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

• Published in: BMC psychiatry Vol. 23; no. 1; p. 109
• Main Authors: Walter, Kristen H, Otis, Nicholas P, Ray, Travis N, Glassman, Lisa H, Beltran, Jessica L, Kobayashi Elliott, Kim T, Michalewicz-Kragh, Betty
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 17.02.2023; BioMed Central; BMC
• Subjects: Care and treatment; Clinical trials; Demographic aspects; Depression; Depressive Disorder, Major - therapy; Drug therapy; Environment; Exercise; Health aspects; Hiking; Humans; Intervention; Major depressive disorder; Mental depression; Military personnel; Multilevel Analysis; Natural environment; Nature exposure; Nature-based recreation therapy; Physical activity; Psychiatry; Psychological aspects; Psychotherapy; Psychotropic drugs; Sports; Surfing; Walking; United States; United States > US; Nature-based recreation therapy; Natural environment; Exercise; Outdoor activity; Physical activity; Nature exposure; Depression; Randomized controlled trial; Military
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-022-04452-7

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. 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. 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). 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. 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. Clinical trials registration number NCT03302611; First registered on 05/10/2017.