AMHA-OR - Exercise & Psychotherapy
Exercise and Psychotherapy: Better than Antidepressants
Michael Conner, PsyD
Too often we accept the outdated assertion that medication and psychotherapy are the “proven” treatment modes for depression. Psychotherapy and exercise can reduce or eliminate symptoms of depression in almost anyone. There are good studies that demonstrate this and my work with patients confirms it.
Exercise is an important and positive addition to psychotherapy. Books, articles and guidelines for combining exercise and psychotherapy in treatment have been developed. I’m so convinced of this that I installed an exercise gym in my office for patients. I also have simple exercise equipment patients can take home with them. The combined results and interaction effects are immediate and powerful. I can hardly imagine using antidepressants as the first treatment for depression.
According to the U.S. Health Department, more and more people are depressed. The reasons are stress, the consequences of stress, and a culture that promotes the pursuit of stimulation and pleasure as distraction or escape from emotional problems. Instead of more healthy activities, people are pursuing stimulation and pleasure through food, alcohol, television and video games while sitting on the couch -.
Why do patients in the U.S. take antidepressants without trying more healthy and proven approaches first? There are two reasons.
Antidepressants are big business. Americans spend more than 86 billion dollars a year on antidepressants alone. Pharmaceutical companies spend nearly 10 billion dollars each year on marketing and promotion. Antidepressants are among the most commonly prescribed and most profitable drugs in America. Very little money is spent in the U.S. to promote awareness of healthier alternatives.
Second, people in the U.S. seem to believe drug marketing. Research results are widely misinterpreted and oversimplified in U.S. newspapers, magazines and on television. The problem has become so wide spread that many health care and mental health professionals misunderstand the research as well.
The Biggest Misunderstanding
Journalists, media personalities and advertisements incorrectly report that antidepressants can help up to 65% of people diagnosed with depression. But when you read the research, and account for placebo effects, you realize that 40 to 50% of depressed people would get better without an antidepressant. Only 15 to 25% improve somewhat on drugs. Research repeatedly confirms that 40 to 50% of depressed patients get better because of the passage of time, changes they make in their lives, and fortunate events. And if you read all the studies on antidepressants you discover that nearly 6 out of 10 studies show that antidepressants don’t work at all. The failed studies are never publicized and are often kept secret. There is very little difference in how “antidepressing” one antidepressant is over another. In fact, the “new generation” of antidepressants (like Prozac) are not more effective than the old ones. The main difference is a patient’s ability to tolerate unpleasant and even embarrassing side effects. The newest medications are just more expensive with different risks and side-effects.
There are some important realities that are fully supported by research and publications.
How Do Most People Recover From Depression?
Most people get better because of the passage of time, fortunate events, or positive changes in their life style. Medications can prevent people from making changes in their life. In Europe, many people who stay on antidepressants for 10 years are generally worse off than those who found and chose healthy alternatives. Psychotherapy and exercise can help create a better life.
Exercise and Psychotherapy
Professionals often refer to psychotherapy as a “talking cure” when in fact it is a psychological and behavioral science. It is about our awareness as well as what we think, feel and do.
Exercise can benefit people of all ages. Almost any strenuous exercise can reduce or eliminate symptoms of depression. This can include activities like walking, hiking, rowing, biking, running or weight lifting. Exercise on a daily basis that involves social interaction is best. The effect of exercise is positive, both immediately and long term.
Researchers at the University of Texas Southwest Medical Center found that reduction of depressive symptoms after individuals exercised for 30 minutes, three to five times per week over 12 weeks. High-intensity activity produced a 47 percent reduction. Low-intensity activity resulted in a 30 percent reduction. Stretching activity revealed only a 29 percent reduction
A Duke University study compared the benefits of aerobic exercise, medication and a combination of the two. After 10 weeks of treatment, patients in all three groups were significantly less depressed, and two-thirds no longer met the diagnostic criteria for depression. And when researchers followed up with the test subjects six months after the study was completed, they found patients in the exercise group were more likely to be partially or fully recovered than those who were in the medication or medication plus exercise groups.
Depending on the study, the effectiveness of psychotherapy and antidepressants can be very misleading. Short term studies make antidepressants look more effective than they are in reality. A 12 week study by the National Institute of Mental Health (NIMH) concluded that antidepressants are more effective than psychotherapy and that psychotherapy combined with antidepressants is best in the treatment of depression. However, another NIMH study of antidepressants demonstrates that a 16 week trial of psychotherapy is more effective in the long run to one year of antidepressants. Patients who have 16 weeks of psychotherapy will have about the same relapse rate a year later as people who take an antidepressant the whole time.
The following will be true for the majority of people.
Exercise can be included in a psychotherapy treatment plan and used as a behavioral health “action method”. A psychologist might talk with a patient while they are exercising. When combining psychotherapy during exercise, a therapist might work with a patient on their prior experience with exercise, their fear of equipment, anxiety when exercising in public, fear of injury, or their discomfort using and gaining awareness of their own body.
Resistance to exercise can be addressed using techniques such as historical resynthesis, perceptual shifting, countering, stress inoculation, validation and operant conditioning. Realistic expectations and beliefs about the benefits can be reinforced in vivo and through documentation of gains over time. A psychologist may eventually prescribe exercise between appointments. Patients are more likely to continue exercise as a life style when therapeutic exercise is included and reinforced as part of a treatment plan.
Psychotherapy is more than just talking about problems. It is about supporting a healthy lifestyle where people are engaged in meaningful, stimulating and rewarding activities. The biggest challenge for a person who has been depressed is to start exercising and to keep exercising once they feel better. Patients have difficulty starting exercise. Motivation is usually low because they are depressed and exercise requires an investment of energy that is often low to begin with. Depressed people often have realistic and unrealistic fears that need to be examined. People who are depressed often have a pessimistic attitude. They are often reluctant to change their lifestyle to include something unfamiliar that requires a long term commitment and efforts.
Research and experience reveals that merely recommending new behavior to patients is not adequate to initiate and maintain a change. This appears to be why physicians and psychologists who merely recommend exercise find that very few patients actually follow their advice and remained committed.
Psychologists are uniquely qualified to help patients change their behavior and life style. However, research indicates that the willingness of a psychologist to recommend and use exercise in a treatment plan is probably related to their own experience and commitment to exercise.
People who have not seen a health care professional in a long time, and those with health problems, should have a medical check-up before entering a new exercise program. This is especially important for people who have high blood pressure, are overweight, smoke, are diabetic or have family history of heart disease. People with skeletal or muscle problems should consult with a physical therapist.
People are more likely to continue exercise if their activity involves positive social experience, scheduled times for exercise and when they measure progress and pay attention to all the benefits. Exercise and psychotherapy can eliminate depression and create joy.
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