You Are Not Alone – Physical Therapy And Mental Health
By Julianne Simpson, PT, DPT
My patient stood while I gave cues on posture and breathing mechanics, trying to help improve diaphragm and abdominal mechanics. “Try to let go of your abs,” I said. The room went quiet. The mood shifted very quickly. I looked and my patient was holding back tears.
I put my hands on my patient’s hips to help cue squat mechanics. The patient froze and appeared to stay checked out for the rest of the session.
These are both examples of physical contact or physical cues triggering strong emotions, possibly related to prior trauma. While these stories are non-specific, experiences like these are not uncommon during a session of physical therapy when working with trauma survivors. A recent student of mine, Katie Sturtevant, SPT, saw examples like the above and presented an in-service on mental health statics and physical therapy treatment of mental health conditions. The bulk of the information below is pulled from her research. She graciously allowed me to use her research.
Mental health dysfunction is common. The most common types of mental illness are anxiety disorders, depression, PTSD, and dual diagnoses. (1) 1 in 5 US adults experience mental illness. (1) 12 month prevalence of mental illness all US adults is 19%. (1) As we break down the data, we see higher rates in white (20%), American Indian/ Alaska Native (22%), mixed race (27%), and LGB (37%) adults.(1) Among transgender adults, the rate is about 50%. (2) In fact, 48% of transgender adults have considered suicide in the past 12 months. (3)
These high rates mean that a LOT of patients receiving physical therapy care have or have had mental illness. Can physical therapy care or exercise help improve the mental health of those with mental illness? Katie Sturtevant, SPT, researched this topic and found research supporting:
– Anxiety reduction for 24 hours following exercise (4)
– PTSD :
* Aerobic exercise may be helpful when prescribed as part of an interdiciplinary treatment model (5)
* This study’s exercise protocol improved neck pain, and those patients also had a statistically significant reduction in depression symptoms in participants with PTSD (6)
* From a qualitive study where participants participate in aerobic exercise guided by physical therapists “Exercise in a physical therapy context can improve the patients’ perception of their physical ability and create a sense of liveliness, improving their depressed state. The therapeutic relationship is essential for supporting the patient’s vulnerability and ambiguity in an empathic and perceptive way.” (7)
* From a study about exercise as an add-on intervention for major depression: “Exercise in a physical therapy setting seems to have an effect on depression severity and fitness, in major depression. Our findings suggest that physical therapy can be a viable clinical strategy to inspire and guide persons with major depression to exercise.”
In sum, if you are experiencing mental illness or mental health challenges, exercise and/ or physical therapist led aerobic exercise may help. The physical therapists at Movement Systems Physical Therapy would love to help you get moving!
Remember – You Are Not Alone.
If you or someone you know is in crisis and needs immediate help, call the toll-free, 24-hour hotline of the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255)
You can find additional resources here, thanks to Seattle’s KEXP.
Julianne Simpson, PT, DPT, holds a BA from Oberlin College and a Doctorate of Physical Therapy from Eastern Washington University. A general orthopedic and pelvic health therapist, she is passionate about helping people move more and empowering her patients to live healthier lives. She dreams of raising kind children, cycling over the Alps and surfing in Alaska.
(1) Infographic You Are Not Alone. Nami.org. https://www.nami.org/NAMI/media/NAMI-Media/Infographics/NAMI-You-Are-Not-Alone-FINAL.pdf. Published 2020. Accessed August 25, 2020.
(2) Budge SL, Adelson JL, Howard KA. Anxiety and depression in transgender individuals: the roles of transition status, loss, social support, and coping. J Consult Clin Psychol. 2013;81(3):545-557. doi:10.1037/a0031774
(3) Report from the 2015 Transgender Survey. Transequality.org. https://www.transequality.org/sites/default/files/docs/USTS-Full-Report-FINAL.PDF. Published 2020. Accessed August 25, 2020.
(4) Morgan, W. (1979). Anxiety Reduction Following Acute Physical Activity. Psychiatric Annals,8(3), 36-45. doi:https://doi.org/10.3928/0048-5713-19790301-06
(5) Tibbey, J.; Davenport, Todd E.; and Mansoor, Jim K., “Exercise for posttraumatic stress disorder: systematic review and critical synthesis of the literature” (2014). School of Pharmacy and Health Sciences Faculty Presentations. 80.
(6) Park, S. D., & Kim, S. Y. (2015). Clinical feasibility of cervical exercise to improve neck pain, body function, and psychosocial factors in patients with post-traumatic stress disorder: A randomized controlled trial. Journal of Physical Therapy Science,27(5), 1369-1372. doi:10.1589/jpts.27.1369
(7) Danielsson, L., Kihlbom, B., & Rosberg, S. (2016). “Crawling Out of the Cocoon”: Patients’ Experiences of a Physical Therapy Exercise Intervention in the Treatment of Major Depression. Physical Therapy,96(8), 1241-1250. doi:10.2522/ptj.20150076
(8) Danielsson, L., Papoulias, I., Petersson, E., Carlsson, J., & Waern, M. (2014). Exercise or basic body awareness therapy as add-on treatment for major depression: A controlled study. Journal of Affective Disorders,168, 98-106. doi:10.1016/j.jad.2014.06.049