Climbing Intervention Effective, Durable for Depression?

Batya Swift Yasgur, MA, LSW

January 31, 2020

Bouldering psychotherapy (BPT), an intervention that combines a unique style of rock climbing with psychotherapy, may offer an effective and durable treatment option for depression, new research suggests.

Results from a randomized controlled trial show that BPT reduced symptoms in patients with mild to moderate depression. This effect was maintained up to 12 months.

"The results of this study indicate positive short- and long-term effects of BPT on severity of depression," the investigators, with lead author Laura Schwarz, a medical student and doctoral candidate at Friedrich-Alexander University Erlangen-Nürnberg, Germany, write.

The study was published online in Heliyon.

Need for New Treatments

Most therapies for depression involve antidepressants, psychological treatment, or a combination. However, antidepressants are often associated with side effects, poor adherence, and stigma. In addition, a significant number of patients do not receive psychotherapy for depression, the authors note.

"New therapies are needed to complement traditional strategies," they write.

Physical activity is included in several European guidelines as supplementary therapy for the treatment of mild to moderate depression. Bouldering has recently been shown to be effective in ameliorating depressive symptoms.

Bouldering is a sport in which climbers try to master "short but tricky climbing routes" up surfaces that are usually less than 4 or 5 meters high. It is performed without a rope or harness. Climbing gyms provide routes that differ in the level of difficulty, corresponding with various levels of physical fitness.

Previous research has demonstrated the therapeutic effects of climbing and bouldering for a variety of physical, neurologic, and psychological disorders, including attention-deficit/hyperactivity disorder, anxiety, and eating disorders.

Earlier studies support the role of climbing and bouldering in treating depression, but these studies have had methodologic weaknesses or have only examined short-term effects.

The current study examined the potential effect and durability of BPT in reducing symptoms in patients with mild to moderate depression.

The study initially included 108 individuals with depression who were randomly assigned to receive the active intervention or were placed on a wait list.

Of these, 97 participants (57.7% women; mean [SD] age, 45 [12.2] years) completed the first 8 weeks (48 in the intervention group and 49 in the wait-list group); 69 (33 in the intervention and 33 in the wait-list group) completed the final follow-up assessment.

The participants' depressive symptoms were evaluated with the World Health Organization (WHO) questionnaire on well-being and the Beck Depression Inventory II (BDI-II).

The participants' level of depression was evaluated at baseline (t0), after 8 weeks (t1), and at 16 weeks (t2). Follow-up occurred after 12 months (tF).

For the intervention group, follow-up took place an average of 10 months after the intervention had ended. For the wait-list group, follow-up took place approximately 8 months after completion of the intervention.

BPT sessions were led by therapists who had received special training in therapeutic rock climbing.

Each session focused on a specific subject, such as self-efficacy, anxiety, or trust, and included mindfulness or meditation, psychoeducation, a subject-related activity, and bouldering.

Potential Mechanisms

The participants' average WHO well-being score was 7.95 (4.89). In addition to the BPT intervention, 70% of participants were undergoing psychotherapy or were being treated with an antidepressant.

After the first 8-week program, the intervention group's scores on the BDI-II improved by 7.21 points; for the wait-list group, scores improved by only 2.14 points (Cohen's d, .59).

Group allocation and baseline depression score were the only significant predictors of improvement (P < .001).

For participants in the intervention group, the BDI-II sum score was significantly lower at t1 in comparison with the score for the participants in the wait-list group.

Both groups improved significantly during their respective intervention periods. Neither group experienced further improvements during the follow-up period.

At follow-up, effect sizes for the wait-list group and the intervention group were .43 and .37, respectively.

"The lower effect size in the intervention group can be explained by the longer follow-up period in comparison with the wait-list group," the authors note.

The reduction in depression scores during the 8-week BPT intervention and the "moderate" effect size were "comparable to the effect sizes found in meta-analyses on the effect of exercise in depression," they note.

Several mechanisms may explain the antidepressant effect of bouldering, such as regaining self-confidence and self-efficacy, an increase in cognitive functioning or social competence, and a sense of achievement and motivation.

"These psychological mechanisms, as well as a variety of skills the participants learned in an interactive way during the intervention, might persist after the intervention and help participants overcome illness-related problems in the long-term," the investigators write.

Meaningful Effects

Commenting on the study for Medscape Medical News, Michael Thase, MD, professor of psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, said the study provides further evidence that engaging depressed people in physical activity — in this case, bouldering — "can have meaningful therapeutic effects."

Thase, who was not involved with the study, noted that previous research has evaluated a wide range of activities, including brisk walking, jogging, aerobics, weight lifting, and other forms resistance training. "We can be increasingly confident that the benefit has more to do with being physically active than the particular type of activity," he said.

The authors suggest that further research "should compare the bouldering intervention with psychotherapy alone or other forms of physical activity that have been found to be effective in the past."

The study was supported by the Psychiatric University Hospital Erlangen. The authors have disclosed no relevant financial relationships.

Heliyon. 2019;5:e02929. Full text

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