Running Therapy: A dynamic approach to counseling for Anxiety
Running Therapy
Running Therapy (RT) has been studied since the early 1970’s, however, the positive effects of exercise on mental health has been noted since, as early as, 1905 when a paper was published by Franz and Hamilton coining that exercise has decreased depressive symptoms (Sachs & Buffone, 1984). Running Therapy can be defined as the utilization of running exercise in conjunction with psychotherapy practices implemented by a mental health profession with the goal to aid clients with both their physical and psychological health (Sachs & Buffone, 1984). Thaddeus Kostrubala has been considered the god-father of RT by not only creating the title but being the first psychiatrist to engage his psychiatric patients in sessions that integrated running exercise and therapeutic talk (Kostrubala & Schüler, 2019). While Kostrubala thought to combine therapeutic interventions and exercise in the same setting, practicing this integrative approach has been scarcely researched since then. Hays (1994) describes running exercise to have decreasing effects on both depression and anxiety. According to the American Psychiatric Association (2013), GAD symptoms include a general sense of worry, for more days than not, that may entail restlessness, fatigue, difficulties concentrating, muscle tension, and sleep disturbance. Running can induce a sense of, “…mastery, patience, capacity for change, generalization, distraction, positive habit, symptom relief, consciousness alteration, and biochemical changes” (Hays, 1994, p. 725). More specifically, exercise and running have been connected to an increase in self-efficacy, a sense of control, self- concept and creativity (Sachs, 1982). These concepts can be connected to the reduction of Generalized Anxiety Disorder symptomology. Regardless of the evidence that is depicted in connection to running and the decrease of anxiety symptoms, there is still little research discussing running and therapeutic intervention being utilized within the therapeutic setting. While the focus has been to connect running and the positive effects towards mental health, there has also been insights towards other movement forms that have similar results such as jogging or walking.
Walking, jogging and mental health.
It has been posited that that even during a brisk walk clients tend to experience a sense of comfort and gain the ability to be more in touch with their thoughts and emotions in real time (Hays, 1999). According to the Anxiety and Depression Association of America (ADAA) (2018) exercise such as walking for at least ten minutes has long lasting positive effects that have been shown to decrease stress and general anxiety symptoms. It has also been noted that walking has the ability to increase energy levels, self-awareness, and environmental awareness (Hays, 1999). Studies have suggested that exercise below the ventilatory threshold, otherwise seen as walking at a regulated pace not to the point of increased ventilation, is positively correlated with consistent levels of enjoyment and an increase in positive mood during and post physical movement (Crush, Frith, & Loprinzi, 2018). Crush, Frith and Loprinzi (2018) also identified that consistent long-term commitment to mild levels of physical activity, such as walking, have long lasting effects for the continuation of positive mood and motivation. Exercise within the ventilatory threshold, where ventilation is moderately increased, such as jogging, have similar positive effects on mood (Crush, Frith, & Loprinzi, 2018).
The internal psychophysiological mechanisms at work imply that moderate exercises, such as jogging, can manipulate biochemical states within the brain that help increase positive affect and mood (Harper, 1984). More specifically, jogging has been shown to activate levels of certain biochemical neurotransmitters, such as catecholamines, that are connected to increased positive mood and decreased stress (Harper, 1984). Harper (1984) conducted a study where college students, who participated in a five-mile jog, five days a week for 14 weeks, exhibited significant decreases in anxiety states and an increase in self-concept. Furthermore, the prescribed amount of jogging appeared to also alleviate other general anxiety symptoms such as sleep disturbance, fatigue and increased concentration and self-efficacy (Harper, 1984). While the evidence is mounting regarding the benefits of exercise on mental health and more specifically on decreasing anxiety symptoms, there is still little research connecting exercise and other traditional therapeutic interventions. Mindfulness has been a heavily studied intervention to aid with anxiety relief and utilized to clinically treat anxiety mental health disorders.
Mindfulness Approaches
Mindfulness-based interventions have been a growing practice within the counseling field especially in relation to treating clinical mental health disorders such as Generalized Anxiety Disorder (GAD). Jon Kabat-Zinn, a Buddhist professor within Massachusetts, keyed the practice of mindfulness in connection to stress reduction (Pullen, Running with Mindfulness: Dynamic Running Therapy (DRT) to Improve low-mood, anxiety, stress and depression , 2017). Mindfulness can be defined as the act of heightening one’s awareness with the self and the surrounding environment in an accepting and non-judgmental way (Call, 2014). Research has indicated a decrease in anxiety symptoms when individuals engage in this mindfulness practice (Call, 2014). Pullen (2017) sited, “…the simple act of recognizing your thoughts can free you from the distorted reality they often create and allow for more clear sightedness and a greater sense of manageability in your life – Jon Kabat-Zinn” (p. 11). Individuals who experience anxiety symptoms often express the sense of not having the ability to cope with certain thoughts, sensations, and emotions (Call, 2014). Mindfulness provides a cognitive approach to reframing thought processes and increasing awareness in a gentle manor that ultimately has resulted in the decrease of anxiety symptoms. Combining mindfulness-based interventions and exercise could prove beneficial when taking a psychophysiological approach by connecting and creating a bridge within awareness of the mind-body experience. This dynamic integration of practices could result in monumental effects towards positive mental health and overall well-being for clients suffering from the crippling symptoms of GAD.
