The Exercise Prescription for Depression and Anxiety
Episode Stats
Summary
Dr. Jasper Smits is a professor and clinical psychologist, as well as the co-author of the book, Exercise for Mood and Anxiety: Strategies for Overcoming Depression and Enhancing Well-Being. In this episode, Dr. Smits discusses why exercise has been found to be as effective for depression as medication, and why a particular type of exercise is better for particular disorders. We then spend the rest of the conversation digging into the Catch 22 that surrounds depression and exercise.
Transcript
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Brett McKay here and welcome to another edition of the Art of Manliness podcast.
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Now, if you went to the doctor about treating your depression or anxiety, you might expect
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to be written a prescription for Zoloft or Xanax.
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But if you went to see Dr. Jasper Smits, he might write you a different kind of prescription,
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one that instructed you to take a jog around the block.
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Dr. Smits is a professor and clinical psychologist, as well as the co-author of the book, Exercise
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for Mood and Anxiety, Strategies for Overcoming Depression and Enhancing Well-Being.
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Today on the show, we talk about why he likes to use exercise as an option for patients
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who struggle with mood disorders, anxiety, and even general stress and anger, but don't
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We discuss how exercise has been found to be as effective for depression and anxiety as
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medication and, of course, has a much better side effect profile, why it works, and whether
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a particular type of exercise is better for particular disorders.
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We then spend the rest of the conversation digging into the Catch-22 that surrounds depression
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If exercise is good for depression, but when you're depressed, you don't feel like exercising,
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how do you find the motivation to get going with it?
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We discuss strategies for starting and sticking with exercise that can help not only those
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who struggle with mood disorders and anxiety, but anyone who's looking to make physical activity
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After the show's over, check out our show notes at aom.is slash exercise for mood.
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So you've got a book called Exercise for Mood and Anxiety, Proven Strategies for Overcoming
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And you're a psychologist, and you've taken a look at exercise, but you're taking a look
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at exercise, the mental health benefits of exercise.
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I think most times when you see research about the benefits of exercise, it's always on the
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physiological, how it helps your heart, your muscles.
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What led you down the path to exploring the psychological benefits of exercise?
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Yeah, you know, I've been interested in getting good treatment to people with mood and anxiety
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And as a psychologist, as you just mentioned, I've been a big fan of psychotherapy, trained
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I like the evidence for that treatment, and I'm heavily involved in the implementation of
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it locally, but also through trainings and so forth.
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I think they have an important role in the treatment of mental health problems, anxiety
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And when you take a look at how these two fare, they do really well.
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But as you could probably expect, a lot of people also don't do very well with CBT or don't
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And even if they could, let's say they have the right disposition to respond well to these
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interventions, they may not have access to it, to CBT, like I can't find a good provider,
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Some people just don't like talk therapy or they don't like taking medications.
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And I think it's up to us, people who research these kind of interventions or invested in
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getting good treatments out to people, is to increase the offering.
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I'm really excited to see the expansion of digital health products.
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And when I think about what's available and what should be part of the offering, I think
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Exercise has strong effects for mood and anxiety disorders and related problems.
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And I also think that exercise fits in well for people who come to see us.
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Most people, you know, they come to see us obviously for symptom relief, and that's where
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medications and psychotherapy can really affect us.
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But most people actually come not just for that, but they just want a better life.
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And I think exercise is part of that picture for most people.
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If you ask people who are physically active, you know, what does it do for you?
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And, you know, the direction from physical health to mental health is there.
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If you feel physically better, you often feel mentally better as well.
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And it's been rewarding to be involved in sort of pushing this out as one of many available
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strategies for people who struggle with mood and anxiety problems.
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So the goal is to increase the offerings or the options for people who have some mental
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In the book, you highlight a lot of research that talks about the mental health benefits
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So like, for example, what do we know about the benefits of exercise for mitigating or managing
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For depression, the evidence base is actually really pretty good.
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You know, the gold standard for interventions is to do a randomized controlled trial.
