Working with the mind in the body - combining psychotherapy with fitness

Psychotherapy is good for the mind and for improving your mood, and we also now know that exercise is good for the mind too as well as the body (Keefe, 2018). Most people have a sense of what it’s like to do some form of exercise, to go to the gym, for a swim or a run, even just to go for a walk, and again a lot of people have an idea of what it’s like to sit and talk to a therapist about their feelings, but could you combine the two activities?

While fitness will make you feel better, the problem is that if you are depressed, anxious or traumatised, the thought of going for a run or to the gym may feel overwhelming, just at the moment, you could benefit most from it. There is a clear role for a therapist here to help you find the motivation, confidence and inner resources to help you put your trainers on and take the first steps.

A number of therapists, who have trained as fitness instructors or personal trainers, or who are keen runners, combine exercise and fitness with psychotherapy in actual sessions to help people with their mental health and well-being needs.

Jean Baxter, PhD, is an American psychologist and personal trainer who has developed “PsychFit”, a five-week programme comprising body-weight and free-weight exercises with mental tasks to be performed while exercising. This includes thinking of all the words you associate with your depression and then the opposite to each of those words - down/up, dark/light - and to focus on the positives. We feel strong and capable when exercising because we are moving, and “feel-good” chemicals such as endorphins and dopamine are released. Thinking positively at the same time can help reinforce that feeling. Baxter also recommends keeping careful note of your emotional state before, during and after an exercise session and shows how emotions are stored in the cells of the body through being communicated via the central nervous system. Emotions stored in this way can be experienced as aches and pains or stiffness in the body, which can be released through exercise. If a part of your body feels looser after a work-out, it could be that the emotions trapped there have been released.

A recent study by the University of Limerick, led by Brett Gordon, found an association between resistance training (weight lifting) and a reduction in depressive symptoms, regardless of age, sex or health status. Writing about the study on bigthink.com, Derek Beres notes humans were designed to move and carry heavy loads and sees our sedentary, non-mobile lives as an underlying cause for depression.

William Pullen, a British psychotherapist and keen runner, has developed “Dynamic Running Therapy” (DRT) which he describes as “Running with Mindfulness” in his book of the same name. DRT begins with a mindfulness-based grounding exercise, followed by a run at a comfortable pace or walk while reflecting on a question related to some aspect of your depression or anxiety. This can be by yourself or in the company of a running companion: if the latter, you would take turns to talk about what is worrying you or getting you down, and to listen to your companion as they speak and you both run. For Pullen, being outdoors in nature, and the motion and movement of running, are integral parts of what makes the difference.

Sakyong Mipham writes about his practice of meditation while training to run marathons in his book “Running with the Mind of Meditation: Lessons for Training Body & Mind”. Bella Mackie’s book “Jog On – How Running Saved my Life,” tells her personal story of how important running was to her recovery from life-long chronic anxiety, how the physical exertion gave her a break from her anxious thoughts, and space to recover. She recommends though that running is combined with therapy, and/or medication as required.

Dutch psychiatrist Bessel Van Der Kolk, in his book “The Body Keeps the Score”, discusses why he encourages the highly traumatised people he works with to engage in physical activity (exercise, yoga, dance) to aid their recovery.

Exercise has such a powerful impact on psychological health that, for many people, that will be enough on its own to maintain their mental well-being. For others, this approach of exercise and therapy may be what is needed: combining the power of exercise to make you feel calm, relaxed and confident, with therapy to help you understand and work through the causes of your depression or anxiety, can be a transformational experience.

If you are struggling with your mental health and people are encouraging you to exercise, it may just feel too overwhelming to even think about, so a therapist can start by helping you think through the barriers which prevent you from exercising and helping you find the confidence to start. Helping you to notice where you feel emotions in your body, and the physical responses when you tell your story, are also ways to help connect mind and body and begin to process the emotional experiences which are stored physically and available to be put into words.

