As a licensed clinical psychologist with many years of experience, I've observed a troubling phenomenon. Many of my clients enter treatment because they are feeling depressed and anxious. They may be able to function in their day to day life, but they are struggling--they feel down, sad, nervous, and have low levels of energy. Naturally, many of these same clients are reluctant to try taking antidepressant or anti-anxiety medications because of concerns regarding the side effects they may experience. Typically, in these situations, the conversation goes something like this:
Me: So you don't want to take medications, I can understand that. Have you considered trying regular exercise? There are many studies that suggest that exercise can reduce depressive and anxious symptoms as well as psychiatric medications.
Client: Yes, I have been meaning to start exercising for a while. I really should start doing that, especially if it makes me feel better emotionally.
Me: Great! Let's make a plan of how you can start exercising. What kinds of activities do you enjoy?
The client and I come up with a simple plan for them to get more exercise. They always intend to start immediately.
Fast forward to the next session, the next session, and the session after that:
Me: How is it going with exercise?
Client: Umm, well, I sort of haven't gotten to it yet....
To be honest, I have had almost zero success getting depressed or anxious clients to start exercising. Perhaps it's my technique, but I feel that can't be the whole story. In addition to having years of training and clinical experience, I also come from a long line of highly skilled naggers--if you ever met my Grandma Shirley, you would definitely agree! After having this happen over and over for years, I came to the following conclusion:
People who are depressed or anxious have an extremely hard time starting to exercise on their own, even though intellectually they know it will help them.
After thinking about it for a long time, I realized that maybe as a therapist, I could help them get started exercising in a more concrete way. Why not have an office with two treadmills? The client and I could walk at a moderate pace during sessions. We would both be getting the mental and physical health benefits of exercise, and it would help the client get started with the habit of exercise.
What would we lose from getting up off the couch? As I thought more about it, I realized that the main reason we sit during sessions is because Freud did it during his sessions. I still think sitting has a lot to recommend it, but there wasn't a specific scientific rationale that suggested it was the best, or only way, to conduct treatment.
In addition, I wondered if we both would also benefit from the increased cognitive ability that seems to occur when people perform cognitive tasks while being physically active. Studies have shown, for instance, that people are better able to learn a foreign language when riding an exercise bicycle at a moderate pace than when they are sitting in a chair. Would the same be true for psychotherapy?
Further, although psychiatric medication definitely can be helpful and necessary for many people, I wondered if some people could be helped simply by exercise alone. Instead of experiencing negative side effects of medication, they would experience positive side effects of exercise, such as a reduced risk of heart disease, type 2 diabetes, cancer, dementia--the list is endless. I wondered whether if people could start exercising regularly for a period of 6-8 weeks, if their symptoms would improve without medication. Perhaps by then, they would feel happier, more energetic, and more motivated to exercise on their own.
Thus, after much deliberation, I have put my thoughts into action. I have opened a small treadmill therapy office with two treadmills (as well as two chairs). Over the past few weeks, I have conducted several pilot sessions with depressed and anxious clients. I am still collecting data, but I have observed the following things thus far:
1) Clients seem to really enjoy the element of exercise in their sessions, and state that they feel more energized, and physically comfortable after the session.
2) Clients are able to bring up and concentrate on important, and often upsetting, clinical material while walking on treadmills during their sessions. They also appear able to express their feelings, including crying while walking, with no ill effects.
3) Clients appear somewhat more insightful about their own issues, particularly after 20-30 minutes of walking. I have worked with a few long-term clients who seemed to have revelations that have eluded them for a long-time.
4) Clients seem more energized in terms of being able to implement their insights during therapy back into their everyday life.
5) I seem to be able to concentrate on clinical material as well as or better than when I am sitting in a chair.
6) Noting that they feel better physically and emotionally after sessions, clients have been more motivated to exercise on their own outside of sessions.