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And when you look at those trials for exercise, they yield effects that are comparable to what
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It's not as strong as these to establish interventions, but mostly because there have been just fewer
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So when you look at the size of the evidence base, it's less.
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But when you look at the effects, it's about equally effective.
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There have only been a handful of studies that have actually compared exercise to, let's
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But when you look at those, exercise stacks up actually pretty well in terms of tolerability.
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Dropout rates are about similar to those interventions.
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So that evidence base is what gives us the comfort of suggesting this as a prescription for
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people with mild to moderate forms of depression.
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Is there any research about exercise and anxiety?
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And often actually studied mostly in medical populations.
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So anxiety among people who have a chronic illness and less so in the anxiety disorders,
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let's say obsessive compulsive disorder, panic disorder, post-traumatic stress disorder.
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Evidence has grown there, but much smaller in number.
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But the findings that are out there to date also suggest that the effects are really pretty
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And to where I feel comfortable making a part of the offering and say, like, when I look
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at these trials and I look at the effects, I think it shows that exercise does definitely
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And in many cases, also better than what is a reasonable control like stretching or something
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I know the research is limited, but has any research been done about particular types of
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exercise being particularly useful for a specific type of mood disorder?
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I mean, I guess the question, I mean, like, do you prescribe like, okay, if you're depressed,
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Or is it basically just any type of exercise will give you benefits no matter your mood disorder?
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Yeah, I think if we just stick with the evidence, and that's never a bad idea, right?
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If we stick with the evidence, we'd say if you follow the public health guidelines for
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exercise, which is like 75 minutes of vigorous or 150 minutes of moderate intensity exercise
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a week, aerobic, with a combination of some strength training, put you in a good position
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And that's, I'm saying that because that's often the dose that's been studied in these large
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But I think we're starting to see in some initial research here that an effective exercise
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prescription for people with any mood or anxiety disorder, or whatever they present with, is
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going to require that you really take into account their preferences in terms of what they would
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like to do and what they think they can do, as well as the targets.
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And let me speak a little bit more about the targets.
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Targets I think about, let's say, let's take someone with a mood problem where you find
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that isolation, for example, is a big factor in their depressed mood.
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Then an exercise program that involves social activity, so a group like exercise or exercise
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with a buddy, is likely going to be more effective in getting them their effects than if they are
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Most people, particularly those who come to see us who are inactive, don't necessarily have
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a positive experience with exercise or history with exercise, and they don't necessarily like
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And so, exercise is often equated with hard work, running, running outside, running in
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And those are not the things that you want to start with, with someone who already is suffering
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from depressed mood and who has a hard time engaging in values-based actions.
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And so, much of the work up front is really about getting a good sense of what it is that
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the person might be interested in doing and going over a list of different possible activities
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And so, for some people, that might be taking a yoga class.
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Or for other people, that might be taking up swimming.
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Any kind of exercise that is often different from aerobic.
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And that might be a really good starting point for people to start forming an exercise
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habit and to also recognize that over time, that exercise habit might change.
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So, as people get more comfortable with, let's say, yoga activity and more comfortable with
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actually making that part of their weekly habit, Tuesday mornings is an hour that I reserve
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for yoga, they may be more interested and willing and able to pick up or add another activity
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that may be a bit more strenuous, like more strongly in aerobics.
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So, they may go from an easy, so to speak, yoga to more of a power yoga, or they may find
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another class that's available at the gym that they attend.
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And so, I am a big believer in spending a good amount of time with people at the beginning
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to get a sense of what they think they might like, list those activities, and then tie them
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And then start building that exercise program over time, making sure that you stay flexible,
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that that program likely will change as people get more used to activity in general.
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So, with a lot of mental health interventions, whether it's talk therapy or drugs, sometimes
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it takes a while before you see the effect, particularly with cognitive behavioral therapy.
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It's not something you, I mean, oftentimes you don't notice it right away.
