Introduction

Surfing draws in athletes of all ages to a sport that is skillful and strategic, yet

adventurous. The athlete utilizes a surfboard to paddle out to the waves, then rides them back

into shore. Unlike many sports, surfing combines athleticism with nature to develop a lifestyle

distinctly known for being laid-back and unique. It originated in Western Polynesia thousands of

years ago as a way for fishermen to bring their catch back into shore, and has evolved into a

worldwide phenomenon because of key people, such as the Father of Modern Surfing, Duke

Kahanamoku. He was an olympic swimmer who had a passion for surfing, and his reputation put

a spotlight on the sport, which increased the publics interest in surfing along the West Coast.

Another key figure was Tom Blake, who was known for his revolutionary changes to the

surfboard, making it more lightweight and maneuverable for the surfer. Blake played a large part

in the revival of surfing because surfers wanted to find new ways and approaches to the sport.

His innovative new board designs included a small fin on the underside of the board that allowed

surfers to turn and cut into waves. These changes made surfing easier, and thus discover new

ways to ride the swells, or waves. In addition to key people, surfing increased in popularity

because entertainment and daily lifestyle focused on relaxing and leisure after the end of World

War II. Examples include beach movies and surf fashion such as floral button-up shirts and

flip-flops. Surfing also benefitted from the war because new technology developed for weapons

could be used to make boards last longer, such as waterproof glue and fiberglass. These

innovations made better surfing equipment more accessible to everyday people.

The relaxed mentality of the sport, combined with the release of endorphins from

exercise could have a positive influence on mental health. Additionally, surfing is an easily
accessible sport for the large population of people that live along the coast. Researching how to

maximize this impactful combination could lead to advancements in mental health fields

concerning veterans, the disabled, those dealing with trauma, and ones overall mental

well-being. Professional studies can provide insight into the impacts of surfing, and interviews

with local surfers can give firsthand knowledge from their experiences. My sources are meant to

provide more insight to the psychological benefits of surfing, such as the release of endorphins,

however I would also like to conduct my own study to gain more in-depth information about the

quantity of endorphins released. Though I am not a surfer, I am fascinated by the surfing

lifestyle, and have done extensive research about the topic, therefore, some bias may be present.

My hope for this study is to gain a deeper understanding of the specific increases in particular

hormones as a result of surfing in order to aid those battling mental illnesses.

Literature Review

Surfing is a water sport that combines athleticism with nature to develop a lifestyle

distinctly known for being laidback and unique. Camps, programs, and even a simple group of

friends who share a passion for the sport can develop interpersonal skills that improve mental

health. Waves for Change is a surf camp based in South Africa that is designed to provide a safe

place for kids suffering from Post Traumatic Stress Disorder (PTSD). They are a special camp

because they train their counselors to be more than a leader to their kids, but also as a big

brother or mentor. An aspect that makes surfing unique is the fact that the ocean is a vast body

that contains numerous dangers and unknowns, meaning that the child is forced to fully trust

their counselor and peers in order to surf well (Kelto, 2014). Robert Bisantz, a computer

programmer and water sports fanatic, explains in an interview that the mystery of the ocean is
enticing to him because he finds his zen out there, surrounded by creatures and nature. It also

forces him to focus only on his task and deal with things out of his comfort zone, which grows

him as a person and surfer (R. Bisantz, personal communication, September 26, 2017). Dan

Ryan, a youth pastor and surfer in his free time, was also interviewed, and when asked how he

thought surfing could be therapeutic, he responded by saying that, surfing offers a sense of

accomplishment, opportunities to trust an instructor, and the waves are a reminder you are part of

something bigger than yourself. (D. Ryan, personal communication, September 25, 2017). He

agrees that the ocean is so large and is accompanied by so many variables, but being out in the

waves is an experience like no other. Another surf program designed for children with

disabilities emphasizes independent participation with little rules and close physical contact, so

the participants can improve social skills without being overwhelmed by stimuli (Clapham,

Armitano, Lamont, & Audette, 2014). This type of program can also underscore interpersonal

skills such as friendship, social trust, and enjoyment as children build relationships with their

fellow surfers (Porter & Stuhl, 2015). However, surfing can connect more than just campers and

counselors. The Surf Clinic of Naval Medical Center San Diego (NMCSD) helps soldiers with

combat-related polytrauma build community and release stress with other soldiers going through

similar situations in between catching waves (Fleischmann et al., 2011). Connections can also be

made locally, such as in surfing competitions. For instance, competitions along the coast of

Liberia bring together numerous skilled athletes, such as Benjamin McCrumade and Elijah

Brown, who fiercely compete for titles, however they are still able to bond over their passion for

the sport and lift the other on their shoulders in their victory. Surfing is especially significant in
Liberia at this time because it allowed the people to rally together in joy, encouraging one

another, one year after the Ebola outbreak (Mukpo, 2016).