A number of therapists, such as some of these authors, are also using fitness to literally help you bridge the gap between the therapy room and the park or gym, between mind and body, by providing sessions of therapy and fitness, and this can bring considerable advantages.

A therapist/fitness instructor would know how to plan a session appropriate for your level of fitness and personal goals so that it is fun, challenging and safe. They could also make sure you warm up properly to avoid injury and ensure your muscles and cardiovascular and respiratory systems are working as well as possible during the workout. They could also check in with you at the start about your feelings, thoughts and mood, and think about what the physical feelings in your body might be telling you about unexpressed and cut-off emotions and experience. They could lead you through the session and help you notice changes in your emotional state and listen to the ideas, thoughts and reflections which occur to you as you work out.

If, as is likely, your therapist isn’t actually able to offer fitness sessions as well, but you want to start running, swimming or going to the gym, you can try talking to your therapist about the impact of working out on your mood, and what thoughts and new perspectives occur to you during and after a fitness session.

Exercise frees the mind to think differently about problems. Damon Young, a weight-lifting philosopher from Australia, refers to this phenomenon as “transient hypofrontality”. In jogging, walking and other forms of exercise, the pre-frontal cortex (the conscious, thinking part of the brain) is turned down as the motor and sensory parts of the brain are turned up: “Busy with pounding legs, and pumping arms, the intellect’s walls come down and previously parted ideas and impressions can freely mingle”. Having someone to talk to about the new ideas and insights which emerge in this way, as Pullen suggests, adds to and reinforces the process.

Outdoor fitness, comprising interval runs of different lengths and speeds with body-weight resistance exercises, in a natural environment, combines the best of all the approaches discussed above and could be an even more powerful intervention when combined with therapy.

If that sounds a bit too rigorous, simply moving more during the day will also help your mood, as well as being good for you physically. Try sitting less and walking more – walk to work or to a further away bus stop or tube station, go for a walk at lunchtime, use the photocopier furthest from your desk, do more gardening or housework... all these little added extras will really make a difference.

The session can end with a cool down to reduce your heart rate to resting and stretches to return muscles to resting length, relax you and improve flexibility and the chance to reflect on how you feel emotionally and enjoy the sense of achievement and the benefits that can bring.

Running in a park, even in the wind and rain but especially on bright, cold, clear days, lifts your spirits and helps you feel free. Movement can make you feel free, so if you are struggling with something emotionally right now, why not just stand up and move and see what happens? If it helps, why not explore further how to make fitness part of how you care for your mental health.

Bibliography

• Baxter, J. 2011. Manage your Depression through Exercise: the Motivation you need to start and Maintain an Exercise Program. Sunrise River Press. North Branch MN.
• Beres, D 2018. https://bigthink.com/21st-century-spirituality/study-confirms-lifting-weights-reduces-depression?fbclid=IwAR2QKwj2NkuxcK6DTwO6pxccQkJD5nEGJU-f7v-SEfW60W-mHrVc2fKy5IQ Accessed on March 8th 2019 at 10.30 a.m.
• Keefe, 2018. Health in Mind & Body: Exercise as a Treatment for Depression and Taking the First Steps. https://www.counselling-directory.org.uk/counsellor-articles/health-in-mind-and-body-exercise-as-a-treatment-for-depression-and-taking-the-f. Accessed 11.03.19 at 21.37 hours.
• Mackie, B. 2018. Jog On: How Running Saved My Life. William Collins. London.
• Mipham, S. 2012. Running with the Mind of Meditation: Lessons for Training Body and Mind. Harmony. New York.
• Pullen, W. 2017. Running with Mindfulness: Dynamic Running Therapy (DRT) To Improve Low Mood, Anxiety, Stress and Depression. Plume. New York.
• Van Der Kolk, B. 2014. The Body Keeps the Score: Mind and Body in the Transformation of Trauma. Allen Lane. New York.
• Young, D. 2014. How to Think about Exercise. Macmillan. London.