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Or do you, once people start moving their body, do they notice a marked difference?
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Yeah, I think it's one of the beauties of exercise, and particularly exercise for mental
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I mean, we often think about exercise for physical health, and let's say we think about
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it for weight loss, as something that is going to take a while.
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And so, the distance between starting the exercise or the activity and the desired outcome
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And I think that's actually also true for stable reductions in depressed mood.
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When you think about these large randomized controlled trials, they often go for three
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months and then assess where people are in terms of their depressed mood for that particular
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But as I said, the beauty for exercise is that most people, even if they don't enjoy the
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actual activity, and that is that during the activity, they report it being difficult and
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challenging, they will report a nice reduction from how they felt in terms of stress or tension
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or depressed mood before the activity relative to after the activity.
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So, you get that immediate boost of like, hey, I did the exercise, that may have been really
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difficult, but man, I feel much better now than I did at the beginning.
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And we use that usually as the hook to get people interested and curious about making this part
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of their regular habit, is pay attention to what exercise does for you that particular day.
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I usually tie exercise prescription to what is relevant to a person for that particular day.
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Let's say I take someone who gets really stressed by attending work meetings and they have a big
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I might say, hey, this meeting is a Thursday at noon.
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Can we plan an exercise belt, let's say in the morning, so that you feel the effects of exercise
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before you go into that meeting, fare better in that meeting in terms of feeling a bit more
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stress resistant, a little less reactivity during that meeting, so that at the end of that day,
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you look back, you can say, hey, this really worked for me.
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Like today, even though it was difficult this morning when I woke up and I decided to do that
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And that's a reason for me to continue to do it.
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And then as people get into that habit of doing this more over time, they will start seeing those
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more durable reductions in depressed mood or anxiety or whatever it is that they are seeking
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Exercise, as you said, when you're pitching this to a patient and saying, hey, this might give
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you like immediate benefits in the short term, and it can be a nice supplement to what we're
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So I think I'm sure, imagine a lot of people when they're coming to you, they want a quick
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They know that it's not going to be a quick fix.
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They got to do some work, but exercise, hey, this can do maybe something a little bit
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I do think that's one of the appealing parts of the exercise prescription is that you can use
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One of the things that I do sometimes with my patients is just the 10 pushups.
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People who sometimes experience intense activation of stress or frustration and don't really know what to do with that feeling and feel like all they can do is maybe act on
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that feeling in a way that's ultimately going to be more harmful than good.
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Then something like 10 pushups can be really helpful to allow people to sort of shift their
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attention from that intensity to, again, back to where they want to be, which is to focus
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on what's in front of them, whether that's their work or whatever they were doing at that
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So the short bout can be really helpful for getting people to see those quick reductions in whether
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it's frustration, tensions, or sad mood that allows them to stay engaged in a way that
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So we've talked about, okay, there are benefits.
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Do we know how exercise works in helping with mood disorders?
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I think we have a lot of ideas of why it may work.
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And, you know, as a psychologist, I've been mostly interested in sort of the behavioral psychological
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And one of the reasons why I actually started researching exercises, because I thought in
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an intense form, and that is when you really get people to do aerobic exercise, and they
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feel all kinds of bodily sensations like racing hard, sweating, breathing faster, it can actually
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serve almost like something that we call exposure therapy, which is really effective with people
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And that is, if you get people to do these quick bouts of exercise, they get to really
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see that even though it could be uncomfortable to see your heart racing, or that you're breathing
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faster, that you're sweating, it doesn't mean that it's going to lead to disastrous consequences.
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People with anxiety sometimes are concerned that heart racing is going to lead to, let's
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say, a heart attack, or that breathing faster is going to lead to suffocation.
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So in that way, exercise can be a really effective way to deliver that kind of exposure therapy.
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So we've thought, hey, maybe it's one of the mechanisms of exercise is what we call this
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reduction in fear of fear or anxiety sensitivity, the sensitivity to anxiety and the related sensation
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or building up people's what we call the stress tolerance, the ability to withstand the stress
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and say like, hey, it's there, feeling it, I do have a tendency to want to push this away.