As a result of hard work, surfing can also increase feelings of self-confidence and good

self-esteem. For example, Chris Burkard travels to the most remote and unusual surfing spots in

the world to photograph surfers, which was a physical and creative challenge in light of the

numerous modes of transportation he needed to get to his location, and the below-freezing waves

that he took on. However, to him, the benefits outweighed the costs. In his TED Talk, Burkard

states that, Anything that is worth pursuing is going to require us to suffer just a little bit, and

that tiny bit of suffering that I did for my photography, it added a value to my work that was so

much more meaningful to me than just trying to fill the pages of magazines (2015, 8:45)

Furthermore, children with disabilities have improved self-confidence when they can move in

the water without assistance during their surf camps (Clapham, Armitano, Lamont, & Audette,

2014) and positive reinforcement combined with recognizing the participants achievements can

increase their self-esteem, leading to higher levels of effort and perseverance and decreased

anxiety levels (Armitano, Clapham, Lamont, & Audette, 2015; Gaspar de Matos et al., 2017).

Because neurotransmitters such as dopamine, serotonin, and norepinephrine are released during

exercise, there is an improvement in mood and an overall decrease in depression, as seen in the

soldiers from NMCSD (Fleischmann et al., 2011). Although some may be hesitant to try surfing

because of changing shark populations patterns, especially in Australia, which is famous for its

surfing spots, the chances of being attacked remain low (West, 2011, 744). Instructors and

counselors at camps are also trained to prioritize the safety of the participants. Physically, this

activity has the ability to chemically improve a participants state of mind, while the company
they are with can encourage them, showing that surfing can yield feelings of self-confidence and

good self-esteem.

Entering the Conversation

The source material discusses aspects of surfing such as how community can build

interpersonal relationships that improve mental health, or that as a result of hard work, surfing

can increase feelings of self-confidence and good self-esteem. It also touched on how surfing

increases the release of hormones such as dopamine, serotonin, and norepinephrine as a result of

physical exercise, however it did not go in-depth about how those hormones were measured, or

to what degree they were increased. This could be because the case studies that I pulled often

focused on the tangible results of surfing, such as increased mood, improved social skills, and so

on, rather than the science and specific hormones behind those changes. If our brains release

enough of those hormones during exercise, could surfing and other forms of physical activity

replace drugs such as antidepressants, or at least be paired with the drugs to make them more

effective, and eventually lead to a decrease in dosage? To answer this question, I will conduct a

case study to measure the increase in the hormones serotonin, dopamine, and norepinephrine in

teenagers age 13-19 who have been diagnosed with depression.

While I am not a surfer, there is still the potential for bias in my study because the studies

that I looked at while conducting my research had already discussed the topic of mood

improvement due to hormones. My hope for this study is to find out if the amount of released

endorphins is significant enough to affect prescriptions for mental illnesses, such as depression.

In terms of results, the best case scenario would be that the released endorphins would impact a

patients mood significantly enough to where they could decrease their antidepressant
prescription, or stop it altogether. While that may be wishful thinking, and the endorphins

released may not be significant enough, the study will at least provide more insight as to the

specific changes in hormone levels that stem from a physical activity, such as surfing.

The population will be all teenagers along the coast of North Carolina who have been

diagnosed with depression, and I will take a simple random sample of four mental health clinics

along the Outer Banks. I will then give a paper survey (Figure 1) to all teenagers age 13-19 in

order to essentially choose 20 participants from each establishment for the study. The ideal

number of participants would be 15 people from each clinic, however I will select 20 to account

for participants that wish to drop out at any time. The model participant would be a teenager age

13-19 who is diagnosed with moderate depression, but is not on antidepressants. We do not want

to endanger a patient by including them in the study if their depression is not controlled, or if

their doctor does not approve of their participation. Those 80 participants will then be split into

four groups: the control group and three experimental groups. The control group will continue to

not use antidepressants throughout the study and will not surf, one experimental group (group A)

will surf without antidepressants, group B will use antidepressants without surfing, and group C

will both surf and use antidepressants (see Figure 2). Since the study will involve the use of

antidepressants and other prescription drugs, it is imperative that there is written consent from

every participant, their family, and their doctor in order to prevent liability issues. Additionally,

the review board must know that we recognize that depression is a sensitive subject and

engaging in tests may not be what is best for the participant, so it will be understood that a

participant can drop out of the study at any time if they, or others, feel as if their mental health is

at risk.
Figure 1:

Participant Name Age

Question Response

How long have you been diagnosed with

depression?

Have you been prescribed any medications to

help your symptoms?

How severe are your symptoms?

Do your health care provider and your parents

approve of your participation?

Are you willing to change your daily mental

health regimen for 8 weeks?

