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Exercise Gives a Lift to Psychotherapy

Pumping iron, logging in miles on the local track and whacking a racquetball are becoming standard fare in some therapy practices. Exercise can relieve the symptoms of depression and anxiety and even tackle more serious disorders such as schizophrenia and manic-depressive illness,
say clinicians and researchers who study the clinical utility of exercise or use it in treatment.

"Exercise is about as close to a panacea as you can get, and I don't believe in panaceas" says Jerry May, PhD, former chair of the U.S. Olympic Committee's Sports Psychology Committee and psychiatry professor at the University of Nevada at Reno's School of Medicine. "It is a health
inducer, a stress reducer and a self-confidence booster."

Pumping patients up

Clinicians use exercise in a variety of ways in their practices, says Kate Hays, PhD, a clinical and sport psychologist at The Performing Edge in Concord, N.H. They include: gathering information on the patient's exercise use at intake and prescribing exercise over the course of therapy;
consulting with patients and exercise trainers on the best ways to use exercise to aid mental health; touting sports psychology principles in therapy; and using exercise as the venue for therapy, particularly walking with clients.

While there are no hard figures on how many clinicians use exercise in therapy, the practice appears to be growing, says Shane Murphy, PhD, director of Gold Medal Psychological Consultants in Monroe,
Conn. Part of the rise in interest, he thinks, comes from younger psychologists who learned about sport psychology and wanted to apply what they learned, not just research it, Murphy said.

Supporting data

Research over the last 20 years support clinicians' heightened work in the area. While some studies have been flawed by a lack of control groups and other methodological problems, researchers are confident enough in the literature to state a firm link between exercise and lowered levels of
depression and anxiety. One of the first major studies in the area, by John Greist, MD, in 1978 found that exercise by itself was as or more effective in lowering symptoms among depressed patients than therapy.

Other psychologists note that exercise probably can't replace what psychotherapy offers--the gradual shift in cognition and emotion that helps one cope better--but can enhance that process.

For depressed patients, exercise provides a basic sense of accomplishment, says John Silva, PhD, professor of sport psychology at the University of North Carolina at Chapel Hill. "The depressed person
has often given up their goals, is low in energy and feels it doesn't make sense to do anything," he said. Exercise, with its focus on short-term goals, energy enhancement and step-by-step mastery of an activity, represents "the antithesis of all of those feelings."

In addition, exercise can give depressed people nonthreatening social support, Silva said. It's easy to make friendly conversation and disregard your physical appearance when you're exercising with someone else: "Putting on a T-shirt, shorts and sneakers and going running with someone has a great equalizing effect," he says.
Exercise can short-circuit the cycle of cognitive and physical tension that characterizes anxiety disorders, Silva said. "Cognitive anxiety creates physical anxiety," he said. "If you can dissipate the somatic anxiety through exercise, you're not sending as many cues to the brain that you're highly
anxious. Exercise provides a kind of mental 'time out' that gives the body a break, too."

In the therapy office--and sometimes directly outside of it--clinicians are tailoring these optimistic findings to a range of clients. Private practitioner Toni Farrenkopf, PhD, of Portland, Ore., uses the principles of sports psychology--goal-setting, focusing, negative thought-stopping and positive
visualizations--with nearly all of his clients. "Exercise comes up with just about every client because it's one of the basics," he says.

Instead of medication

Practitioners are using exercise with more seriously mentally ill clients, too. Martinsen successfully uses exercise as an adjunct to therapy with schizophrenic and manic-depressive patients. He believes it
works well because it puts a part of their treatment into their own hands.

"These patients often regress at the institute because their expectations of what the institution can do for them are too great," he said. "Exercise is a practical way to show them that their own work, their own efforts, are important for their outcome."

While the benefits of exercise are manyfold, Hays advises clinicians to be cautious when incorporating it as part of treatment. Issues to consider include clients' health status, boundary issues and confidentiality
concerns. When a therapist and client walk together, for example, the outdoor setting may inadvertently encourage the therapist to be more personally expressive, which can make the patient feel threatened. Likewise, if others see the two walking together, the patient's confidentiality can be unwittingly breached, she said.

But those who use exercise with clients say they wouldn't do it any other way. "People don't have years to hang around and work on their issues," Gavin believes. "Exercise can help them process their treatment much more

American Psychological Association




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