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But because I'm exercising, and I have this experience, I know that I can actually stick
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And that is a powerful mechanism for many anxiety and related problems.
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And so that may be what's happened at the psychological level.
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And then I think also in the book, you highlight, you know, there's probably some endorphin stuff
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going on, we all know about your body releases neurotransmitters when you exercise, and that
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I mean, I think, does exercise affect the brain?
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And I think that question is particularly interesting for researchers who are obviously interested in
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figuring out the mechanisms of action for any intervention.
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The idea is that if we know how it works, maybe we can make it even better.
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Or we can learn about new treatments if we figure out how exercise can improve mood and what are
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Perhaps we can develop new drug treatments that act on these brain regions.
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And so it can be informative from that perspective.
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I also think it's helpful sometimes for patients and provider to know how it affects the brain,
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because somehow knowing that it affects the brain makes the intervention for many more
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legitimate, like it makes it a real intervention.
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And my sense is that it is challenging to pinpoint where the action is.
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And I think in part, because it's difficult to study, studying mechanisms of actions really
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require, you know, lots of assessments, lots of subjects to really figure this out.
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I also think it is challenging because exercise works for so many different things.
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It also works for all kinds of physical health problems.
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So most likely, exercise will have broad effects and also lots of different mechanisms at different
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I really like the work that's being done in that area.
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But I do think it's going to take a while for us to really get some good insights as to
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But hopefully, we will see it in the years to come.
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We're going to take a quick break for your word from our sponsors.
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There's research that suggests that it does work.
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So your goal is, okay, what can I do to help my patients do this thing that I know that
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But the catch-22 with a lot of mental health issues, particularly depression and anxiety,
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is that you typically are not motivated to do anything.
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So it's like, how do you get motivated to exercise, which a lot of people aren't motivated
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And so you spend a lot of time in the book walking through strategies to overcome this
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Let's talk about, first off, the obstacle of depression getting in the way of exercise.
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Like, what are the cognitive distortions that can occur with depression or even anxiety
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too, that gets in the way of people doing something that they know could help them?
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But the first is, this is not going to work for me.
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Pessimistic outlook and fitting with that is this particular intervention doesn't work
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And perhaps there's also some history of exercise that feels to the patient, confirms
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that I've never liked exercise or I've never really gotten the benefit of exercise like
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And I think it starts with first some education and just briefly outlining what the effects of
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exercise can be, which I think is important for any kind of intervention.
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So ultimately, you know, patients might appreciate knowing that it might work and it works for
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others, but they might still leave with this sense like, well, if it works for others, that's
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And I think that's where it comes to experiential learning.
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So I usually set up basically an experiment with my patients and hope that I can get them
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to be willing to try exercise for a short period of time, even like, let's say a week.
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And the experiment is really to see if we manipulate exercise, so we get people to commit
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to some sort of exercise for that week, if it actually does deliver or yield the kind of
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So now I'll go back to what I mentioned before, which is the targets.
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So let's say I have someone with a depressed mood who also struggles with sleep, or one
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of the powerful effects of exercise is improved sleep.
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So I might ask that person to say, like, how about we track sleep for the next week and
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just kind of a sleep rating in the morning, what was the quality of your sleep?
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And what we can do is come up with what we think is reasonable exercise for you.
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I'm not asking you to exercise for the rest of your life or even for two weeks.
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For the next week, would you be willing on some of these days to engage in exercise and
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then see what happens with your sleep on those days?
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We'll manage or we track your exercise or your physical activity.
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We'll also track your sleep and then we can review those data together and we can decide
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Most patients will be intrigued and they'll respond and say, like, well, I can probably
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do anything for a week, but let's talk a little bit more about what exercise might look like.
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And you can't just send a person away and say, like, hey, why don't you go try this now?
