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Using Exercise in Mental Health Treatment

The connection between exercise and mental well-being has become increasingly obvious as research on the subject grows. Unfortunately, most mental health counseling training programs don't cover the topic, and as few as 10% of psychotherapists talk to their clients about exercise.

Research suggests that exercise can have a significant positive impact on depression, anxiety, eating disorders, addictions, cognitive functioning, and more. Not only can exercise be used to treat these issues (sometimes as well as traditional psychotherapy or medication), but it also works as a preventative measure.

This guide will focus on how exercise can affect mental illness, while offering ideas on how to use this knowledge to your advantage as a mental health professional.

Exercise Psychoeducation

It's no secret that exercise can improve physical health, but what exactly does it do for mental health? How does exercise help to create mental well-being, and what specific problems can it help treat?

How does exercise help improve mental health?

Beneficial physiological changes of exercise include improved sleep, the release and improved metabolism of chemicals—such as serotonin and endorphins—in the brain and central nervous system, and physical changes to the brain. Exercise increases brain volume and blood flow, which improves neural functioning.

The psychological impacts of exercise include heightened self-esteem, the interruption of negative thoughts, and an increase in healthy social contact. Together, these changes (paired with improvements to physical health) can vastly improve overall quality of life.

What mental illnesses benefit from exercise?

Depression
  • Regular exercise significantly reduces the symptoms of mild to moderate depression.
  • Exercise can prevent the onset or recurrence of depression.
  • Exercise can help counteract the weight gain caused by antidepressant medications.
Anxiety Disorders
  • Regular exercise significantly reduces the symptoms of anxiety.
  • Exercise can act as a healthy form of exposure to the physical symptoms of panic attacks, such as increased heart rate and sweating. Exposure can help clients become more familiar and comfortable with the sensations that were formerly perceived as dangerous or scary.
Substance Abuse
  • Regular exercise can reduce the frequency and intensity of drug cravings.
  • Clients who begin exercising are less vulnerable to relapse.
  • Some studies have found lower rates of first-time drug use in youth involved with exercise programs.
  • Exercise provides a healthy replacement activity for time previously occupied by drug use.
Eating Disorders
  • Exercise was found to be more effective than CBT for the treatment of bulimia in one study of young women.
  • Adding an exercise component to CBT improves treatment outcomes for binge eating disorder.
Other Benefits
  • Improved sleep
  • Slowed progression of Alzheimer's disease
  • Stress relief
  • Improved mood
  • Increased energy
  • Slowed cognitive decline associated with aging
  • Better physical health and fitness

Types of Exercise

Both anaerobic and aerobic exercises have been found to improve mental health, but a combination of the two is most effective. Anaerobic exercise involves short bursts of intense activities. These exercises are performed using energy stored within muscles. Aerobic exercises are lower intensity, but can be maintained for a longer duration. They rely on the energy generated from oxygen intake.

Anaerobic Aerobic
dumbell person bicycling
  • Weightlifting
  • Any type of sprint (running, biking, etc.)
  • Interval training
  • Climbing
  • Walking, jogging, or biking
  • Elliptical or ski machines
  • Swimming
  • Dancing

The mental health benefits of exercise are greater when workouts are more intense and more frequent. However, a person can benefit from as little as 30 minutes of walking, 3 days a week.

Using Exercise in Conjunction with Psychotherapy

Although we know exercise can be leveraged to beat mental illness, research tells us little about how to best integrate exercise with psychotherapy. However, preliminary studies indicate that even brief bouts of therapy can motivate clients to begin exercising. Below, we will look at two strategies that have support.

Exercising During Sessions

The practice of walking during therapy sessions has become increasingly popular over the past several years. The benefits are numerous, and getting out of the office can add a bit of fun to sessions.

Tip: If your office is located near a natural area, the benefits of walking can be even further enhanced. Researchers have found that brain activity in areas associated with negative emotions is reduced when walking in nature, as opposed to in an urban environment.

For some clients, walking can reduce the intimacy of looking at a therapist eye-to-eye, which helps them feel more at ease and willing to share. Additionally, research suggests that walking can improve emotional awareness, creativity, and self-awareness during therapy sessions.

Maybe most importantly, walking during therapy sessions sets a good example, it can be used to teach clients about the benefits of exercise, and it knocks out a daily workout.

Here are some points to consider before integrating walking into your own practice:

Walking and Talking: Considerations
  • Walking outdoors during session might pose a risk to confidentiality. Be sure to discuss this with your client beforehand, and ask how they would like to handle encounters with other people.
  • Respect your client's wishes. The decision to walk should be totally up to your client.
  • Pay attention to how walking affects treatment. Walking can be beneficial for some, but it might be distracting for others. This includes you, the clinician. Make sure you are still able to concentrate and make progress toward the completion of treatment goals.
  • Be aware of boundaries. For some, exercise might become competitive, or embarrassing if they feel outdone. Other times, conversation might veer away from treatment goals and turn toward friendly chatter. Counteract these risks by emphasizing that treatment continues to be the first priority even while out of the office, and frequently reviewing how how boundaries are affected.

Encouraging Exercise

Starting an exercise plan can be very difficult. Like anything else in psychotherapy, suggesting that a client does something, and leaving it at that, won't do much good. People who are new to exercise will run into a number of barriers, which you can help them overcome. Common barriers include:

  • Uncertain about how to exercise.
  • Not enough time to exercise.
  • Feel embarrassed about exercising.
  • Lack the motivation to exercise.
  • Forget to exercise due to lack of routine.

As psychotherapists, creating a specific workout plan is beyond our scope of expertise. In some cases, clients should be referred to a professional to assist with this process. However, overcoming barriers and offering basic education about the topic is appropriate. Let's address each of the barriers listed above.

"I don't know how to exercise."

Fortunately, even a moderate level of exercise can result in improvements to mental health. While higher intensity workouts result in better outcomes, even a 30 minute walk, 3 times a week, has been found to be beneficial.

"I don't have enough time to exercise."

Fitting exercise into a busy life can be a legitimate concern, but is mostly a problem related to priority. Can a person truly not fit exercise into their day, or are they prioritizing other things that might not really be as important? This can be a good topic to discuss with time-crunched clients.

If there really isn't time, let your client know that exercise can be squeezed into small slots of time. Two 15-minute walks are as good as one 30-minute walk. How about taking the stairs instead of the elevator, parking far away from the grocery store, or stepping outside for 10 minutes during lunch? Get creative, and help your client come up with a few ideas they can practice regularly.

"I'm embarrassed about exercising."

This barrier will require exploration about what aspect of exercise is embarrassing. Many people are intimidated by gyms, and creating a plan that's entirely outside, or integrated into daily activities, might be enough to overcome embarrassment.

"I'm not motivated to exercise."

Motivation can be a real problem, especially when working with depressed clients. In these situations, it can be valuable to explore what exercise options your client would genuinely enjoy. The best exercises are ones that someone will be happy to do. Is your client a photographer? How about they head out to a nature trail, walk, and take a few photos? Other options are sports, biking, or walking with a friend.

"I always forget to exercise."

It's easy to forget exercise before a routine has been established. Help your client create a schedule along with exercise reminders. This can be achieved by tying exercise to a specific part of the day ("Walk for 30 minutes immediately after dinner"), setting an alarm, or posting sticky-note reminders on a bathroom mirror or fridge.

The Mental Health Benefits of Exercise worksheet includes a page to help your clients plan a basic exercise routine. This tool can be used as a take-home reminder to increase follow-through.


Hopefully this guide has helped to clear up what we know about the link between mental health and exercise, while providing a few ideas you can implement into your practice. Good luck out there!

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