Cognitive behavioral therapy (CBT) is currently the treatment of choice for most anxiety disorders. Yet, with recovery rates of approximately 50%, many patients fail to achieve complete remission. This has led to increased efforts to enhance treatment efficacy. Physical exercise (PE) has in recent years been advocated as means to augment the effects of CBT for anxiety disorders.
PE appears to reduce anxiety through other mechanisms than CBT, some of which might also have the potential to augment the effects of psychological treatment. In fact, in the last 20 years, several cognitive behavioral strategies have been found to improve the patients’ adherence to exercise, noting that it should be included in the treatment of obesity.
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How physical activity affects our wellbeing
Physical activity has a huge potential to enhance our wellbeing. Even a short burst of 10 minutes’ brisk walking increases our mental alertness, energy and positive mood. Even more, participation in regular physical activity can increase our self-esteem and can reduce stress and anxiety.
#1 Impact on our mood
A study asked people to rate their mood immediately after periods of physical activity, and periods of inactivity. Researchers found that the participants felt more content, more awake and calmer after being physically active compared to after periods of inactivity. They also found that the effect of physical activity on mood was greatest when mood was initially low.
#2 Impact on our stress
When certain events upset our balance in some way, our body’s defenses cut in and create a stress response, which may make us feel a variety of uncomfortable physical symptoms. Physical exercise can be very effective in relieving stress, as research on employed adults has found that highly active individuals tend to have lower stress rates compared to individuals who are less active.
#3 Impact on our self-esteem
Exercise not only has a positive impact on our physical health, but it can also increase our self-esteem. More specifically, physical activity has been shown to have a positive influence on our self-esteem and self-worth. This relationship has been found in children, adolescents, young adults, adults and older people, and across both males and females.
#4 Impact on depression and anxiety
Physical activity can be an alternative treatment for depression, as it can be used as a standalone treatment or in combination with medication and/or psychological therapy. As a matter of fact, it has few side effects and does not have the stigma that some people perceive to be attached to taking antidepressants or attending psychotherapy and counselling.
Namely, physical activity can reduce levels of anxiety in people with mild symptoms and may also be helpful for treating clinical anxiety.
Establishing activity goals
People should evaluate which type of activity is physically possible for them, and the obstacles that can prevent a successful increase in activity. They should also start at a low level, especially at the beginning, and gradually increased to a goal of 150–200 minutes per week.
Compliance to exercise can be enhanced by increasing lifestyle activities, developing an appropriate home-based exercise program, and considering short bouts rather than long bouts of activity.
The aim of behavior therapy is to provide cognitive and behavioral skills to modify our lifestyle, and provides certain recommendations:
- Engage in moderate-to-vigorous exercise for at least 60 minutes on most days.
- Walking may be the preferred exercise.
- Check the baseline number of steps by a pedometer, then add 500 steps at 3-day intervals to a target value of 10,000–12,000 steps per day.
- Jogging (20–40 min/day), biking or swimming (45–60 min/day) may replace walking.
- Physical exercise is intended to produce a calorie deficit of at least 400 kcal/day, favoring weight loss, maintaining muscle mass and preventing weight cycling.
Self-Monitoring
Self-monitoring is a vital part of the behavioral treatment, as it raises our awareness of the exercise habits and helps identify ways to maximize the energy deficit. Physical activity can be recorded in a monitoring record in minutes and/or steps, using a pedometer.
People may also benefit from recording activities, moods, and thoughts associated with exercising. This information may help identify obstacles to exercising. Self-monitoring records can also be used to provide information to identify activity contingencies that can be targeted for intervention.
Involving significant others
According to a study on CBT and exercise, social support is a key ingredient for behavioral change. Data show that social support is considered to be an important aid, and significant others may play an important role in encouraging their loved ones to increase daily physical activity and to reinforce the changes.
Significant others should be educated about physical activity, and should be actively involved in exploring how to help develop and maintain an active lifestyle. The general advise to give to significant others includes creating a relaxed environment, reinforcing positive behaviors, adopting a positive attitude, exercising together and accepting patients’ setbacks.
Building the mindset of an active lifestyle
There is a need for adding new and more effective cognitive interventions to the standard strategies to help develop a mindset of long-term active lifestyle, and they following are key tips to do just that:
- Make a list of personal reasons to adopt an active lifestyle: By reviewing the list every day and especially when you are feeling difficulties, you will train the mind to focus on exercising.
- Set short-term goals and cognitive credits: Goal setting is a key component of cognitive-behavior therapy and has been shown to be effective in focusing the attention of participants toward behavior change.
- Address obstacles with problem solving: Train in using problem solving to address problems that hinder exercise adherence.
- Cognitive restructuring: Through this technique, people learn how much thoughts influence both mood and behaviors, and that a more rational and functional way of thinking can help improve adherence to lifestyle programs. Cognitive restructuring is used to modify cognitive biases (all-or-nothing thinking) and to correct unrealistic expectations.