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You actually have to start talking about, well, what might that exercise week look like for
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Is there a friend who can do something with you?
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Do you remember an activity that you sort of feel like you can maybe try for this week?
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Is that something else that might come to mind?
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So it's a lot of sort of problem solving, troubleshooting, and brainstorming there in
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the beginning to come up with a plan that is feasible.
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The question I ask at the end is like, hey, we've now discussed this.
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You're going to walk for 20 minutes with your friend.
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You're also going to do this Sunday morning at 10 a.m.
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We have the places where you're going to meet your friend.
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This is going to be effortful because it's going to be very different from what you've
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done in the past and certainly what you did over the last few weeks.
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How likely do you think it is that you actually will be able to do this?
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And if a person says, you know, 70%, 80%, I'm happy.
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And I think that's a good way to get this started.
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If it's less than that, we have to go back maybe in that session or subsequent sessions
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to figure out what parameters we need to change to get that to a higher likelihood.
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And what's interesting is the way you describe that process.
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You're not telling the patient to like, well, just get motivated from within, find that from
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You actually created with the patient the motivation like that's outside of them.
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There's like a person, there's a place, there's a time.
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It's nothing really is like, there's hardly any internal motivation going on.
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I think that if we just tell people, go do it, we will see something that we also see
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in the literature, which is 40% of people report being inactive, even though they hear
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from their physician, you should be physically active.
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So just telling people to go do it, particularly with something that's effortful, like exercise,
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and then particularly also when you already struggle with mood, it's just a non-starter.
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So you're going to have to work with a person to shape their environment such that they can
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actually be motivated to do this so that exercise can sort of go up to the hierarchy all the
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way to the top of things that they are motivated to do.
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I think a buddy system is really helpful there.
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And clearly what's important is to build in the ongoing rewards.
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I want a person at the end of that exercise bout that they do, let's say on that Sunday
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morning when they walk with a friend, to talk to their friend about how it felt to exercise.
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How do you feel now relative to how you felt when you woke up this morning?
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And attend to those immediate rewards of exercise because we're all motivated to do something
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And it's our task as provider to figure out where the rewards lie for exercise for people.
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And it's going to be different for different people.
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And that's where you have to really have this conversation with the patient about what is
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it for you and what do you think it will do for you?
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And can we set it up in a way to where you're going to see the positive effects of exercise for
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Because in the end, when we think about any intervention, whether it's like psychotherapy,
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where much of the focus is on skills training, or drug therapy, where the prescription is long-term,
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exercise too, it's not about getting a person to exercise for, let's say, two or three months
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With exercise, it really is about getting a person from being a relatively inactive person
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to become someone who sees exercise and physical activity as part of their life, something that
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they will do on a weekly or daily basis or whatever fits with their life.
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They will see themselves as someone who's physically active.
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And getting a person to that is just requiring that you start slowly and that you get a person
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excited about this in the sense that they see how this works for them.
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And what benefits that has emotionally for them, particularly in the beginning.
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So what do you do with, let's say you got a patient and you did that first week with them,
00:27:23.080
success, they've caught the vision, and they've got this habit of exercise going.
00:27:28.740
But when you're working through any type of mental health issue, you're going to have days
00:27:32.620
that are, you're going to have a setback because of increased stress, et cetera.
00:27:36.080
How do you help your patients prepare for those setbacks so that whenever it comes,
00:27:42.140
they still do that thing, that exercise that can help them?
00:27:47.220
Yeah, I'm glad you're bringing that up because nothing is linear typically in the treatment
00:27:55.260
It isn't like you start at the bottom, so to speak, and then you, in a straight line,
00:28:02.380
Oftentimes, you see some improvements and then you see some dips and then some improvements
00:28:07.100
and then some dips again, lapses or relapses, if you will.
