Exercise and Psychotherapy

One issue that is relatively neglected by most psychotherapists is the extent of their clients’ degree of physical activity.  This is partly understandable since psychotherapy is, at least as practiced by most therapists, a very sedentary activity and, my admittedly limited impression is that most therapists don’t  exercise themselves.   I recently handed out a questionnaire concerning personal exercise at a professional meeting of therapists and very few bothered to fill it out and return it.   Of the handfull who did, some admitted that they don’t exercise at all or do it very irregularly.  Yet physical activity is probably, based on research I shall discuss,  at least as effective as many types of medication for alleviation of anxiety, depression and improvement of general psychological well-being, but without any of the side effects that occur with drugs.   I am relatively certain, however,  that referrals by therapists to physicians for medication occur much more frequently  than referrals to gyms or suggestions about how their clients might improve their psychological health through exercise.

The Positive Health Benefits from Regular Physical Activity

It is common knowledge that exercise is good for one’s physical health, particularly as one gets older.

According to the Mayo Clinic, (http://www.mayoclinic.com/health/exercise/HQ01676), it helps in these ways:

1.  It controls weight.   We know that one-third of the American population is obese and that with the elimination of physical education classes in schools and the reduction in physical activity children get today, the obesity rate will most probably increase in coming years.  Unless changes are made the financial and psychological costs to our entire society will be calamitous .

2.  It helps to combat diseases.   Regular physical activity, no matter one’s current weight, boosts high-density lipoprotein and decreases unhealthy triglycerides.  This keeps blood flowing smoothly, which decreases the risk of cardiovascular disease.  Regular physical activity also can prevent or manage stroke, type 2 diabetes, certain types of cancer, arthritis and improve balance, which can help to  prevent falls.

3.  It boosts energy by building muscle strength and increasing endurance and balance.

4.  It prolongs life.  Consumer Reports On Health, in the February, 2013 newsletter cites studies from the National Cancer Institute on 655,000 adults showing that 75 minutes a week of moderate physical activity was linked to an additional 1.8 years of life expectancy, and those who were active for 450 minutes a week added 4.5 years.

What is less well known is that regular exercise is also helpful for one’s psychological and emotional health.  It can improve mood,  ward off depression and alleviate anxiety.

Effects of Physical Activity on Learning and General Brain Functioning

There is evidence from some recent research that exercise may help to reverse the cognitive effects of aging by stimulating the growth of brain cells.  It was long believed that the brain is a static organ, with the only changes over time being a reduction in the number of brain cells and concomitant decrease in memory, reaction time and learning ability.  But neurological research in the last decade has revealed that the brain is  very plastic.  There is a protein factor in the brain, called BDNF, that nurtures the brain and helps brain cells to grow more branches.  John Ratey, a psychiatrist, who has written an excellent book called Spark, calls it “miracle-grow for the brain.”  It helps a dynamic process, called LTP (long-term potentiation process) proceed, which  affects the hippocampus, a part of the brain that is involved in memory.  Ratey even shows that physical activity improves learning ability in teenagers.  He discusses two high schools, one in a middle class neighborhood in Illinois, the other in a lower class town in Pennsylvania.  In each one the emphasis of in the gym classes was changed from achievement (e.g., how fast they could run a mile) to effort expended (what the kids’ heart rate was when they finished running the mile).  It was found that basing grades in physical education on effort increased the performance of these students in math and science more than increased classes in those subjects.  This is clear evidence that regular physical activity affects brain functioning in a very positive manner.

Effects of Physical Activity on mood, anxiety level and autonomic system functioning.

A study by James Blumenthal, PhD, a clinical psychologist at Duke, found that people diagnosed with major depression who were helped to initiate an exercise regime had higher rates of remission of their depression than those given a placebo.  Those who maintained regular exercise also had lower depression scores after one year than those who were less active.

Another investigator, Otto and colleagues, reviewed 11 studies on the effects of exercise on mental health and also found that exercise could be a powerful intervention for clinical depression.

Still another researcher, Mary de Groot, PhD, found that diabetics who were also depressed, improved both their depression and diabetes if they combined exercise and CBT.  And, finally, other researchers have found that exercise can help both in ameliorating anxiety and curing and warding off panic disorder.

What is not usually addressed are the reasons why sixty-seven percentage of Americans don’t exercise regularly.   And why many more don’t exercise frequently or vigorously enough to get the full benefits from their physical workouts.   Until recently, I didn’t even address with my own clients the issue of physical activity.  I was willing to refer them to psychiatrists or nurse practitioners for medication for depression or anxiety, but neglected how much physical activity they got despite the fact that exercise can be much better than medication for many people.  Exercise doesn’t have side effects and can help a person’s sense of efficacy much more than passively ingesting a drug.   I have recently begun to include on my intake form questions concerning issues of physical activity with my clients.  I ask them whether they get regular exercise, what form that takes and, if they don’t exercise, a brief explanation of why they don’t.

In later blogs I will discuss how people can overcome their aversion to exercise and what they can do to increase their level of physical activity and psychological and physical health.    I will also address the types and variations of exercise that are necessary for complete benefit.

I have prepared a questionnaire about the reasons people don’t exercise for readers of this blog to fill out to help them explore their attitudes about physical exercise.   Here are some of the things I have found to be true:

1.  Many people say they don’t have enough time to exercise.

2.  Many say they find exercise boring.

3.  Physical conditions, such as sore backs, bad knees, obesity and other chronic ailments prevent them from engaging in physical activity.

4.  They tell themselves they should do it, but rebel against shoulds in general, particularly those  involving an activity they don’t enjoy.

5.  Their  families of origin did not engage in sports or physical activity.    Their  parents may even have taken a contemptuous attitude toward “jocks” and exercise.  Thus they didn’t acquire the habit of regular physical activity when they were young.

6.  They had negative  experiences in gym classes, being treated like Army recruits by drill-sergeant-like gym teachers.

7.  They were not strong enough or physically adroit enough as children, so were picked last in team sports, which was humiliating to them.  This resulted in an aversion to any kind of sports or physical activity in general.

8.  Physical activity is engaged in for awhile;  they then get frustrated, feel sore, stiff and in pain,  and stop.

9.  They demand that they do it at a high level in the beginning or not having done it for awhile, feel like a failure and give up.

10.  They have never done it before in their lives and say to themselves “now is too late.”

11.  They are embarrassed to be exercising in a gym because they feel inferior to other people.  This is especially  true of many males, particularly when it comes to using weights or weight machines.

12.  Exercise is  inconvenient; they don’t live in a neighborhood where, for example, they can take walks and feel safe and find it enjoyable.  Or they don’t live near a gym.

13.  They don’t know what kind and how much exercise would be necessary and don’t know who to ask.  Or they are too embarrassed to ask about something that they think seems so obvious.

14.  They don’t get immediate physical results–e.g., a reduction in cholesterol levels or weight loss–and give up too soon.