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Mind & Body Health: why I'm becoming a fitness instructor as well as a psychotherapist.

I've been a #therapist (first a counsellor and now a psychotherapist) for over twenty years and a few months ago, decided that I wanted to train as a #PersonalTrainer. I've successfully completed the first stage of the training and am now a Level Two #GymInstructor. This week I will start the next stage of the training to actually become a Personal Trainer.

This isn't just about having something different to do (in most of my therapy work, I sit very still and listen in a small room. Fitness training, in a gym or - my personal preference - a park, is all about movement and space and energy). I actually see becoming a fitness trainer as an extension of my work as a therapist and want to find ways to combine the two activities to help people recover from #depression, #anxiety and #trauma. In this blog, I'm going to explain how.

Looking back, the seeds of this idea were sown a very long time ago when I worked at the #RefugeeCouncil in Brixton in the #mentalhealth Team and received training on #NarrativeExposureTherapy, (#NET), a therapy designed to help traumatised refugees work through traumatic experiences. My training till that point had been traditional and #psychodynamic. This was the first time I had been shown how to pay attention to what was happening in my client's body as they recounted their experiences: in NET, you don't just ask the client to tell you their story, but also ask about what they experienced physically during whatever traumatic incident they are working through - did they feel pain and where, did their heart-rate increase, were they sweating and also, about whether the client feels the same physiological responses when they remember and talk about the experience. Bringing the body into the room and engaging with how the trauma is experienced and remembered in the body.

I later moved to #Freedomfromtorture (at the time, the Medical Foundation for the Care of Victims of Torture), a charity which rehabilitates survivors of torture and which works creatively with the body and with the physical and emotional pain of their clients. The organisation has an extensive group therapy programme, providing football, gardening and even bread making groups for their clients, all of which involve physical activity and which clients deeply value. A deal with a local leisure centre enabled clients to access gyms and swimming pools - those who couldn't talk about their trauma found relief simply through exercise.

While there, I trained with a group of colleagues in #EMDR, which deepened my understanding of the impact of trauma on the brain and the body. Through the course and reading the work of Dutch psychiatrist, Bessel Van Der Kolk, I came to understand how traumatic experiences and the emotions which accompany them are recorded, held and remembered physically, in the body itself and not actually in the mind. I learnt how asking clients to notice the body and what it felt as we processed traumatic memories could release deeply buried memories which talking could never get to. I met clients who wanted to move as we worked through memories, to enact the actions they had been prevented from taking during the original trauma (to push someone away, defend themselves) and saw the powerful release this could lead to. Trauma seemed to be so much worse where the fight or flight mechanism was triggered but you were unable to escape: muscles were instructed to move by the nervous system and primed with oxygen, cortisol and adrenaline, but were trapped, so couldn't move. The relief of finally being able to move can be immense.

I also found that exercise was having a positive impact on me personally: I had joined #BMF an outdoor fitness class run by former military fitness instructors which was challenging but great fun too. The non-stop combination of interval running and repetitions of body weight exercises - press ups, sit ups, burpees, squats, bear crawling - was getting me fitter and improving my health but I was also finding it a wonderful way to relax at the end of a hard day. Being outdoors was a major part of it, even in the rain, cold and occasional snow, so warm did we get once we started running and the group effect, through training with the same people every week: something powerful happens when you run with others, as a pack. Connections are made at the unconscious, non-verbal, right-brain, emotional level.

The effect I saw on the emotions of the other group members and the way the instructors went about their business of showing us all what we were actually capable of, were early and continued inspirations.

The NHS now recommend exercise for psychological health as well as physical health and GPs will prescribe fitness classes to patients with depression and anxiety.

Thinking about all of this and the power of exercise to relieve psychological symptoms, led me last Autumn to decide to become a Personal Trainer and I began my training in November 2018.

Now, I am far from being the first person to think of this and I've read several books recently which have inspired me: Bessel Van Der Kolk's book "The Body Keeps the Score" of course, as mentioned, on how to work with the body to relieve trauma, but also "Manager your Depression through Exercise" by Dr Jane Baxter, a Clinical Psychologist and Certified Physical Trainer in America who has designed a mainly weights and resistance-based programme for depression. In "Jog On: how running saved my life", Bella Mackie tells the story of how running helped her to overcome life-long chronic anxiety. William Pullen, in his book: "Running with Mindfulness: Dynamic Running Therapy (DRT) shows how combining running with mindfulness has a beneficial impact on low-mood, anxiety, stress and depression. And if you're interested in a more philosophical approach to the subject, I can recommend "How to Think About Exercise" by Damon Young, a weight-lifting, boxing philosopher from Australia.