00:28:11.120
And I think it's so important to bring this up with patients at the beginning, that even
00:28:18.240
though we're after initial successes and we are going to build on those successes together
00:28:22.920
and as a provider, I very much act like your coach, much like a gym instructor or a fitness
00:28:30.180
instructor, I know that there are going to be times that your actions didn't line up with
00:28:36.760
Like you had set out to go do this particular exercise, but something came up and you didn't
00:28:41.320
or something was really stressful and you said, hey, I'm all out and I'm not going to follow
00:28:51.260
And setting it up as an expectation and also normalizing that, I think it's just the beginning.
00:28:56.880
And because oftentimes in the dynamic with a provider is also this, I don't want to disappoint
00:29:04.840
And if I am not really doing what we set out to do, well, then maybe this intervention is
00:29:11.300
So anticipating this and making this something that is going to be part of that journey moving
00:29:16.940
forward to become a physically active person, that is, there are going to be times that it's
00:29:24.120
And those times that it's not working for them just require more conversations with the
00:29:30.500
And that is like, hey, let's talk about what happened and let's talk about what explains
00:29:35.520
that and let's pick up from there and see what we can do today to pick back up.
00:29:42.320
And if that means, hey, you can start where you left off or we need to do something a little
00:29:48.400
But that sort of flexibility that you have as a provider, but also fund the patient side
00:29:53.940
is what's needed to be effective with this type of intervention.
00:29:57.840
So, I mean, it sounds like you're doing like cognitive behavioral therapy and this helping
00:30:04.780
Typically people who are depressed, they have that catastrophizing or like that, well, black
00:30:11.080
Well, I didn't do what I wanted to do, so I just shouldn't do anything at all.
00:30:17.120
Instead, you'd say, hey, well, you didn't do what you wanted to do, but maybe you could
00:30:21.100
just walk for 10 minutes and learn how to be okay with that.
00:30:27.060
I think our CBT skills are really effective when it comes to exercise coaching and managing
00:30:33.020
the exercise program and interpreting the effects and helping patients stay motivated
00:30:39.480
and attending to the cognitions, like you just said.
00:30:43.720
What is it that you're telling yourself right now?
00:30:45.660
Or what are you telling yourself about exercise?
00:30:47.940
Or what are you telling yourself about what's going to happen over the next week?
00:30:51.060
And let's take a look at that together and see if there are different ways of looking
00:30:55.900
Recognizing that oftentimes those predictions or the way that people talk to them are mood-driven.
00:31:01.640
They're very different how you talked about this, let's say, two weeks ago.
00:31:06.740
And addressing thoughts like that or talking about thoughts like that in that way opens
00:31:13.300
up the possibility that patients can develop some flexibility and say, man, I am really
00:31:18.780
And I find myself, like you said, sort of back where I was before in terms of how I think
00:31:27.460
If I look back over the last few weeks when we did this effectively, this is how it worked
00:31:36.560
And that's an opening again for them to get back and start where they were the previous
00:31:41.480
week or maybe dive into a different set of activities to continue their exercise regimen.
00:31:48.280
This stuff works even if you don't have a diagnosed mood disorder.
00:31:51.540
Like this is actually just useful information or skills to have if you're trying to implement
00:31:56.940
any type of healthy habit, whether it's exercise or nutrition, the same sort of thing.
00:32:03.800
You know, and I, you know, as a psychologist, I work a lot with people who have a disorder
00:32:10.040
like depressive disorder or an anxiety disorder.
00:32:14.160
And, but, you know, most of the patients come to me and they're not like, hey, can you help
00:32:20.220
And most people, even though that's obviously what they want, they really come to see us because
00:32:26.040
they want a better life and a better life is they want to feel better about themselves.
00:32:31.160
They want to feel better about what the future has to offer for them and all the things that
00:32:37.840
And healthy behaviors are often a big part of that.
00:32:41.340
People tend to feel better when they're physically active.
00:32:43.840
They look at themselves and say like, this is who I am.
00:32:47.940
I notice that, you know, that physical pain that I feel a little bit like in terms of,
00:32:55.640
That's just a signal that I'm actually using my body and I'm being active.