This 8-week study will consist of the participants learning how to surf and their hormone

levels will be measured at the end of each week. At the end of the 8-week period, the trends in

hormone levels will be compared amongst participants in the same group, then compared to the

results of the other groups. This study exists in order to see the effect of antidepressants and

physical exercise (surfing) on levels of dopamine, serotonin, and norepinephrine. Key figures

that will contribute include local surf instructors at Wrightsville Beach, NC and lab technicians

who will run tests on samples from the participants. The experimental groups will start taking

antidepressants one week before the first surfing session, and the progression of surfing sessions

is indicated in the Figure 3 below.

Figure 2:

No Antidepressants Antidepressants

No Physical Activity Control Group Group B

 Physical Activity Group A Group C

Figure 3:

Week Description

1 Basics: safety and dryland techniques

2 Review dryland if necessary, move into water

3 Build on and improve skills previously learned

4 Build on and improve skills previously learned

5 Build on and improve skills previously learned

6 Build on and improve skills previously learned

7 Prepare for optional surfing competition

8 Surfing competition

As previously stated, each participants hormone levels will be measured at the end of

every week. However, in order to compare, we must have a baseline. This means that each

participants hormone levels will be measured one week before they begin surfing, and those

prescribed antidepressants will have their levels measured again the day before they begin. To

measure serotonin levels, a blood sample will be collected and analyzed, and a urine test will be

conducted to measure dopamine and norepinephrine levels. The results will then be put into a

table such as Figure 4 below, and each participant will have their own chart.

Figure 4:

Participant Name Group

Week 1 Week 2 Week 3 Week 4 Week 5 Week 6 Week 7

Serotonin
 Dopamine

Norepinephrine

In addition to measuring hormone levels, one long-term goal of this study is to see how

physical activity makes the participants feel, so that it could potentially be used as a substitute or

together with antidepressants. To figure this out, participants will also fill in the survey below

(Figure 5) and once again, the results will be combined into a comparative table (Figure 6). By

comparing the results side-by-side, I will be able to easily see if there is a difference between

how antidepressants or physical activity affect the participants. In this study, we will collect both

qualitative data, in the form of hormone measurements, and quantitative data in the form of

surveys. Both forms of data collection benefit the study in different ways. Qualitative data allows

us as researchers to see specific changes in hormone levels and see why those changes occur,

whereas quantitative data shows us how the participant feels throughout the study. By comparing

both forms of data, we are able to see how hormone levels affect a patients mental health status.

Figure 5:

Participant Name Group

Question Strongly Disagree Indifferent Agree Strongly

Disagree Agree

After the surfing session, I feel

better about myself.

I feel like I am building community

here with my peers.

My antidepressants, or lack thereof,

are improving my mental state.

Physical exercise, or lack thereof, is

improving my mental state.
 I look forward to coming back for
my next session.

Figure 6:

Question:

Group Strongly Disagree Indifferent Agree Strongly

Disagree Agree

Control

This study would essentially serve as a starting point for using physical activity,

especially surfing, as a progressive way to combat mental illnesses. Surfing would be considered

a validated method to help with depression if hormone levels significantly increased. For

example, the normal range for serotonin levels is 101 to 283 ng/mL, but a teenager battling

depression would have significantly less than the normal range. In this case, surfing would be

beneficial if those serotonin levels rose to be within the normal range over the course of the

8-week study. As previously stated, to measure serotonin levels, a blood sample will be collected

and analyzed, and a urine test will be conducted to measure dopamine and norepinephrine levels.

Additionally, the results of the survey would provide qualitative data about how the participants

feel in response to their antidepressants.

To present my results and conclusions to the review board, I would create a presentation

in which I showcase all of my findings, including Figures 1-6. I would discuss information that I
had previously gathered from my source material, and incorporate what I learned from my own

study. To start, I would acknowledge that we are working with human subjects with mental

illnesses and a potentially hazardous sport, therefore, an extra degree of precaution will be

present to make sure the these participants are kept safe at all times. Because of this, it will be

universally understood by everyone concerned with the study that a subject may withdraw their

participation at any time. Additionally, I would analyze any patterns and trends that I saw

between the four different groups, and discuss what I have learned about the effects of surfing on

mental health. If the study is approved, the results would be shown as a potential alternative

choice to parents and teenagers who are reluctant to start on antidepressants. Even if they opt to

get a prescription, surfing can still act as a way to get physical activity and release energy. In

order to reach my target audience of parents, I would emphasize how beneficial surfing would be

to their childs mental health and how it could save them money by decreasing their

antidepressant prescriptions. To reach teenagers, I would focus on the fact that surfing is an

engaging physical activity that is not only fun, but allows the participants to build relationships

with their peers and mentors.

