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"CWS Manual"

“Exercise eases symptoms of anxiety and depression”
(from Kristin Vickers Douglas; Mayo Clinic Staff - www.mayoclinic.com/invoke)

The Mayo Clinic Staff (Rochester, Minnesota, USA) has prescribed regular exercise in addition to medication or talk therapy for depression.

Many distinguished clinicians (including Kristin Vickers Douglas) believe that regular exercise is of considerable importance in the treatment of mood disorders (“affective disorders”).

When performed rationally, physical activity can maintain physical fitness, contribute to enhance resistance to disease, and stave off high blood pressure, diabetes, obesity and other diseases.

A growing volume of research shows that exercise also can help alleviate symptoms of certain mental disorders, such as depression and anxiety, and help prevent a relapse after treatment.

Exercise doesn't have to come in large doses to offer psychological benefits. Even as little as 10 minutes of low‑intensity walking helps.

Rather, the idea is that doing something in terms of physical activity is better than doing nothing in order to trigger the mechanisms that reduce negative moods and improve positive moods. And with a little planning and a relatively small degree of commitment adding exercise to a treatment program will not seem so daunting, even in cases of severe symptoms of depression or anxiety.

Despite ongoing research, it isn’t clear just how exercise reduces symptoms such as sadness, anxiety, stress, fatigue, anger, self‑doubt and hopelessness. One of the physiological mechanisms that may be at work is an increase in levels of certain mood‑enhancing neurotransmitters in the brain. In addition, exercise may boost feel‑good endorphins (endogenous opioids), release tension in muscles, diminish sleep abnormalities, reduce levels of the stress hormone cortisol and even increase body temperature, which has calming effects.

These same effects could be produced – even more strongly – following the practice of Cold Water Swimming (CWS).

Psychological benefits: According to Dr. Vickers‑Douglas, psychologically, exercise can work in numerous ways. Among them: Improved accomplishments and confidence. Engaging in physical activity affords a sense of accomplishment and can provide a boost in self‑confidence ‑ you've met a goal or challenge. Achieving physical activity goals, no matter how small, can boost self‑confidence and a sense of accomplishment, which makes it easier to take the next positive step.

Positive distraction: One of the characteristics of depression or anxiety is to repeatedly focus attention on oneself, one’s symptoms and the consequences of one’s symptoms ‑ to ruminate. But that kind of dwelling (and loss on interest in the outside world) interferes with the ability to problem solve and engage in more active coping strategies. It can also make depression more severe and longer lasting.

Dr. Vickers‑Douglas says that physical activity can help shift attention away from one’s own ego, and from unpleasant or unhelpful thoughts, and instead direct attention toward neutral or pleasant thoughts and activities. Exercise provides a positive shift in focus ‑ to your surroundings, to the music you listen to, to other people.

Improved self‑esteem: With anxiety and depression, self‑esteem can take a hit. Getting exercise, even small amounts, can reshape how the depressed person thinks about their appearance and their own self‑worth. Doing something for themselves means granting themselves more value.

Positive pairings: The physical experience of physical activity ‑ breathing changes, sweating, increased pulse ‑ can mimic the signs and symptoms of anxiety or panic disorder. But in the case of physical activity, these symptoms occur without emotional distress. In that way, exercise can help disconnect the pairing of physical symptoms with distress. For people with panic disorder, it's the symptoms themselves that come to be feared. Associating something positive with those symptoms, instead of a panic attack, for instance, can help to manage the symptoms and not live in fear of them.

Environmental reinforcement: Exercise also gives you an opportunity to experience positive social or environmental reinforcement. Physical activity often means experiencing positive interactions with others or their environment, such as a smile or kind word from a passerby, or the sights and sounds of nature.

Positive coping skills: Doing something beneficial to manage your depression or anxiety is a positive and active coping strategy. It's likely that no one single biological or psychological factor associated with physical activity is responsible for improving depression and anxiety. Rather, it is the combination of many different factors.

Dr. Vickers-Douglas believes there is plenty of evidence to suggest that exercise is important for emotional well‑being and is helpful in reducing symptoms of depression. Above all, there is no reason to wait until the direct, indirect and interactive influences of physical activity on mental health are fully understood.

Overcoming the inertia of depression: Of course, knowing that something is good for you doesn't make it any easier to actually do it. Though they are aware of the benefits of exercise, most people in the general population don't engage in any regular physical activity or quit shortly after starting an exercise program.

Depression and anxiety can make it even more difficult to get active. By its nature, depression means that you don't enjoy activities, that you're often fatigued or sedentary, that you just don’t feel like it, that you lack motivation, or that you don’t stick to treatment regimens very well.

It may be hard enough doing the dishes, showering or going to work. How can one possibly consider adding exercise to the mix?

Overcoming the inertia: Another challenge is maintaining, or adhering to, an activity program.

Setting realistic goals, doing some problem solving, and recognizing that exercise won't always be fun or easy can help.

Talking with the doctor: Although not all mental health professionals have adopted exercise as a part of their treatment regimen, talking to a family doctor or therapist for guidance and support is advisable. This implies jointly assessing issues and concerns about an exercise program and how it fits into the patient’s overall treatment strategy.

If possible, it is important to identify enjoy activities. Decide what type of exercise or activities the patient is more likely and less likely to do, as well as where, when and how often.

Activities like gardening, jogging, basketball, kite-flying (‘Kite Theraphy’) or a walk in the woods may be enjoyable and feasible to different degrees in different people.

Set reasonable goals: The goal doesn't have to be to walk for an hour five days a week. Even a 10‑minute walk can help lift your mood, get you into a more positive environment and refocus your thoughts, even temporarily, away from negative or self‑critical thinking patterns. This means custom‑tailoring plans to the individual’s personal needs and abilities.

