A Novel Approach using Blue Mind Science
By Tracey Chester, LMFT, CCTP
Founder and Director of the Pain Trauma Institute
In the summer and fall of 2023 an innovative study was born, “Project Stoke” (Surfing Therapy with the Ocean and Kinesthetic Engineering). Project Stoke is a collaboration between the Pain Trauma Institute (PTI) and USC’s Department of Biokinesiology and Physical Therapy led by Dr. Jason Kutch. Our project was focused on exploring the therapeutic potential of surf therapy for chronic pain; and served as a foundation for future research utilizing virtual reality as a modality to help this population. Building on previous work identifying patterns of neural dysfunction in patients with Chronic Overlapping Pain Conditions (COPCs), this initiative investigated how the immersive ocean environment and dynamic nature of surfing provided relief from pain and trauma-related symptoms. Surf therapy combines the physical and psychological benefits of surfing with structured therapeutic interventions, offering a unique and holistic approach to care.
Beyond pain relief, surf therapy offers broader psychosocial benefits.
Blue Mind science, pioneered by Wallace J. Nichols, explores how aquatic environments positively affect the brain, reducing stress, enhancing focus, and fostering a sense of calm. These principles underpin the transformative impact surf therapy has on participants managing complex chronic conditions. Surf therapy combines physical exercise, psychological resilience, and social connection within the therapeutic context of nature, offering an innovative application of Blue Mind principles. Preliminary evidence suggests that it engages both neurological and physiological mechanisms that alleviate pain, reduce stress, and improve overall quality of life. Further research is warranted to explore the specific neural and biochemical pathways involved, including the potential role of water-induced states in modulating chronic pain and trauma.
The theoretical framework in this study is one of immersive therapy with a manageable level of threat The dynamic and immersive nature of surfing incorporates exposure to manageable physical challenges, promoting neuroplasticity and resilience. Alex and Jake both overcame fear-avoidance behaviors, regaining trust in their bodies through incremental successes on the board. This process aligns with Blue Mind principles, which suggest that water-based activities stimulate the release of feel-good neurotransmitters like dopamine and serotonin, enhancing mood and reducing the perception of pain.
The need to focus entirely on the oncoming wave forms a unique state of mindfulness, that is characterized by reduced anxiety and enhanced emotional clarity, achieved through the sensory experience of water, which includes its sound, movement, The experiences of our participants provide compelling evidence of the multidimensional benefits of surf therapy in managing chronic pain and trauma.
Using the Groundswell Community Project model,
Which was adapted for chronic pain in this study, integrates Positive Psychology, Somatic Therapy, Mindfulness, Play, and indigenous connections to nature. Sessions consisted of approximately 70% land-based activities and 30% water-based surfing, focusing on promoting present-moment awareness, emotional processing, and bodily attunement. This combination not only encourages physical activity but also creates a safe, supportive space for participants to explore their emotions and develop resilience.
The pilot study involved nine participants (three males, six females aged 30-62 years old). Dr. Jandra Mueller, Director of Education at the Pelvic Health and Rehabilitation Center, was involved with participant selection based on meeting criteria of COPCs. Resting stage EEG as well as clinical questionnaires and self-reported pain data were collected both prior to and after being in the water. The EEG data was collected using a 4 channel MUSE device collecting at 256 Hz. Dr. Kutch explains, “In this pilot project, we aimed to build a multidisciplinary team that can use neuroscience and engineering approaches to understand and develop these therapeutic effects. Our Aim for this addressed the question of whether 6 weeks of surfing therapy reduces pain and neural dysfunction in patients with COPCs.”
The study showed promising results. Pain scores decreased by an average of 50%, with significant improvements occurring during water-based sessions. The McGill Pain Questionnaire highlighted a 56.17% reduction in descriptive pain terms, reflecting a shift from intense descriptors like “exhausting” to milder terms such as “tired.” EEG data also revealed changes in neural markers associated with pain, further supporting surf therapy’s potential as a therapeutic modality.
For many participants,
Surf therapy became a turning point in rebuilding trust and confidence in their physical abilities. Initially hesitant and apprehensive about their limitations, participants found themselves gradually pushing past their fears. Christina, who struggles with multiple injuries, endometriosis and pelvic pain used the buoyancy of the ocean and the encouragement of her instructors to take small but meaningful risks. Over time, standing on the surfboard, even for brief moments, became a powerful statement of her resilience. For Jake, who suffers from chronic pelvic pain, the physical challenges of surfing helped him confront his fear of pain and re-injury. Each session provided a safe space to explore his body’s boundaries and rediscover its capacity to adapt and recover.