Conclusion

My original topic was the inquiry of the psychological benefits of surfing. After pulling

research from academic articles, Ted Talks, and NPR podcasts, I was able to find multiple

benefits of the sport, including increased self-confidence, decreased anxiety, and the

establishment of lasting friendships in the surfing camps. Along with psychological benefits,

surfing also had obvious physiological benefits, such as increased muscle strength, improved

cardio endurance, and improved balance. Additionally, surfing has been used as a physical and
mental outlet for children with disabilities, troubled youth, and war veterans suffering from

PTSD and polytraumatic injuries.

My work within the project relates to previous work because I drew conclusions from

multiple sources that related to my topic. The scholarly articles consisted of studies that were

conducted. Most of which, were surfing camps designed for a specific group of people, such as

troubled youth or disabled veterans. I was able to look that the studies that were done already and

see the benefits that came from those camps. Additionally, testimonies, such as Chris Burkards

Ted Talk, or the NPR podcast about surfers in Liberia, made the research more personal because

they were able to tell us exactly how and why surfing affects their lives.

In light of the amount of studies that I looked at during my research, I decided to create

my own study to model how many endorphins are released during exercise, and their potential

effect on prescription medications. However, how could surfing affect those battling addictions?

Could it potentially have similar results in that the addicts can find a healthy outlet and face their

addictions? Surfing gave those in the previous studies a way to overcome their struggles, build

community, and improve their mental health, so it could potentially be the same for those facing

addiction. Even if no one pursues another study to see the effect of surfing on those battling

addictions, my hope as a researcher is that my study at the very least raises awareness for those

diagnosed with depression. Mental illnesses are a difficult burden to carry throughout life, so

hopefully the results of this study are able to help someone better manage their symptoms or

even decrease their prescription medication. Physical activity can have an extremely significant

impact on our mentalities, and my hope is that this study shows those with mental illnesses that

they can feel better by relying on more than their medicine.

 References

Armitano, C. N., Clapham, E. D., Lamont, L. S., & Audette, J. G. (2015). Benefits of Surfing for

Children with Disabilities: A Pilot Study. Retrieved September 17, 2017, from

http://digitalcommons.uri.edu/cgi/viewcontent.cgi?article=1013&context=kinesiology_fa

cpubs

Burkard, C. (2015, March). Transcript of "The joy of surfing in ice-cold water". Retrieved

September 17, 2017, from

https://www.ted.com/talks/chris_burkard_the_joy_of_surfing_in_ice_cold_water/transcri

pt

Clapham, E. D., Armitano, C. N., Lamont, L. S., & Audette, J. G. (2014, March 27). The Ocean

as a Unique Therapeutic Environment: Developing a Surfing Program. Retrieved

September 17, 2017, from

http://www.tandfonline.com/doi/abs/10.1080/07303084.2014.884424

Fleischmann, D., MD, Michalewicz, B., MS, Stedje-Larsen, E., MD, Neff, J., MD, Murphy, J.,

PhD, Browning, K., MPH, . . . McClay, R., MD, PhD. (n.d.). Surf Medicine: Surfing as a

Means of Therapy for... : JPO: Journal of Prosthetics and Orthotics. Retrieved September

17, 2017, from

http://journals.lww.com/jpojournal/Fulltext/2011/01000/Surf_Medicine__Surfing_as_a_

Means_of_Therapy_for.6.aspx

Gaspar de Matos, M., Santos, A., Fauvelet, C., Marta, F., Evangelista, E. S., Ferreira, J., . . .

Mattila, M. (2017, June). Surfing for Social Integration: Mental Health and Well-Being

promotion through Surf Therapy among Institutionalized Young People[Scholarly

 project]. In ResearchGate. Retrieved September 17, 2017, from

https://www.researchgate.net/publication/317956933_Surfing_for_Social_Integration_M

ental_Health_and_Well-Being_promotion_through_Surf_Therapy_among_Institutionaliz

ed_Young_People

Kelto, A. (2014, December 02). If Everybody Had An Ocean, Could We Surf Our Way To

Mental Health? Retrieved September 17, 2017, from

http://www.npr.org/sections/goatsandsoda/2014/12/02/366600463/if-everybody-had-an-o

cean-could-we-surf-our-way-to-mental-health

Mukpo, A. (2016, February 06). After Ebola, Surf's Up Again In Liberia. Retrieved September

17, 2017, from

http://www.npr.org/sections/goatsandsoda/2016/02/06/465691865/after-ebola-surfs-up-ag

ain-in-liberia

Porter, H., & Stuhl, A. (2015, January). Riding the waves: Therapeutic surfing to improve social

skills training in children with autism. Retrieved September 17, 2017, from

https://www.researchgate.net/publication/292116941_Riding_the_waves_Therapeutic_su

rfing_to_improve_social_skills_training_in_children_with_autism

West, J. G. (2011). Changing patterns of shark attacks in Australian waters. Marine and

Freshwater Research, 62(6), 744. doi:10.1071/mf10181