Does Bouldering Work as a Form of Psychotherapy for Depression?

Physical activities, particularly bouldering psychotherapy, may reduce depressive symptoms, according to a new report published in BMC Psychiatry. Researchers evaluated the effectiveness of manualized bouldering psychotherapy as an intervention for the treatment of depression compared to performing physical exercise. Bouldering generally involves climbing to a moderate height without ropes or harnesses.

In this German, multicenter, randomized, controlled study, 133 outpatients with depression (mean age, 42±12.5 years; 69.2% female) were allocated into 1 of the 2 intervention groups—bouldering psychotherapy or a home-based exercise program—from January 2017 to March 2018.  The primary outcome was severity of depression, which was evaluated with the Montgomery–Åsberg Depression Rating Scale (MADRS). Using an exploratory approach, secondary outcomes such as self-esteem, coping skills, body image, interpersonal sensitivity, and anxiety were also measured.

The bouldering program consisted of 10 weekly 2-hour sessions following a standardized protocol (introduction, action phase, closure). These elements encompassed mindfulness, bouldering exercises under therapeutic supervision, psychoeducational approaches, exchange of experiences between participants, body-related relaxation exercises, and free bouldering. The home-based exercise program according to psychoeducational and training materials and exercises were performed altogether for 1 hour weekly for 10 weeks.

Depressive symptoms significantly improved in both groups after the 10-week intervention period. However, patients in the bouldering group showed a significantly larger reduction in depression scores compared with the control group (MADRS decrease, 8.4 vs 3.0 points; Cohen d=0.55; P =.002). Specifically, the bouldering group improved more than 1 severity group grade, whereas the improvements in the control group remained within the same severity group overall.

The confounder-adjusted regression analyses revealed that group allocation significantly predicted postintervention MADRS score (β=-5.60; P =.001). Additionally, there were significant differences in change scores between the 2 groups for anxiety (P =.046; d=0.35), global self-esteem (P =.011; d=0.45), and body image (P =.018; d=0.42), with the bouldering condition demonstrating stronger improvements.

The participants of the exercise group received less psychotherapy than those in the bouldering group, a potential limitation of the study. Furthermore, there was no external control of the duration of exercise session in the control group, and there may have been favorable bias for the bouldering group due to higher expectations of applying for a study on this particular therapeutic approach.

The study results support the positive effects of physical activity and specifically bouldering in improving depressive symptoms. Future research could investigate its efficacy in relevant subgroups and other mental disorders to allow a more individualized treatment strategy in clinical practice.

“There is good reason to believe that psychotherapeutic bouldering may be a viable alternative to classical mental health treatments, particularly when addressing patients whose needs are not covered by the current care system,” the researchers concluded.

Reference

Karg N, Dorscht L, Kornhuber J, Luttenberger K. Bouldering psychotherapy is more effective in the treatment of depression than physical exercise alone: results of an multicenter randomized controlled intervention study. BMC Psychiatry. 2020;20:116.