Updated: Feb 3, 2020
It's not uncommon that people ask me about ways to relieve distress that don't require a mental health provider. And, I understand this question. There are so many barriers to quality care - work schedules, childcare, cost, distance from your home, you name it. Of course, I think anyone who is suffering should get a fantastic therapist who offers effective treatment. I'm biased of course, but therapy really does work. That said, maybe that's not an option for you right now. What can you do?
Some advice, from a clinical psychologist: if you can do it, if you can make yourself do it when you use all the willpower you have, if you have just enough energy to add one thing to your life, exercise. I'll say it again. If you have it in you, if the depression or anxiety have not yet fully gotten hold of you, if your body can do it, if you're wondering if something can lift you out of this rut, and you're not doing it yet, absolutely, 100% start exercising.
Well, of course.
It probably isn't huge news to you that exercise makes people feel better. It's an old adage you may have heard from just about a thousand sources. Maybe some friend has already tried, very unhelpfully, to tell you that it'd be easy to get out of your rut if you'd just pull yourself up by your bootstraps and go to a spin class. You were looking for some support and all you got was a cliché.
There are times when depression, anxiety, and other difficulties are going to make it impossible to add something like an exercise routine to your life. And I certainly don't think it helps at all to suggest that exercise will really solve the problem, that it can replace the benefits of mental health treatment, or that it could possibly be a replacement for feeling supported and validated by the people in your life. Still, I stand by it. It's not a cure, but it's a balm. If you can make yourself do one thing, do this. Here's why.
Exercise reduces depressive symptoms.
This is the strongest reason to start exercising now. If you are struggling with symptoms of depression, exercise is especially likely to be helpful. In their review of the scientific literature on exercise for depression, the Cochrane Library found that exercise reliably reduces symptoms of depression, with moderate effects compared to no therapy, after reviewing thirty-seven randomized controlled trials studying the benefits of exercise for depression.
Let me give you a little background information. The Cochrane Library is one of the absolute best sources of accurate information about whether the treatment you are receiving is actually evidence-based. That's not just for mental health treatment; in fact, they spend a lot of their time looking into the science of medical interventions. They are an objective, extremely thorough source of information, and they'll tell you straight up what the science says. If you haven't had a lot of scientific training, it can be a little hard to wade through their information. You may have to trust me on this, but support from a review conducted by the Cochrane Library is a big deal.
Exercise reduces anxiety.
People started researching exercise for depression first, and only recently started looking into whether exercise helped people with anxiety disorders. Still, the evidence for anxiety is pretty positive. This recent scientific paper reviewed the research on physical exercise for anxiety disorders, PTSD, and OCD, and found that anxiety symptoms improved for people with all of these diagnoses across 11 different research studies after they started exercising. Exercise was equally helpful to medication for panic disorder.
Exercise improves regulation of emotion.
Difficulties with emotion regulation cut across a lot of different mental health problems. Do you find yourself more reactive than other people to daily life stressors? Have particular trouble being productive after receiving criticism? More likely to feel stressed for a long time after something bad or irritating happens? You're not alone - many of the clients I see struggle with emotion regulation, whether they have a specific diagnosis or not.
Researchers have looked into how exercise helps with emotion regulation, in part because exercise can improve your heart rate variability. Heart rate variability is basically a sign that your nervous system is good at handling stress. And, it's true, exercise seems to help people regulate their emotions - after exercise, people who normally have a hard time regulating their emotions don't react as negatively to stress.
A caveat: I don't suggest beginning to introduce excessive, compulsive exercise into your routine. Exercise should always be for self-care. Never introduce exercise as a way to harm or punish yourself. Remember to take good care of your body - it's the only one you'll ever have.
Okay, so, is there any particular exercise I should do?
Well, the best form is the one you're willing to do. Right now, that may be a walk around the block once a day. Start there. Build from there. Keep moving.
What to work up to? Most of the research has looked at the effects of around 30 minutes of aerobic exercise, around 3 times per week. This includes things like jogging, bicycling, swimming, and other cardiovascular exercise such as elliptical. If you need cheap access to a gym, check and see if your city's Parks and Recreation department has inexpensive public recreation centers. In the Atlanta area, you can get a gym pass for $110 per year for a single adult through our Parks&Rec department - not bad.
It can be a little more expensive, but there's also some research evidence that yoga can be helpful for depression, anxiety, and maybe for PTSD. I myself have published a case series showing some benefit of yoga for Generalized Anxiety Disorder. This research is in its early stages and isn't very well-conducted, yet. For example, my study only included three cases, so it's hard to say whether yoga would help most people with GAD. I think the ideas in many yoga classes, especially being mindfully aware of your body, jive well with mental health treatment. I always encourage my clients to start yoga if they are interested in it (I myself am a certified yoga instructor, though I have not taught yoga in a long time).
I would say it's unlikely that any form of exercise will help as much as personalized, evidence-based, professional help. Still, if you're struggling with your mental health and therapy isn't an option right now, exercise might give you some relief.
If you are in a place where you are ready to commit to psychotherapy, feel free to reach out to the Anxiety and Trauma Clinic of Atlanta for personalized, evidence-based treatment.