Health in mind and body: Exercise as a treatment for depression and taking the first steps
The NHS (NHS.uk) recommends and prescribes exercise as a treatment for depression and anxiety, as the evidence grows for its effectiveness in the treatment of these conditions. People who exercise regularly (30 minutes of rigorous – heart rate increasing – exercise, three times per week is the recommended minimum) tend to not just be fitter and healthier but happier than similar groups of people who don’t exercise.
I attend an outdoor fitness class and running and exercising in a group in Finsbury Park at night, watching the lights of the city below us lifts my mood and relaxes me as well as making me fitter.
Does this mean that we should all abandon psychotherapy and take to the gym? Or should we try to do both, but keep them both separate? Well not exactly. Realising that you need to look after the health of your mind and your body is really important but I would go further and say that mind and body are the same and need to be looked after together.
Looking at how exercise can help alleviate depression and indeed trauma and the role psychotherapy can play in exercise may help to clarify what I mean.
In my practice, I recommend physical activity to clients as I am convinced of its benefits for both depression and trauma. There are though connected psychological issues connected which can act as barriers to exercising and require psychotherapeutic intervention:
Exercise increases the flow of blood to the brain, releasing chemicals called endorphins, and other neurotransmitters such as serotonin which lift your mood, acting as a “natural anti-depressant” (Psychology Today). Other chemicals released by exercise boost brain growth and health, improving functioning (which is sometimes impaired by depression), which also helps you feel better.
When someone is depressed, the lack of energy, low self-esteem and negative thinking typical of this condition can make it very difficult to even think about starting to exercise: adverts for gyms, classes and personal trainers always seem to feature incredibly fit, lean, attractive people. The message is clear – train with us and you too could look like this. Some even feature “before and after” photos of satisfied customers. But if you are depressed, you may be beset with thoughts like “I can’t do that, I can never look like that….everything I do ends in failure….what’s the point, I’ll give up soon.” These thoughts can make it really hard to take the first step.
You may have had bad experiences of fitness in the past: Being shouted at by a particularly unsympathetic PE teacher at school or finding you were always the last to get picked for a team may have put you off exercising for years. You may have injuries, a physical impairment or disability, which also makes it more difficult to start exercising (though by no means impossible, as the inspiring examples of the Paralympics and Invictus Games show us.)
Working with a psychotherapist can help you identify these thoughts and the memories and experiences which cause and drive them. Once identified, you can work through them with the therapist (perhaps through talking therapy or, if really deeply buried, using Eye Movement Desensitisation and Reprocessing (EMDR) to dispel their hold upon you and develop strategies to build your confidence, get you started and help you continue. Psychotherapy is a great way also to notice and track the emotional changes you experience as you become fitter and reinforce the impact this is having on your psychological well-being.
Writing on the Psychcentral website (Psychcentral), Summer Beretsky explains how the increased heart rate, breathing and adrenaline flow caused by exercise are also symptoms of a panic attack and can be really frightening for someone who is anxious, whatever the benefits. That same increase in heart rate or breathing can also trigger memories of traumatic events: An increase in heart rate and breathing are part of what happens when your “fight or flight” mechanism is triggered during an assault. If you have been traumatised by, for instance, an assault, sexual assault, rape or traumatic birth, you may find that certain forms of physical contact, or being placed in a particular position, may trigger memories of the trauma.
Again, working through your concerns about exercising with a therapist can help you address these concerns through processing the traumatic memories they are linked to. This will make being triggered, much less likely but a therapist trained and experienced in working with people who have been traumatised will also be able to teach you techniques for bringing yourself back to equilibrium if you are triggered.
Too much of most things can be harmful and that includes exercise and fitness. If you have an addictive personality or perhaps have had issues with eating in the past, over-training, especially coupled with a restrictive diet, can reproduce earlier, problematic and harmful behaviours. Even with sensible amounts of exercise, if you are using it to block out or avoid problems in other areas of your life (your relationship, work), this can be a problem.
A post on the Mind website from @BipolarBlogger (“The myths of exercise and depression”), discusses the dangers of over-exercising during a manic episode and notes its role in eating disorders.
Exercising can relax you if stressed or lift your mood if you are feeling down, but a therapist can help you keep in mind and work on, the underlying issues which are causing you stress and distress in the first place: it could be harmful in the long run if you use exercise to block out issues in your life without addressing them or thinking about them.
These, and many other connections between mind and body happen because the mind is part of the body: we think, feel, remember and forget, using our brains and nervous systems. Van der Kolk (2014) shows the role the body plays in recording experiences and non-verbal memories and how acting on the parasympathetic nervous system through breathing can calm someone down if triggered by traumatic memories. We all even feel feelings in different parts of our bodies.
If you are troubled, it can be helpful to think about the health of your mind and body together and to work on both: therapy alone or exercising alone will help, but there are real benefits if you work on both: paying attention in therapy to how your body feels and responds to emotion and memory and when exercising, noting the impact on your mood but also being aware of your relationship to exercise, what it means to you and how you are using it.
Finally, remember that even if you are not feeling up to doing three thirty minute sessions of vigorous exercise every week, simply moving more for five minutes per day initially will bring mental and physical benefits and you will be surprised how quickly you can build up from there.
If you are feeling down as you read this, why not get up and go for a walk. Notice how your mind and body feel before, during and after the walk. You might be surprised at what you find…
https://www.mind.org.uk/information-support/your-stories/the-myths-of-exercise-and-depression/#.W-1Ej_Z2tyw (Accessed 15/11/18 at 10.06 am).
https://www.nhs.uk/conditions/stress-anxiety-depression/exercise-for-depression/ (Accessed 15.11.18 at 11.04 am.)
https://www.psychologytoday.com/intl/blog/brain-bootcamp/201009/can-exercise-cure-depression (Accessed 15.11.18 at 10.50 am).
https://psychcentral.com/blog/when-physical-exercise-feels-just-like-a-panic-attack/ (Accessed 16.11.18 at 10.24)
Van Der Kolk, B. 2014. The Body Keeps the Score: Mind, Brain and Body in the Transformation of Trauma.
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About Andrew Keefe
Andrew Keefe is a Psychodynamic Psychotherapist and EMDR Therapist, working in private practice in East London and Holborn. He previously worked as a therapist at The Refugee Council, Freedom from Torture and WPF Therapy. He has special interests in working with survivors of violence and terrorism, sexual abuse and birth trauma.