00:32:59.500
And the same is true as you said for nutrition.
00:33:02.520
People tend to feel better when they're, you know, they're, they're eating more healthily
00:33:09.540
So let's talk about another issue that, that springs up with patients when you prescribe
00:33:14.720
So maybe they know that they're going to feel good after it's done.
00:33:17.840
But when they're doing the exercise, particularly if they've been inactive for a really long
00:33:23.780
time, it doesn't feel good while they're doing it because it's just, it's uncomfortable,
00:33:33.700
In fact, you're like, ah, this doesn't feel good.
00:33:35.940
So what do you do with patients there to coach them through that?
00:33:41.140
And I think it depends a little bit on the patient.
00:33:43.140
Like actually for some people that not feeling good during exercise can actually be something
00:33:50.240
that is important for their treatment plan is to say like, what can we do actually for
00:33:56.920
you to increase your tolerance of these kinds of sensations and that you actually relate to
00:34:06.040
We've done some work on smoking cessation and evaluated an exercise program for smoking
00:34:11.820
cessation, but particularly for people who go back to smoking after they quit because
00:34:18.000
they don't know what to do with those symptoms of withdrawal.
00:34:22.580
And when they experience that, the first thing they do is they go back to their cigarettes
00:34:30.040
And in those cases, we find actually it's really helpful to do more of those intense exercises
00:34:35.420
so that people can be more prepared to persist during the times of withdrawal.
00:34:45.680
And then it's working with them to really learn to sort of accept those feelings and stay
00:34:56.700
It could be sort of that reminder of like, hey, this is why I'm doing this.
00:35:01.320
And this is why I'm actually engaged in this kind of uncomfortable set of exercises.
00:35:08.040
It could be as simple as also sort of practicing the half smile, which is like just sort of notice
00:35:14.380
or be aware of how you're actually showing this kind of distress right now.
00:35:19.700
Is there anything that you can do in terms of your posture or your facial expression that
00:35:24.940
will actually have you relate to this a little bit differently?
00:35:28.420
That's for a particular group of people where the target really is to increase what we call
00:35:34.240
But, you know, for most people, like you said, exercise when it's too uncomfortable and it's
00:35:39.520
really not a reason for them to engage in it, like it doesn't necessarily help them with
00:35:48.580
Then we do figure out how to make the exercise a bit more interesting, engaging, and less aversive.
00:35:55.320
And so with very few people, actually, I start with intense aerobic exercise.
00:36:01.400
I might work up to that with people, but oftentimes it is actually reducing that.
00:36:05.680
I am totally okay, for example, in the beginning of an exercise regimen, if we get people to just
00:36:11.460
exercise very lightly and just monitor sort of their heart rate, keep it fairly low and sort
00:36:19.640
And let's actually make sure that you progress in this training to where you feel like you
00:36:24.880
can handle what is a bit more intense bout down the road.
00:36:29.860
And there's another thing you do too, is sort of doing some problem solving.
00:36:34.740
If you don't, if you feel uncomfortable doing it, like find out ways you can mitigate, like
00:36:38.860
you're still feeling uncomfortable, but it's not as bad.
00:36:41.620
So, I mean, I guess an example I thought of, like play a team sport, do something with a
00:36:45.600
So if for some reason, whenever you're suffering with other people, it somehow weirdly reduces
00:36:50.360
the suffering and it kind of is motivating to see someone else is doing that, that might
00:36:57.900
I like that suggestion a lot that what are some of the ways in which you can make the exercise
00:37:04.840
Certainly doing exercise with other people for many will do that.
00:37:09.500
If it's a group exercise for some, it actually makes it a little bit more challenging.
00:37:13.200
Those people who have, let's say, social anxiety problems, they sometimes find it actually a
00:37:18.740
bit more challenging to exercise with other people.
00:37:22.560
You want to figure out ways in which people can engage with the activity to where it's
00:37:31.400
So they will notice the activation, the physiological activation, yet that's not all that they notice.