Needless to say, I've been thrilled with my preliminary results so far. In fact, clients' experiences have exceeded my initial expectations of the benefits of incorporating exercise with psychotherapy. Of course, it's still early on, and I'm sure I have much to learn. I'll be using this blog to chronicle my discoveries. I am excited to see what the future holds for what appears to be a promising innovation in psychotherapy.
Me: So you don't want to take medications, I can understand that. Have you considered trying regular exercise? There are many studies that suggest that exercise can reduce depressive and anxious symptoms as well as psychiatric medications.
Client: Yes, I have been meaning to start exercising for a while. I really should start doing that, especially if it makes me feel better emotionally.
Me: Great! Let's make a plan of how you can start exercising. What kinds of activities do you enjoy?
The client and I come up with a simple plan for them to get more exercise. They always intend to start immediately.
Fast forward to the next session, the next session, and the session after that:
Me: How is it going with exercise?
Client: Umm, well, I sort of haven't gotten to it yet....
To be honest, I have had almost zero success getting depressed or anxious clients to start exercising. Perhaps it's my technique, but I feel that can't be the whole story. In addition to having years of training and clinical experience, I also come from a long line of highly skilled naggers--if you ever met my Grandma Shirley, you would definitely agree! After having this happen over and over for years, I came to the following conclusion:
People who are depressed or anxious have an extremely hard time starting to exercise on their own, even though intellectually they know it will help them.
After thinking about it for a long time, I realized that maybe as a therapist, I could help them get started exercising in a more concrete way. Why not have an office with two treadmills? The client and I could walk at a moderate pace during sessions. We would both be getting the mental and physical health benefits of exercise, and it would help the client get started with the habit of exercise.
What would we lose from getting up off the couch? As I thought more about it, I realized that the main reason we sit during sessions is because Freud did it during his sessions. I still think sitting has a lot to recommend it, but there wasn't a specific scientific rationale that suggested it was the best, or only way, to conduct treatment.
In addition, I wondered if we both would also benefit from the increased cognitive ability that seems to occur when people perform cognitive tasks while being physically active. Studies have shown, for instance, that people are better able to learn a foreign language when riding an exercise bicycle at a moderate pace than when they are sitting in a chair. Would the same be true for psychotherapy?
Further, although psychiatric medication definitely can be helpful and necessary for many people, I wondered if some people could be helped simply by exercise alone. Instead of experiencing negative side effects of medication, they would experience positive side effects of exercise, such as a reduced risk of heart disease, type 2 diabetes, cancer, dementia--the list is endless. I wondered whether if people could start exercising regularly for a period of 6-8 weeks, if their symptoms would improve without medication. Perhaps by then, they would feel happier, more energetic, and more motivated to exercise on their own.
Thus, after much deliberation, I have put my thoughts into action. I have opened a small treadmill therapy office with two treadmills (as well as two chairs). Over the past few weeks, I have conducted several pilot sessions with depressed and anxious clients. I am still collecting data, but I have observed the following things thus far:
1) Clients seem to really enjoy the element of exercise in their sessions, and state that they feel more energized, and physically comfortable after the session.
2) Clients are able to bring up and concentrate on important, and often upsetting, clinical material while walking on treadmills during their sessions. They also appear able to express their feelings, including crying while walking, with no ill effects.
3) Clients appear somewhat more insightful about their own issues, particularly after 20-30 minutes of walking. I have worked with a few long-term clients who seemed to have revelations that have eluded them for a long-time.
4) Clients seem more energized in terms of being able to implement their insights during therapy back into their everyday life.
5) I seem to be able to concentrate on clinical material as well as or better than when I am sitting in a chair.
6) Noting that they feel better physically and emotionally after sessions, clients have been more motivated to exercise on their own outside of sessions.
Needless to say, I've been thrilled with my preliminary results so far. In fact, clients' experiences have exceeded my initial expectations of the benefits of incorporating exercise with psychotherapy. Of course, it's still early on, and I'm sure I have much to learn. I'll be using this blog to chronicle my discoveries. I am excited to see what the future holds for what appears to be a promising innovation in psychotherapy.
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