Working Out Your Emotions With Exercise
Dozens of research studies over the last two decades have established
the mental health benefits of exercise, and even explored exercise
as a treatment for depression and anxiety. Recent studies by Duke
University researchers found that exercise can be as effective as
medication in treating depression, and is associated with longer-lasting
But Wayne Sandler in Los Angeles, California, is believed to be
one of the few therapists in the country to combine exercise and
therapy at the same time. "This was one way to deal with both physical
well being and emotional well being, simultaneously," Sandler said.
Although many mental health professionals see little harm in combining
exercise and treatment, some question whether the practice is stepping
over a boundary that could adversely affect the therapist-patient
"Is there a potential for a slippery slope?" asks Kate Hays, a Toronto
clinical and sports psychologist. She says that therapy traditionally
takes place in a formal office setting. By introducing something
unconventional into that environment, there is the possibility for
a relaxed standard in the therapy session.
Dr. James Lake, a Pacific Grove psychiatrist who chairs the American
Psychiatric Assn.'s caucus on alternative and complementary therapies,
said he had never heard of combining therapy with exercise in the
way that Sandler does.
Research has shown an association between exercise and mental health,
Lake said, but it can be hard to measure exactly how exercise is
beneficial, since people who exercise also tend to be involved in
other activities that promote well-being.
One other therapist who is combining counseling and exercise is
Jane Cibel, a clinical social worker and personal trainer in Washington,
D.C. Cibel guides her patients through a 50-minute workout session
that includes strength training with free weights and cardiovascular
exercise on a treadmill. Throughout the session, she engages the
patient in talk therapy.
Cibel says the relationship between a therapist and a patient is
similar to that of a personal trainer and a client. "If they're
working out with a trainer, people are talking the whole time,"
she said. "I don't think I ever met someone who, after working out
at the gym, was more depressed."
Sandler said his patients have been positive about the exercise
therapy. Several of his patients have told Sandler that working
out during the therapy makes him seem more like a "normal person,"
rather than an intimidating psychiatrist.
The benefits of his approach, Sandler says, go beyond the simple
idea of combining two activities in the same time period. Sharing
the experience of exercise with the patient can deepen the interpersonal
connection between the doctor and patient and break down barriers
that can interfere with the therapy, he said.
Sandler said he was aware of the "boundary" issues, and that was
a prime reason why the treadmills are in an office setting. By performing
the exercise in traditional surroundings, the therapy preserves
those boundaries, while still maintaining the benefits of exercise,
Walking or running outside, for example, might foster an inappropriate
connection between the doctor and the patient, Sandler said, but
it also has one other significant disadvantage: There is no guarantee
The approach is not right for everyone, Sandler acknowledged. Research
suggests that exercise benefits patients with mood disorders, such
as anxiety, but not necessarily other conditions. Sandler said he
carefully chose which patients to introduce to the therapy.
Despite strong evidence linking regular exercise to mental well-being,
exercise is still not a common treatment for mental health problems.
Hays, the Toronto psychologist, said one reason exercise wasn't
recommended more often by therapists was because "it takes a certain
amount of effort and focus and willingness, and a lot of people
feel that it is much easier to have a medication prescribed to them."
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