Surf therapy offered participants moments of respite from the constant pain and emotional weight of their conditions. Jake described how being in the water provided a brief but meaningful reprieve, allowing him to focus on the present and escape the grip of chronic discomfort. Similarly. Nina, who suffers from complex pelvic pain, experienced a transformative moment during her first session, where the playful, freeing environment of surf therapy brought her genuine joy for the first time in years. For all participants, these moments of relief were more than physical—they symbolized hope and a renewed connection to happiness.
Physically, surf therapy engages the body in ways that improve strength, coordination, and proprioception while alleviating inflammation. The cold ocean water activates the parasympathetic nervous system (PNS), contributing to reduced pain perception and a calming effect. Psychologically, immersion in water triggers a state of mindfulness and relaxation associated with the “Blue Mind state.”. Participants like Nina described this state as a rare reprieve from the constant weight of chronic pain and emotional grief.
This freedom extended beyond pain.
Nina found herself smiling and laughing with others, marveling at how the ocean’s embrace could momentarily lift her from the depths of grief and exhaustion. Mental resilience was a key outcome of surf therapy for all participants. Jake noted how the process of confronting his fears in the ocean helped him manage the “fear of pain” itself—a psychological hurdle that had often kept him from engaging in physical activities. Each session became an exercise in pushing through discomfort and proving to himself that he could recover afterward. Christina echoed this sentiment, as the supportive environment of surf therapy helped her focus less on potential failure and more on the empowerment and joy of the experience.
Additionally, the ocean’s vastness and rhythmic waves foster a sense of awe and connectedness to something greater than oneself—a perspective that can shift attention away from pain and foster a sense of purpose and grounding. Surf therapy also reframes recovery goals within the biopsychosocial model of chronic pain management. Rather than striving for complete elimination of pain, participants emphasized functional improvements, emotional growth, and reconnection with activities that bring joy.
Surf Therapy
represents a powerful, holistic approach to managing chronic pain and trauma, offering hope and empowerment to those navigating these challenges. It fosters physical strength, stress relief, and emotional release while building resilience and self-confidence. Participants also benefit from a sense of community and peer support, reducing feelings of isolation often associated with chronic illness. While more research is needed, the study underscores surf therapy’s potential as an innovative and effective approach for managing chronic pain. Its dynamic, nature-based framework offers a unique pathway for healing, combining physical movement, mindfulness, and emotional connection in a transformative experience. With further validation, surf therapy could become a powerful tool in chronic illness and trauma recovery.
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More About the Author
Tracey Chester, LMFT, CCTP, Founder and Director of the Pain Trauma Institute
Tracey is the founder and clinical director of the Pain Trauma Institute. She is a certified clinical trauma professional, a licensed marriage and family therapist, surf therapist, and a certified grief counselor.
“For me, it is a personal mission to help patients struggling with chronic pain or illness to achieve a full and meaningful life, despite their health struggles, as I know firsthand what it is like to live with chronic pain and its devastating effects on all aspects of life. Pain does not happen in a vacuum; it happens in a human being with a personality, likes and dislikes, strengths and weaknesses, and ways of thinking”
More About the Pain Trauma Institute
At the San Diego Pain Trauma Institute we empower you to relieve pain of all kinds through evidence-based mental health services and collaboration with our community of medical and research advisors. Pain Trauma Institute is a mental health clinic ocean therapy, grief counseling, psychotherapy for depression, anxiety, and other mental health issues related to chronic pain, caregiving, day-to-day life stressors, and trauma of all kinds.
We are a team of mental health therapists and physicians here to facilitate healing as a whole person. Through holistic treatment we seek to relieve suffering by understanding the current stressors you’re managing as well as the root cause rather than treating symptoms alone. We offer grief and trauma-informed care, meaning we take into account the mental, emotional, social, and physical factors impacting your unique experience.
Chronic Overlapping Pain Conditions
Improved understanding of neuroscience drives advancements in new technologies and treatments. For more information on this topic, check out the iCarebetter: Endometriosis Unplugged Podcast, where Jandra Mueller and Stephanie Prendergast talk with Jason Kutch, PhD about his groundbreaking research and own experience with pelvic pain. You can listen on both Apple Podcasts or Spotify.
Check it out for more information and please share your questions, we are happy to help answer them!
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