Walk and Talk therapy is therapy that takes place with a licensed mental health professional while walking outdoors. Psychologists, therapists, and other healthcare providers are becoming increasingly interested in bringing treatment into the great outdoors. For example, the “Walk with a Doc” campaign was started in 2005 by Dr. David Sabgir. As a cardiologist, he was frustrated by his inability to influence behavioral change in a clinical setting so he began inviting patients to go for walks with him in a local park. His idea grew into a movement that now has 500 chapters worldwide. If you're considering walk-and-talk therapy, below are several benefits you can expect as well as a few considerations before you get started.
Benefits of Walk and Talk Therapy:
Expands the Mind: In The Joy of Running, Thaddeus Kostrubala, MD proposed that rhythmic movement, which occurs during running and walking, clears a path for self-discovery. Subsequent research has shown that self-awareness, creativity, and compassion increase during movement. Naturally, these types of internal shifts benefit the therapeutic process.
Increases Exercise: As I’m sure you’ve heard, exercise does a body good. Evidence shows that exercise decreases the risk of coronary heart disease, type 2 diabetes, breast cancer, and colon cancer. Some data shows that simply walking 75 minutes per week increases life expectancy by nearly two years. There is also good evidence that exercise supports mental health, and that it may be particularly beneficial for those with mood disorders, anxiety disorders, and attention-deficit disorders. Single episodes of exercise show immediate improvements in sleep, anxiety, emotion regulation, processing speed, concentration, and memory.
Increases Time Standing: Exercise aside, the simple act of standing more in a given day can improve health. Sedentary behavior is a distinct class of behavior. It is twice as prevalent as smoking, hypertension, and hyperlipidemia. Sedentary behavior independently increases disease risk. This is true even for those who exercise regularly! Risk is reduced by standing at least two hours per day. If a standard therapy session is about 60 minutes, you’re half-way there!
Promotes Wellbeing: Studies have demonstrated that being outdoors increases the pursuit of intrinsic goals, meaning those pertaining to personal growth, intimacy, and community. Proximity to green or blue spaces has been shown to decrease stress. This is true even after accounting for age, sex, income and neighborhood variables such as crime rates and wealth. Being outdoors increases feelings of vitality and has a way of helping us feel grounded in our bodies, and that’s certainly good for therapy.
Saves Time: For many, lack of time is a barrier to physical activity and attending therapy sessions. Speaking of time, if I had more of it, I’d come up with a kinder expression, but walk and talk therapy “kills two birds with one stone."
Humanizes Therapy: Sitting in an office across from a therapist may not be the most natural way for all clients to connect. For some, sitting in an office feels stiff. Therapy, and the therapist, can seem more natural when the context changes. At the end of the day, therapy is all about change, growth, and trying new things. Surely change can apply to the therapy setting as well.
Things to Consider:
Confidentiality: Being outdoors means the client and/or the therapist might run into people they know. For therapists, it’s important to cover this in your consent forms and discuss with clients beforehand. Therapists who have been interviewed about their practice of walk and talk therapy suggest that this is rarely an issue - either because it doesn't happen, it’s easy to casually walk in another direction, or clients are increasingly less concerned about others knowing they participate in therapy. Still, this is an important issue to discuss up front.
Boundaries: It’s important that clients understand that walk and talk therapy is still therapy, it just occurs in a different setting. It's not intended to serve as athletic coaching of any kind. Also, as is the case with therapy that occurs in an office building, it’s important to emphasize that therapy occurs within a professional relationship, one that is different from friendships and personal relationships.
Medical Clearance: Walking is a low impact activity, and it’s likely that most clients can walk and talk safely. Still, it may be helpful to know that, according to the American College of Sports Medicine, when starting an exercise program, clearance is recommended for individuals with symptoms of cardiovascular, metabolic, or renal disease. Clearance is also recommended for individuals with a history of the aforementioned concerns if they don’t currently exercise regularly.
Monitor the Process: It’s important for the client and the therapist to monitor the process of walk and talk therapy as it occurs. For example, while some clients might find it easier to connect with their emotions and share them during walk and talk therapy, others might find the opposite to be true. As always, it’s also important for therapists to track whether or not therapy is being hindered or helped by a particular approach.
References:
Barton, J. & Rogerson, M. (2017). The importance of green space for mental health. International British Journal of Psychiatry (14) 4: 79-81.
DeAngelis, T. (2013). A natural fit: Therapy and exercise don’t need to be mutually exclusive. Monitor on Psychology, 2013; 44 (8): 56. https://www.apa.org/monitor/2013/09/natural-fit
Kelly, J & Shull, J (2019). The Lifestyle Medicine Board Review Course, 2nd Edition. Published by the American College of Lifestyle Medicine.
Kostrubala, M.T (1976). The Joy of Running (2nd edition). Sante Fe, NM: Ora Press.
Nutsfor,D., Pearson, A.L., Kingham, S., Reitsma, F. (2016). Residential exposure to visible blue space (but not green space) associated with lower psychological distress in a capital city. Health & Place, 39, 70-78. https://www.sciencedirect.com/science/article/abs/pii/S1353829216300119
Pearson, D.G. & Craig, T (2014). The great outdoors? Exploring the mental health benefits of natural environments. Frontiers in Psychology, 5, 1178. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4204431/
Ryan, R.M., Weinstein, N., Bernstein J., Brown, K.W., Mistretta, L., & Gagné, M. (2010). Vitalizing effects of being outdoors and in nature. Journal of Environmental Psychology, 30 (2): 159 DOI: 10.1016/j.jenvp.2009.10.009
Weinstein, N., Przybylski, A.K., Ryan, R.M (2009). Can nature make us more caring? Effects of immersion in nature on intrinsic aspirations and generosity. Personality and Social Psychology Bulletin, 35 (10): 1315-29. https://www.ncbi.nlm.nih.gov/pubmed/19657048