Affective Responses to Both Climbing and Nordic Walking Exercise Are Associated With Intermediate-Term Increases in Physical Activity in Patients With Anxiety and Posttraumatic Stress Disorder - A Randomized Longitudinal Controlled Clinical Pilot Trial

Examining acute environmental effects on affective state, expectancy, and intention in sport climbing

Introduction

Psychological research has shown that, among other variables, affective state, expectancy, and behavioral intention influence whether or not a (physically active) behavior is performed. Environmental effects during physical activity on affective state have been well studied; however, research regarding environmental effects on expectancy or intention is limited. Sport climbing is a form of physical activity that is performed both indoors and outdoors and is therefore considered as suitable to study environmental effects. Therefore, the aim of the present study was to investigate environmental effects during sport climbing on affective state, expectancy, and intention. The nature of the relationship between some of these parameters should also be explored.

Methods

Using a within-subjects design, 48 participants were to climb both once indoors in a climbing gym and once outdoors at a crag. The design included questionnaire-based surveys at multiple time points. Affective state, expectancy, and behavioral intention were measured at different test time points.

Results

Two-factor repeated-measures ANOVAs revealed significant main effects of the factors environment (indoor - outdoor) and time (T1 - T2 - T3) for affective state, indicating more positive affective state during outdoor climbing. No environment*time interactions were found. Furthermore, significantly higher intention (d = 0.32; p = 0.032) was measured after the outdoor condition (M = 32.5, SD = 4.1) compared to the indoor condition (M = 31.2, SD = 4.7). Multiple linear regressions revealed that expectancies (measured before and after the session) significantly predicted post-climbing intention only indoors.

Conclusion

The results at least partly suggest environmental effects on behaviorally relevant variables during climbing. Outdoor climbing might provide more favorable characteristics for physically active behavior compared to indoor climbing. Health psychologists or public health professionals who focus on increasing physical activity for their clients could recommend outdoor climbing over indoor climbing.

New ways to cope with depression-study protocol for a randomized controlled mixed methods trial of bouldering psychotherapy (BPT) and mental model therapy (MMT)

BACKGROUND

Due to the growing gap between the demand and supply of therapeutic services for people suffering from depression, with this study, we are investigating the effectiveness and factors of influence of new approaches in group treatments for depression. Two previous studies have already identified bouldering psychotherapy (BPT) as an effective option. It combines psychotherapeutic interventions with action- and body-oriented bouldering exercises. Mental model therapy (MMT) is a new cognitive-behavioral approach for treating depression. It focuses on identifying cognitive distortions, biases in decision making, and false assumptions and aims to correct and replace them with useful mental models. We aim to investigate the effectiveness of the interventions compared with a control group (CG) and to assess the factors of influence in a mixed methods approach.

METHODS

The study is being conducted as a randomized controlled intervention trial. Adult participants with unipolar depression are being randomized into three groups (BPT, MMT, or CG), and the first two groups are undergoing a 10-week treatment phase. CG follows their individual standard treatment as usual. A priori power analysis revealed that about 120 people should be included to capture a moderate effect. The primary outcome of the study is depression rated with the Montgomery and Asberg Depression Rating Scale (MADRS) before (t0), directly after (t1), and 12 months after the intervention phase (t2). Data are being collected via questionnaires, computer-assisted video interviews, and physical examinations. The primary hypotheses will be statistically analyzed by mixed model ANOVAs to compare the three groups over time. For secondary outcomes, further multivariate methods (e.g., mixed model ANOVAs and regression analyses) will be conducted. Qualitative data will be evaluated on the basis of the qualitative thematic analysis.

DISCUSSION

This study is investigating psychological and physical effects of BPT and MMT and its factors of influence on outpatients suffering from depression compared with a CG in a highly naturalistic design. The study could therefore provide insight into the modes of action of group therapy for depression and help to establish new short-term group treatments. Methodological limitations of the study might be the clinical heterogeneity of the sample and confounding effects due to simultaneous individual psychotherapy.

TRIAL REGISTRATION

ISRCTN, ISRCTN12347878. Registered 28 March 2022, https://www.isrctn.com/ISRCTN12347878 .

Climbing as an Add-On Treatment Option for Patients with Severe Anxiety Disorders and PTSD: Feasibility Analysis and First Results of a Randomized Controlled Longitudinal Clinical Pilot Trial

BACKGROUND

Exercise has considerable effects on physical and psychological health. Anxiolytic effects of climbing exercise have been found in people suffering from depression. However, there are no studies on patients with severe anxiety disorders or post-traumatic stress disorder (PTSD) practicing climbing as add-on treatment. Additionally, many studies on physical therapy fail to use adequate active control groups. Therefore, this study aimed to investigate the feasibility of a four-week climbing exercise program for patients with anxiety disorders or PTSD in comparison to a standard exercise treatment and a social control group.

METHODS

Outpatients diagnosed with anxiety disorders or PTSD (F 40, F 41, F 43.1 according to ICD-10) were randomly assigned to (a) climbing exercise (n = 27), (b) Nordic walking exercise (n = 23), or (c) control condition (n = 23) providing the same amount of social contact for eight sessions of 90 minutes each. Psychological parameters (symptom severity, worry symptoms, self-efficacy, quality of life) and biological parameters were assessed at the beginning and at the end of the four-week program. Additionally, follow-up assessments were conducted three and six months after the program ended.

RESULTS

Sixty outpatients (75% female) aged 18-65 years with a longstanding history of a mental disorder (>10 years) and classified as treatment-resistant (95%) and with averaging 3.8 psychiatric comorbidities completed the pilot trial. After participation, symptoms of anxiety disorders were significantly reduced (p = 0.003), and health-related characteristics significantly improved (depression symptoms: p < 0.001, worry symptoms: p < 0.001, self-efficacy: p < 0.001, quality of life-physical health: p = 0.002, quality of life-psychological health: p = 0.006) in all groups. The feasibility of conducting climbing exercises for the patient groups could be demonstrated, and a general acceptance in the groups was recorded. No significant time-by-group interactions were found. At the completion of the program, psychological parameters improved, while biological parameters remained the same in all three groups.

CONCLUSIONS

Participation in the climbing group as well as in Nordic walking and social contact groups demonstrated beneficial results in patients with anxiety disorders and PTSD with severe mental burden. Nevertheless, climbing did not show any additional clinically relevant benefits compared to Nordic walking or social contact. Studies with larger sample sizes and qualitative insights are needed to further evaluate the possible benefits of climbing in this population.