Flowstate is a clinically led organisation delivering evidence based mental health therapy and wellbeing programs in natural environments across the lower South West of Western Australia. Our programs include structured group therapy, individual therapy and community education, all designed and facilitated by clinicians. This is what distinguishes Flowstate from both recreational nature activities and traditional clinical settings. We bring the standards and accountability of evidence based clinical practice into environments that feel accessible, non-stigmatising and genuinely therapeutic.

Participants are not simply spending time in nature. They are doing so within a therapeutic context, guided by a team of mental health clinicians and educators who draw on approaches including Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, sensory modulation and mindfulness based approaches. The natural environment is used as a therapeutic tool, purposefully used to help build skills to support mental health and wellbeing.

The sensory qualities of the natural environment are a key element of this approach. The sound of waves, the temperature of the water, the physical sensation of movement and buoyancy, and the visual expanse of the horizon all have a powerful regulating effect on the nervous system. For participants experiencing anxiety, sensory input from the natural environment can interrupt cycles of rumination and hyperarousal, supporting a return to a calmer, more regulated state.

For neurodivergent participants this is particularly significant. Sensory processing differences are a well established feature of autism, with a large meta-analysis of over 4,600 individuals confirming significantly higher rates of sensory over-responsivity, under-responsivity and sensory seeking compared with typical development (Ben-Sasson et al., 2019). Sensory processing differences are also common in ADHD, with a 2025 systematic review and meta-analysis finding significantly higher rates of sensory sensitivity, avoidance, seeking and low sensory registration compared with the general population (Jurek et al., 2025). These sensory processing differences are closely linked to emotional dysregulation, with distinct patterns of sensory processing associated with heightened dysregulation regardless of the specific pattern involved (Brandes-Aitken et al., 2024). Sensory modulation led by occupational therapists is an evidence based intervention for supporting regulation and participation in neurodivergent individuals, in line with Australian clinical guidelines for both autism and ADHD. Flowstate’s neuroaffirming approach, combined with the sensory rich, movement based nature of the ocean environment, may be particularly well suited to supporting regulation, engagement and connection in ways that a traditional clinical room cannot offer.

Research specifically examining surf therapy as a clinical intervention is still developing. A 2024 systematic review by Carneiro et al. found that while surf therapy shows promise as a therapeutic approach, robust and consistent evidence from controlled trials remains limited. This is consistent with the broader nature based therapy literature, where the evidence for engagement with blue and green spaces as therapeutic environments is strong, but the evidence for structured surf therapy specifically continues to grow.

It is important to note that while surf therapy and nature therapy is an emerging field, the therapeutic approaches Flowstate draws on, including Acceptance and Commitment Therapy, sensory modulation, and mindfulness based approaches are all well established, evidence based clinical interventions delivered by registered health professionals. The natural environment helps to enable these approaches, but importantly the clinical framework underpinning their delivery is robust.

Flowstate is committed to contributing to this evidence base through our ongoing outcome measurement, participation in the International Surf Therapy Organisation’s global community of practice, and sharing of program outcome data with the international surf therapy research community.