Exercise, Traditional Psychotherapy, and Psychophysiology
The thoughts of combing movement within therapeutic settings dates back to Anna Freud’s concept of play therapy in 1928 (Hays, 1999). Utilizing physical activity as therapeutic intervention for children and adolescents has been studied previously and has been found useful for the treatment of mental health disorders (Hays, 1999). However, this same agency to combine movement and traditional therapy has yet to be fully researched regarding the adult population (Hays, 1999). Thaddeus Kostrubala was one of the first within the field to present Running Therapy in his book The Joy of Running in which he discusses the practice and how to utilize interventions (Sachs & Buffone, 1984). Kostrubala was also the first to organize a running therapy group back in March 1973 (Sachs & Buffone, 1984). The group consisted of six adult psychiatric patients, whom had various mental health diagnoses, where all were engaged in a series of walking, jogging, and/or running for one hour sessions that preceded with an additional hour of group therapy (Kostrubala, 1984). All patients, except one who had a diagnosis of paranoid schizophrenia, had continued to recover from mental health symptoms and were able to decrease medication with favorable outcomes that were positively correlated to the use of the integrated approach (Kostrubala, 1984). After favorable results, other researchers were intrigued by the integration of psychical exercise and traditional psychotherapy.
GoSingco-Holmes (1989) mentioned that joggers experienced an overall decrease of anxiety and depression along with an increase in self confidence, post exercise. Based on these experiences, GoSingco-Holmes (1989) conducted a study that integrated both exercise (jogging/running) and group therapy where results were found statistically signifcant in decreasing symptoms of anxiety and other mental health concerns that were compared through the evalutions of a baseline Mental Health Status Exam (MSE) and a post program MSE given to all patients (GoSingco-Holmes, 1989). Based on the research of the study, GoSincgo-Holmes (1989) also presented the notion of psychobiology defined as the concept of the interrealtionship of human biological mechanisms and psychopathology. Psychobiology, in other words, is considered the mind-body connection. This mind-body connection is what GoSingco-Holmes, (1989) presents as the major factor for the success in decreasing anxiety symtpoms. Today, this mind-body relationship is termed as psychophysiology. Psychophysiology, as defined by experts within the sport psychology field, is the study of how both mind and body can reciprocally affect the other (Cooke, 2019). Most research today revolving around psychophysiology focuses on the interconnectedness of psychological states, physical reactions, and behavioral outcomes (Cooke, 2019). Most of these studies are connected to sports psychology and performance outomces of athletes, however, not necessarily on how it connectes to decreasing mental health issues. The little research that has been conducted on the integration of exercise and psychotherapy is usually in separate form where there is a prescribed amount of exercise given to patients followed by an hour session of talk therapy. For example, GoSingco-Holmes’s (1989) study, as mentioned previously, discussed the effectiveness of exercise and traditional psychotherapy practices on decreasing mental health conerns, however, the two practices were evaluated in parrallel fashion and not necessarily directly integrating the two practices as did Kostrubala.
Direct integration of exercise and psychotherapy.
Kostrubala was the first to create a space for this mind body therapeutic experience where he was continuously by his patients side throughout the whole process, therefore directly integrating psychotherapy and exercise. However, the empirical evidence is still lacking regarding the integrated approaches’ effectiveness on decreasing anxiety symptoms. Another concept that can be recognized within this psychophysiological approach is biofeedback. Biofeedback is the practice of providing an individual with observed information regarding their physiological responses to increase body-awareness (Levy & Baldwin, 2019). This level of awareness is induced in the hopes of the individual then gaining the ability to self-regulate viceral stimulation such as heart rate, blood pressure, brain activity, etc. (Levy & Baldwin, 2019). These instances of viceral stimulation can be connected to how the body reacts when experiencing anxiety. More specifically, when an individual experiences anxiety they may experience fight or flight sensations where their autonomic nervous system (ANS) is activated (Levy & Baldwin, 2019). While the ANS is responsible for the regulation of phsyiological reactions (ie. regulation of heart rate, flow of blood, and muscle relaxtion) there are two separate categories within the system; the sympathetic nervous system and the parasympathetic nervous system (Levy & Baldwin, 2019). The sympathetic nervous system can be activated when the body is under physical or emotional stress in which certain neruotransmitters are discharged into the bloodstream in order for the individual to respond to the snesations of fight-or-flight (Levy & Baldwin, 2019). The parasympathetic nervous system is more so connected to the rejuvination of energy and the ability to converse (Levy & Baldwin, 2019). Exercise and experiencing anxiety can mimic simlar physiological responses. However, exercise, as mentioned previously, provides an individual with a sense of control, where as when an individual experiences anxiety they tend to experience a lack of control. Traditional psychotherapy aids with connecting the individual with their parasympathetic nervous system through conversation in order to de-escalate anxiety symptoms. Biofeedback can essentially create a bridge between traditional therapy and exercise therapy by helping the client gain a sense of control through joint movement while also utilizing de-escalating interventions through talk therapy. While traditional talk therapy can provide effective treatment for anxiety symptoms, sometimes there is a need for something more. Experiential interventions such as running, jogging, or walking in combination with traditional psychotherapy can create a space where the client can experience the stimulation of their ANS, however in a more controlled environment where biofeedback is provided for the individual to then naturally and indepdendently regulate both physiological and psychological responses. For example a therapist could walk side by side with their client while engaging in traditional talk therapy and utilize biofeedback through immediacy to create physiological awareness and as a result decrease psychological senstations. Biofeedback can essentially be interpreted as the use of mindfulness, however, integrating other mindfulness based techniques within talk therapy may prove even more beneficial.
