Today, depression is so common in industrialized nations that nearly one in eight people will suffer from it at some point in their life. Patients with depression often report an overwhelming sadness and feel unable to start a new activity; this is frequently accompanied by pessimistic thoughts and rumination.
But depression is also felt physically, with many patients reporting sleeping problems, a loss of appetite, or difficulties concentrating. With depression, people feel isolated and worthless. According to the WHO, depression will become the second leading most common burden of disease right after ischaemic heart disease by 2020. We must, therefore, rethink how we treat this common psychiatric disorder to meet the specific needs of millions of new patients worldwide.
Various studies have already pointed out that the impact of physical activity is, under certain circumstances, comparable to antidepressants or psychotherapy. Physical activities focusing on coordination show strong effects, particularly when performed in groups. This positive effect could be provoked by an interaction between physical and psychological factors. Research suggests that the brain, especially the hypothalamic adrenocortical system, is stimulated during physical activity in a way similar to that seen during the usage of antidepressants. As well as the neurological reaction, the patient is distracted from negative thoughts and feelings during the sports session. In addition, they learn coping strategies to deal with (sporting) setbacks and regain a sense of purpose. The experience of mutual support while exercising together is also crucial.
Based on these promising findings, Luttenberger et. al. (2015) developed a new therapy manual to tackle depression. At the center is so-called bouldering, indoor climbing at moderate heights. In special bouldering gyms, each climber can, based on his abilities, decide which route he wants to climb, and the different routes are marked by colors. This allows both experienced and inexperienced climbers to boulder at the same time. Unlike rock climbing, bouldering is practiced at heights of up to only four meters, so no rope or harness is required and to protect the climbers in the case of falls safety mats are placed underneath.
There have already been clinical case reports and field studies that documented the positive effect rock climbing can have in a therapeutic setting. However, Luttenberger et al. (2015) were the first to research the effects of a bouldering group intervention on people with depression. They developed an eight-week intervention program, which consisted of one session each week. In groups of 12 people, the participants went through a three-hour training session led by two psychological therapists certificated in bouldering therapy. Each session started with a short mindfulness exercise, followed by a specific psychoeducational input, e.g. “fear and trust.” Afterward, a bouldering game or exercise was conducted to practice the newly-learned technique, for example, the participants used breathing techniques to control their fear at the climbing wall. After a short break, the participants also had time to boulder freely under the guidance of the therapists.
To verify the effectiveness of their developed manual, Luttenberger et al. (2015) used a waitlist-controlled study design to measure changes in depressive symptoms. 47 participants on depression were randomly assigned to either the intervention group or the waitlist. If they were assigned to the waitlist, participants had to wait 8 weeks before they could start bouldering therapy. The intervention group started immediately. Both groups were interviewed four times during the three-month study period: at baseline, and after eight, 16, and 24 weeks. During the interviews, the participants reported on their depressive symptoms, resources, and self-management skills.
The results showed that bouldering therapy significantly reduced the severity of the depressive symptoms in the intervention group compared to participants on the waitlist. Besides the reduction of depressive symptoms, participants reported significantly lower phobic anxiety and a greater interpersonal sensitivity. The intervention group also felt more confident in using active and passive coping strategies compared to the waitlist group. The data from the 16 and 24 weeks of follow-up interviews showed that the positive effects were persistent.
As it could be assumed that the outcome might be influenced by the general level of daily physical activity, in the following groups the daily level of physical activity was also measured for 16 weeks by accelerometers. Although an active lifestyle proved to be a positive predictor of change in depression scores, the effects of the bouldering therapy still remained significant in reducing depression (Stelzer et al. 2018).
At this point, little is known about the mode of action that causes these positive outcomes. Bouldering therapy seems to combine uniquely physical activation alongside mental health support. On the one hand, the high amount of time spent exercising during the training session might help to increase the general physical performance of the participants and also promote executive function.
On the other hand, bouldering therapy focuses intensively on psychological aspects. Each session treats a certain subject with a theoretical background and specifically chosen bouldering games, for example, “blind bouldering” in the session on fear and trust. As patients sometimes, for the first time in years, experience that they can solve bouldering “problems,” bouldering therapy also seems to increase the feeling of self-efficacy, since the success is felt immediately.
Additionally, bouldering therapy is designed as a group intervention. The participants are encouraged to support each other during the exercises. Moreover, many bouldering games aim to enhance teamwork and social interaction. This seems to be another strong therapeutic component, which is likely to cause the reported increase in interpersonal sensitivity.
Last but not least, bouldering is a sport that depends on mindfulness. The climber has to concentrate on his/her body and actions to climb up the wall. The mindfulness exercise at the beginning of each session intends to stop rumination, one of the characteristics of depression, and to increase self-awareness.
All in all, bouldering therapy has proven to be an effective therapeutic approach to treat people with depression regardless of their general physical activity level. Patients learn how to climb out of their depression by experiencing self-efficacy and a sense of community which eventually leads them to reconnect with themselves.
These findings are described in the article entitled Bouldering psychotherapy reduces depressive symptoms even when general physical activity is controlled for: A randomized controlled trial, recently published in the journal Heliyon. This work was conducted by Eva-Maria Stelzer, Stephanie Book, Elmar Graessel, Benjamin Hofner, Johannes Kornhuber, and Katharina Luttenberger from the Friedrich-Alexander-Universität Erlangen-Nürnberg.
References:
- Luttenberger K., Stelzer E., Först S., Schopper M., Kornhuber J., Book S. (2015) Indoor rock climbing (bouldering) as a new treatment for depression: study design of a waitlist-controlled randomized group pilot study and the first results BMC Psychiatry 15:201 doi: 10.1186/s12888-015-0585-8
- Stelzer E., Book S., Graessel E., Hofner B., Kornhuber J., Luttenberger K. (2018) Bouldering Psychotherapy reduces depressive symptoms even when general physical activity is controlled for: a randomized controlled trial Heliyon e00580 DOI: 0.1016/j.heliyon.2018.e00580