double jeopardy: Women, the US military and the war in Iraq. Women’s Stud. Int. Forum. 2007;30:16–25. doi: 10.1016/j.wsif.2006.12.002.
    1. Schaefer A.G., Wenger J.W., Kavanagh J., Wong J.P., Oak G.S., Trail T.E., Nichols T. Implications of Integrating Women into the Marine Corps Infantry. Rand Corporation; Santa Monica, CA, USA: 2015.
    1. Borne G., Ponting J. Sustainable Stoke: Transitions to Sustainability in the Surfing World. University of Plymouth Press; Devon, UK: 2015.
    1. Devine-Wright H., Godfrey C. The Wave Project: Evidencing Surf Therapy for Young People in the U.K. [(accessed on 1 February 2021)];Glob. J. Community Psychol. Pract. 2020 11:1–15. Available online:
    1. Katz L.S., Cojucar G., Beheshti S., Nakamura E., Murray M. Military sexual trauma during deployment to Iraq and Afghanistan: Prevalence, readjustment, and gender differences. Violence Vict. 2012;27:487–499. doi: 10.1891/0886-6708.27.4.487.
    1. Kramer M.D., Krueger R.F., Hicks B.M. The role of internalizing and externalizing liability factors in accounting for gender differences in the prevalence of common psychopathological syndromes. Psychol. Med. 2008;38:51–61. doi: 10.1017/S0033291707001572.
    1. Maguen S., Ren L., Bosch J.O., Marmar C.R., Seal K.H. Gender differences in mental health diagnoses among Iraq and Afghanistan veterans enrolled in Veterans Affairs health care. Am. J. Public Health. 2010;100:2450–2456. doi: 10.2105/AJPH.2009.166165.
    1. Vogt D., Vaughn R., Glickman M.E., Schultz M., Drainoni M.L., Elwy R., Eisen S. Gender differences in combat-related stressors and their association with postdeployment mental health in a nationally representative sample of U.S. OEF/OIF veterans. J. Abnorm. Psychol. 2011;120:797–806. doi: 10.1037/a0023452.
    1. Kroenke K., Spitzer R.L., Williams J.B., Löwe B. An ultra-brief screening scale for anxiety and depression: The PHQ-4. Psychosomatics. 2019;50:613–621. doi: 10.1016/S0033-3182(09)70864-3.
    1. Kroenke K., Strine T.W., Spitzer R.L., Williams J.B., Berry J.T., Mokdad A.H. The PHQ-8 as a measure of current depression in the general population. J. Affect. Disord. 2009;114:163–173. doi: 10.1016/j.jad.2008.06.026.
    1. Spitzer R.L., Kroenke K., Williams J.B., Löwe B. A brief measure for assessing generalized anxiety disorder: The GAD-7. Arch. Intern. Med. 2006;166:1092–1097. doi: 10.1001/archinte.166.10.1092.
    1. Watson D., Clark L.A., Tellegen A. Development and validation of brief measures of positive and negative affect: The PANAS scales. J. Personal. Soc. Psychol. 1988;54:1063–1070. doi: 10.1037/0022-3514.54.6.1063.
    1. McCaffery M., Beebe A. Pain: Clinical Manual for Nursing Practice. C.V. Mosby Company; New York, NY, USA: 1989.
    1. Fleischmann D., Michalewicz B., Stedje-Larsen E., Neff J., Murphy J., Browning K., Nebeker B., Cronin A., Sauve W., Stetler C., et al. Surf medicine: Surfing as a means of therapy for combat-related polytrauma. J. Prosthet. Orthot. 2011;23:27–29. doi: 10.1097/JPO.0b013e3182065316.
    1. Bathje G., Pryor J. The relationships of public and self-stigma to seeking mental health services. J. Ment. Health Couns. 2011;33:161–176. doi: 10.17744/mehc.33.2.g6320392741604l1.
    1. Clement S., Schauman O., Graham T., Maggioni F., Evans-Lacko S., Bezborodovs N., Morgan C., Rüsch N., Brown J.S.L., Thornicroft G. What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychol. Med. 2015;45:11–27. doi: 10.1017/S0033291714000129.
    1. Henderson C., Noblett J., Parke H., Clement S., Caffrey A., Gale-Grant O., Schulze B., Druss B., Thornicroft G. Mental health-related stigma in health care and mental health-care settings. Lancet Psychiatry. 2014;1:467–482. doi: 10.1016/S2215-0366(14)00023-6.
    1. Gawda B., Szepietowska E.M. Semantic and affective verbal fluency: Sex differences. Psychol. Rep. 2013;113:246–256. doi: 10.2466/28.21.PR0.113x17z3.
    1. Kelly M.M., Vogt D.S., Scheiderer E.M., Ouimette P., Daley J., Wolfe J. Effects of military trauma exposure on women veterans’ use and perceptions of Veterans Health Administration care. J. Gen. Intern. Med. 2008;23:741–747. doi: 10.1007/s11606-008-0589-x.
    1. Vogt D., Bergeron A., Salgado D., Daley J., Ouimette P., Wolfe J. Barriers to Veterans Health Administration care in a nationally representative sample of women veterans. J. Gen. Intern. Med. 2006;21:S19–S25. doi: 10.1111/j.1525-1497.2006.00370.x.
    1. Dzewaltowski D.A., Estabrooks P.A., Gyurcsik N.C., Johnston J.A. Promotion of physical activity through community development. In: Van Raalte J.L., Brewer B.W., editors. Exploring Sport and Exercise Psychology. American Psychological Association; Washington, DC, USA: 2002. pp. 209–233.
    1. Department of Defense Profile of the Military Community. [(accessed on 1 February 2021)];2018 Available online: .
    1. Wagner G.S., Nelsen C., Walker M. A Socioeconomic and Recreational Profile of Surfers in the United States. [(accessed on 1 February 2021)];2011 Available online:
    1. Forsyth A., Lysaght R., Aiken A., Cramm H. Wilderness adventure program may help combat perceptions of stigma among veterans. Ecopsychology. 2020;12:8–18. doi: 10.1089/eco.2019.0031.

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