Integrating mindfulness.
With the knowledge of psychophysiology and the use of biofeedback, other mindfulness interventions can prove useful when integrating movement and traditional psychotherapy for the treatment of Generalized Anxiety Disorder (GAD). Mindfulness-based interventions have been determined highly effective in anxiety treatment since Jon Kabat-Zinn conducted his first research programs on Mindfulness-based stress reduction techniques (Shapiro & Carlson, 2009). Kabat-Zinn conducted a study that consisted of 22 participants who were diagnosed with GAD and there were significant improvments within GAD symptoms and depression symptoms, as well as, exhibited continued improvements after three years post intervention (Shapiro & Carlson, 2009). Meditative interventions that utilized mindfulness help the client gain awareness of the present moment, as well as, create room for non-judgmental curiosity (Dornelas, 2018). Researched meditative techniques have been noted effective in decreasing anxiety such as yoga, body scans, and walking meditation (Dornelas, 2018). Body scans are essentially an experience of being mindful of bodily sensations within the present moment. Walking mediation specifically is the practice of intentionally gaining awareness of bodily sensations while walking (Kaufman, Glass, & Pineau, 2018). Kabat-Zinn described walking meditation as an experience where the individual is intentionaly focusing on the way the foot meets the ground with each step, with no particular destination in mind (Kaufman, Glass, & Pineau, 2018). This process can be practiced at any pace but is best mastered when starting out slowly (Kaufman, Glass, & Pineau, 2018). This body awareness, through both the body scan and walking meditation interventions, can be connected to conecpets within psychophysiology where the individual is actively connecting mind and body. Biofeedback provided by the clinician could be utilized to help guide clients through these interventions if needed to enhance the mindfulness practice further in conjunction to the natural physiological benefits of movement.
Concluding Thoughts
Movement and exercise have been proven to decrease unfavorable mental health symptoms and promote a better sense of self and over all well-being. Within the field of sports psychology, exercise is used as a powerful tool to assess the interrelatedness of psychological states, physiological states, and performance outcomes (Cooke, 2019). While this information on the psychophysiology of exercise is helpful for the athletic field for performance enhancements, there is little research connecting exercise solely as a means to promote positive mental health in relation to mental health disorders. Within today’s counseling field there is more of a focus on prescribing a certain amount of exercise outside of sessions in conjunction to regularly scheduled counseling sessions that utilize traditional talk psychotherapy. Within traditional psychotherapy, various studies have also concluded the benefits of mindfulness-based practices. Exercise and mindfulness have been empirically studied to help decrease symptoms of general anxiety, however, empirical evidence is lacking regarding the integration of the two practices. The literature proposes profound benefits of integrating both movement and traditional talk therapy and even more so as a treatment utilized with clients who suffer from anxiety symptoms. The notion of Running/ Exercise Therapy became popular in the 1970’s and the work of Kostrubala’s integrated approach, of verbal therapeutic interventions combined with running, intrigued many in the psychology field. Currently there are several professional mental health care providers that integrate Kostrubala’s theoretical perspectives, such as William Pullen who devised his practice of Dynamic Running Therapy, which encompasses the use of movement/ exercise, mindfulness, and talk therapy to treat mental health disorders, including Generalized Anxiety Disorder. While this form of practice is becoming more main stream, significant empirical research is still yet to be performed. Furthermore, while there are a few ethical concerns regarding the implementation of exercise in the therapeutic setting, there also many benefits to combining the approaches. Counselors can learn to practice psychotherapy on a whole new level where there are many advantageous outcomes towards helping clients manage their anxiety more effectively. An integrated approach of practices that have been proven to alleviate mental health disorder symptoms may just be the ticket to devising a significantly powerful tool to utilize within the counseling field.
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