Break it down: It usually helps to have an overall exercise strategy. But focusing on the perfect plan or an ideal rather than what's realistic for you can sabotage your efforts. There is no point starting with the ideal and working backward. It is far preferable to start with the realistic and work forward.

The program can be broken down into smaller parts. If walking for 45 minutes is initially impossible, reduce it to fifteen minutes; even the goal of walking for five minutes can represent an important starting point.

For many of us, states Dr. Vickers-Douglas, just getting our shoes on and getting out the door is the majority of our effort. That's the hardest part: once things are moving, though, it's often easier to keep moving. So it is essential to put as much energy as possible into the front end ‑ into just getting started.

Developing short‑term coping strategies: Despite having adopted a structured exercise program that calls for activity several times a week at the local gym, it is necessary to plan for active ways to cope immediately and quickly with unexpected negative moods, depression, anxiety or other issues.

For instance, if the program includes a day off from exercise, taking a 10‑minute walk may quickly help lift the mood if sadness or anxiety should lead to focusing on negative thoughts. It’s important to learn to respond to a negative mood with physical activity

Exercise should not be thought of as a burden. lf exercise is seen as just another “should” in the depressed person’s life that he doesn't think he’s living up to, he’ll associate it with failure and a sense of frustration. Rather, the exercise schedule should be viewed the same way as therapy sessions or antidepressant medication.

Exercise shouldn’t be just another thing that has to be done, but can't be done because of all of the demands of life. Instead, it should be thought of as something positive that can be done now to help meet crucial goals, including feeling better physically and emotionally.

Address personal barriers: Identify individual barriers to embarking on an exercise program. People who are self‑conscious, for instance, might not want to exercise in public. lf depression feels like carrying a heavy load, the idea of moving deliberately, doing something active, can seem absurd. The barriers may feel overwhelming. But with depression, it is easy to overestimate difficulty.

Instead, a strategy needs to be found to overcome or get around those barriers. lf a crowded gym is out of the question, perhaps a quiet park is a viable option, or a home treadmill or bike. lf the mere thought of spending 30 minutes jogging is unfeasible, five minutes of walking is better than just doing nothing. lf five minutes seems daunting, two minutes might not be.

Prepare for setbacks and obstacles: Exercise isn’t always easy or fun. And it's tempting for depressed people to blame themselves for that. People with depression are especially likely to feel shame over perceived failures. It is essential to avoid falling into that trap. Credit needs to be given for every step in the right direction, no matter how small. A time will come when it gets really hard. But admitting failure, feeling the need to start all over, increases the likelihood of quitting altogether. Depressed people need to be helped to recognize that change is hard and setbacks are part of the change process. By learning how to cope with setbacks, it is possible to learn skills that will help to stay active over the long term.

Sticking with the program: Launching an exercise program is hard work. Maintaining it can be even harder. In the general population, most people who start an exercise program quit after a few months. Dr. Vickers-Douglas says that for people with depression, making change and sticking to it can be even more challenging.

Problem solving: What would happen if you got into your car and it wouldn't start? You'd probably be able to very quickly come up with several strategies for dealing with that barrier, such as calling an auto repair service, taking the bus, or phoning your spouse or a friend for help. You instantly start problem solving. But most people don’t approach exercise that way. What happens if you want to go for a walk but it's raining? Most people decide to put off the walk and don't even try to explore alternatives. With exercise, we often hit a wall and simply give up.

Instead, it is possible to problem‑solve through the exercise barrier, just as one would overcome other obstacles in life. There are always options – they just need to be figured out: you can walk in the rain, go to a gym, exercise indoors, for instance.

Some people believe that being physically active should be easy and natural. Some think of it as just requiring enough willpower. But that really oversimplifies the issue and can lead to feeling like a failure. First it is necessary to identify one’s strengths and skills and then apply those to exercise. Change is never a simple matter, but taking a series of simple steps in the right direction can be a very effective start. Every individual needs to understand what is the very first step for him. In the end, the psychological benefits can make that effort worthwhile.

Dr. Vickers-Douglas concludes by stating: “I really believe in empowering people to take an active role in their treatment, and physical activity can be an important part of that.”

The opinions expressed by Dr. Vickers-Douglas, argued with an uncommon analytical approach, testify to her deep belief in the efficacy of this therapeutic support strategy. The author not only shares this belief, but also argues that a more challenging exercise program – gradually achievable even by depressed individuals – can help reverse mood disorders over the long term, playing a not merely a secondary role, but a determining role as an elective therapeutic option.

Outdoor exercise and physical therapy
Introduce a rational program of outdoor exercise and physical therapy, including:

• - a gradual increase in overall physical activity (exercise), with
  • brisk walks
  • jogging alternating with walking
  • jogging
  • making less use of cars and elevators
  • swimming
• - learning specific techniques for mental and physical control and relaxation, such as
  • autogenous training
  • controlled breathing
  • yoga
  • cold water showers, baths and swimming (CWST/ASS)(Veinsteinas, ASSC, Sanremo 2003; Ciancaglini, ASSC, Sanremo, 2005) (www.smiline.net/ASSC)

Physical therapy and activity for treating stress, anxiety and depression
The methods described here for undertaking physical therapy and activity to treat anxiety, depression and other affective disorders and forms of dependence are the following:

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Author: Riccardo Ciancaglini The Author reserves complete title and full intellectual property rights for articles, photographs, graphics, audio and video materials. In no event may users or third parties publish, re-write, sell, distribute, or broadcast the aforementioned property in any form and by any medium.