00:37:37.840
They also notice their friend around them or, you know, if they're alone, they will be listening
00:37:43.980
to, let's say, a book or a podcast and you teach them to really engage with that as well.
00:37:52.360
So can you do two things at the same time, which is you are experiencing that distress and
00:37:58.580
at the same time, you're also able to actually listen to, let's say, a podcast or listen to
00:38:05.240
And so it is, again, personalized where you work with the patient to figure out, well,
00:38:11.340
What would it take for you to be okay with the activation and also engage or notice the other
00:38:18.400
things that are around you that are interesting and important to you as you participate in the
00:38:25.880
Yeah, as soon as you brought that up, doing something that you enjoy while you're actually
00:38:29.240
We had Katie Milkman on the podcast a while ago about talking about temptation bundling
00:38:33.580
and she mentioned that if you don't like to exercise, well, then you do something, you
00:38:37.180
set something up where, well, I can only listen or like watch this movie that I really love
00:38:44.560
That's the only, and then that can be a motivator to, to get on the treadmill or do whatever
00:38:50.140
I do that for sure for the exercises that I don't particularly like to do.
00:38:54.840
I do some strength training and I really don't find it that interesting or.
00:38:59.240
It doesn't feel very good, but it is the time that I listen to my favorite podcast and it
00:39:05.540
might take me a little longer to get through it because I want to listen to both the podcasts,
00:39:08.960
but I know that I get both in, which is, you know, the podcast time.
00:39:13.620
And while I'm doing that, I actually got that particular exercise or set of exercises done.
00:39:20.140
And so I like tying activity to other rewarding activities, whether that's something that you
00:39:26.920
like to do for yourself or whether it's something that you like to do with other people.
00:39:31.000
And so look for those things that make it more motivating for you and more likely that you
00:39:38.140
So yeah, again, the goal is like, enjoy yourself.
00:39:40.060
Don't think of it just as like medicine that you have to take, make it something that you
00:39:43.420
can enjoy and can be a part of your life for the long run.
00:39:47.500
And I think that's definitely what you want to work and what we work toward with our patients.
00:39:53.660
It may not be there in the beginning when we just set up those initial successes, but
00:39:58.240
as we are trying to build a habit, like something that's going to last over time, we do want
00:40:07.700
And to your point earlier, how do you anticipate the things that, you know, might change over time?
00:40:16.400
A lot of people won't like an activity for very long.
00:40:20.880
They might like, let's say, running for a little bit, but at some point they get kind
00:40:26.560
So you want to stay flexible, anticipate that and say like, over time, your exercise regimen,
00:40:33.720
the set of activities that you engage in might change and you'll stay open-minded and curious
00:40:39.440
to other activities that you will use to replace the ones that you're sort of bored with.
00:40:44.400
Or no longer find interesting, or you develop new friendships, or all of a sudden you're
00:40:49.480
exercising with your family, like you might exercise with your kids, or you might exercise
00:40:54.080
All these things that keep it interesting and keep it something that is enjoyable over time
00:40:59.560
and stay flexible that it might take lots of changes along the way.
00:41:04.320
And that's where I think sometimes providers can be really helpful is to stay creative, help
00:41:11.460
troubleshoot, and come up with ideas that people can implement to keep their habit alive and
00:41:18.980
Well, Jasper, this has been a great conversation.
00:41:20.640
Is there some place people can go to learn more about the book and your work?
00:41:23.480
I think the book is just on Amazon, and that's probably the best access for people to get
00:41:29.180
a sense of how to think about exercise and how to incorporate in their life as they have
00:41:43.360
He's the co-author of the book, Exercise for Mood and Anxiety.
00:41:47.760
Make sure to check out our show notes at awim.is slash exercise for mood, where you can find
00:41:51.460
links to resources, where you can delve deeper into this topic.
00:42:00.860
Well, that wraps up another edition of the AOM Podcast.
00:42:03.640
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00:42:06.960
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