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 a multidisciplinary team including occupational therapists, a psychotherapist, an educator and community support workers. This is what distinguishes Flowstate from both recreational nature activities and traditional clinical settings. We bring the rigour and accountability of 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 structured therapeutic context, guided by a multidisciplinary team who draw on approaches including Acceptance and Commitment Therapy, Dialectical Behaviour Therapy, sensory modulation and trauma informed practice. The natural environment is not a backdrop. It is an active therapeutic tool, deliberately chosen and purposefully used in service of each participant’s therapeutic goals.

The sensory qualities of the natural environment are a key element of this approach. The ocean offers a rich and dynamic sensory experience. 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. Sensory processing differences are significantly more prevalent in autistic people and those with ADHD, and are closely linked to emotional dysregulation (Frontiers in Pediatrics, 2025). Sensory modulation approaches, led by occupational therapists, are a recommended and evidence based intervention for supporting regulation and participation in neurodivergent individuals, and are embedded within Australian clinical guidelines for both autism and ADHD (Australian guidelines for ASD, 2023; ADHD Guideline Development Group, 2022).  For participants who are neurodivergent, Flowstate’s neuroaffirming approach combined with the sensory rich, movement based nature of the ocean environment can be particularly effective in supporting regulation, engagement and connection in ways that a traditional clinical room cannot offer. Flowstate’s clinically trained facilitators are trained in sensory modulation approaches and intentionally draw on the sensory properties of the environment as a therapeutic tool throughout each session.

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, and the authors call for more high quality research in this area. 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 as a clinical intervention continues to grow. Flowstate is committed to contributing to this evidence base through our ongoing outcome measurement and participation in the International Surf Therapy Organisation’s global research framework.

Flowstate’s programs are aligned with the standards of the International Surf Therapy Organisation, whose mission is to advance excellence in surf therapy globally through research, advocacy and practice.