The first four authors all make the point that it is the combination of exercise and therapy, (thinking, talking, reflecting, processing) which makes the difference. Damon Young shows us why Dualism, the idea that the mind/soul and body are separate entities (as proposed by philosophers such as Descartes and even, apparently Plato) is simply wrong: the mind/brain is part of the body and issues of the mind/brain/body need to be treated together.

These experiences have moved me further and further away from any traces of dualism I might have felt in the past towards a firm belief in "Monism", the idea that mind/soul and body are one and my studies in the fitness arena have confirmed that:

Long before you are allowed anywhere near a gym, park or running track there is a mountain of anatomy and physiology to learn in in intense detail and I now have a much deeper understanding of what happens in the body during and after a traumatic incident as well as the brain: if the amygdala, what Van Der Kolk calls the "Smoke Detector" of the brain, receives information which it interprets as indicating a threat, it sends out stress hormones to the heart, lungs and muscles to get them ready to fight, flee or freeze: a part of the brain decides to run but it can't do that on its own. Oxygen has to be brought into the lungs via the mouth, nose and windpipes so it can be exchanged for carbon dioxide in the lungs, then transported to the muscles via the arteries together with the nutrients muscles need for exertion. Chemical reactions take place within muscles to release energy from Adenosine Tri-Phosphate (ATP), initially without, then with oxygen. Electrical signals are sent from the brain to the muscles and all the way down to myosin and actin, the proteins in muscle cells involved in muscle contraction and muscles, especially the gluteus maximus, quadriceps and hamstrings and the gastrocnemius and soleus in the calves, as well as those in the shoulders, arms and feet, need to contract and extend to move feet, knees and hips to be able to run. Ligaments and tendons are recruited too.

I learnt too, how blood is diverted away from non-essential areas of the body, such as the pre-frontal cortex of the brain, towards the muscles, during exercise to give them the best chance. This again is similar to what happens in a trauma and also explains the wonderful feeling of mental refreshment after a hard session. I find I'm so busy trying to keep up that I literally barely seem to think so the thinking part of my brain gets a rest and feels rested and fresh when switched back on.

Later, when something happens to remind the amygdala of the original trauma, when it is triggered, the same stress hormones are released to the same parts of the body, all the way down to the individual cells and proteins.

Trauma is a whole body experience and you need to work with the whole body to treat it.

I now work in independent practice, with a wide range of clients experiencing depression, anxiety and especially, trauma and am thinking through how this is going to work? How can you combine therapy with fitness, practically? This space for creativity is one of the many exciting aspects of this new development in my work. I can see lots of different applications:

I will of course continue to practice purely as a psychotherapist with clients who wish to work in that way. I can also see applications of therapy with people who want to exercise, or who have been advised to but struggle with taking the first steps, perhaps due to the anxiety and depression which brought them to exercise in the first place. With other clients who perhaps over-exercise, therapy can be used to help them think about the meaning of what they are doing: what is being avoided or blocked out by exercising too much. What is not being thought about?

Access the fitness, for everyone, irrespective of age and ability, is really important to me and another area where I see crossover between the two professions. I'm learning on the course about assessment of fitness level and how to design training programmes which are challenging, appropriate and safe, wherever the client is starting from.

Then there is fitness with therapy: fitness sessions in the outdoors mainly, though sometimes in a gym, according to preference. But fitness with an instructor or trainer who is also a therapist, who can help you think about your feelings, before, during and after a session, who can listen to and help you understand the emotional process prompted by the physical activity, can help you use the exercises to process difficult memories which have haunted you. Can help you think about the difficult experiences which led to your anxiety or depression to begin with and help you adjust as you begin to feel better.

I will be writing more about this as I develop my ideas through practice over the coming months and as I learn more about fitness through my continued studies to become a Personal Trainer.

There will always also be people who just want to run and if you want to, we will run together.

Please contact me if you would like to find out how therapy, therapy and fitness or just fitness could help you.

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