The way Layne Beachley describes being in the ocean makes it seem like a quasi-religious experience.
"Plunging into the ocean, I feel this feeling of being clean from the head to the toes … almost as if it cleanses my mind, my body and my soul," she says.
"It's a place where I feel connected. It's a place where I feel a sense of freedom.
"And as a confessed control addict, it's a great place to surrender – because it's a much more powerful force than I am."
Beachley, who won seven world surfing titles before retiring from professional surfing in 2008, is considered one of the most successful female surfers in history.
But his time in the ocean brought him more than professional success. Surfing, she says, "sometimes saved [her] life".
"In the mid-1990s I was diagnosed with chronic fatigue syndrome, and it was a really challenging time because I did not want to acknowledge that I was sick," she says.
"I ended up in a state of depression … I was thinking of ways to end my life every day."
After seeking professional help and making a "complete mental, physical and emotional commitment [her] health, "Beachley returned to surf.
"It was the desire to surf again that kept me alive in the deepest and darkest moments of my life," she says.
"Surfing gives me a healthy dose of perspective and balance in life. If I ever feel overwhelmed, I know I've been away from the ocean for a long time."
Surf as therapy
Beachley describes herself as a "great supporter" of surfing as a form of therapy.
"You go there, you get rid of the fears, anxieties or pressures of life … and that really leads you into your own state of being."
Executive Director of the International Surf Therapy Organization (ISTO), Kris Primacio, says the idea of surf therapy is to incorporate therapeutic services into surfing's "intrinsically motivating" activity.
"Each surf therapy program has a structured approach to surf for a therapeutic benefit," she says.
"The programs have been developed to heal mental and physical illnesses through surfing, and in doing so, we increase participants' self-efficacy and provide them with a sense of accomplishment."
Surf therapy programs typically involve talk-based group therapy, led by a mental health professional or informal peer support, followed by individual surfing instruction.
"We are not really reinventing the wheel – there is creative artistic therapy, there is equine therapy, there is music therapy … we are going to walk behind the path they have created under experiential therapy," says Primacia.
Brisbane psychologist Christine Bagley-Jones says that although surfing is not a formally recognized model of therapy, incorporating physical activity into mental health treatment can have immense benefits.
"Our physical health is intimately linked to our mental health, and vice versa. If we are not feeling well in our heads, it is a good idea to begin exploring how we are taking care of our bodies," she says.
"Surfing therapy looks very much like the physiological components of mental health."
She adds that in addition to the benefits of physical activity, surfing – and other forms of exercise – can help bring someone into the present, creating a sense of mindfulness.
"It allows us to distract ourselves from things that may be troubling us, to get a change of perspective," she says.
"With surf therapy, you have to be 100% focused on the activity in question … and as long as you're totally focused on what you're doing, you can not be thinking or worrying about anxious or depressed thoughts."
ISTO works with 30 surf therapy organizations around the world, including two from Australia. Participants in surf therapy include young people who have suffered trauma, young people with autism, people with physical disabilities, and people with posttraumatic stress disorder (PTSD).
"Surfing is such a physical activity – it creates strength and balance – but it also increases confidence," says Primacia.
"We know that physical activity reduces our stress and can reduce our anxiety. Now, surveys are being done around the world … to see if people are getting a therapeutic benefit from the ocean and more specifically from surfing."
Programs for PTSD
Last year, the US Navy embarked on a $ 1 million research project to investigate the therapeutic potential of surfing for military men with PTSD, depression or sleep problems.
This is followed by research by Los Angeles-based occupational therapist Carly Rogers who investigated the therapeutic benefits of surfing after experiencing the positive impact of this on his own mental health.
Dr. Rogers designed a surfing therapy program in 2004 (which has since been used as the basis for many programs) and conducted a small study with veterans with PTSD symptoms.
"Our participants attended five sessions, and we found that they had decreased self-reported PTSD and symptoms of depression," she says.
"We also found that there was an increase in their participation rates … which really showed a preference for this treatment."
Michael Burge, director of the Australian College of Trauma Treatment, says exercise has been seen as an effective adjuvant therapy "to reduce stress and trauma."
When it comes to the treatment of PTSD, he says that group activities such as surfing may be particularly useful because of their social aspects.
"Social isolation is well known to be a phenomenon of PTSD. People often feel that they are strange and strange because of flashbacks," says Burge.
"When they engage in sports activities, it helps reduce their isolation – there's a sense of fellowship with other surfers … and that can help dramatically."
Surfing removes barriers to traditional therapy
Occupational therapist Joel Pilgrim is the executive director of Waves of Wellness, which conducts surf therapy programs for people with mental health problems.
He says incorporating surfing into clinical therapy can help remove some of the barriers people face when they access mental health support.
"There are a lot of people who run away from traditional services because they do not want to be associated with stigma," he says.
Waves of Wellness workshops were inspired by Pilgrim's work with One Wave, a non-profit surfing community that recently made headlines when Prince Harry and Meghan Markle joined the group at Bondi Beach in Sydney to raise awareness of mental health.
"The idea of being able to get out and focus on your physical health is absolutely imperative to maintain positive mental health," Pilgrim says.
"It's not just the act of being around nature … it's being able to detach ourselves from the traumas that life can cause us."