Last updated: 30-Nov-18
By Sarah Cooke
I was asked to write an article about running and mental health. I am a clinical psychologist and an ultra runner, so this should be right up my street. However, I found myself stopping and starting and changing my mind over the best angle to take. This topic is so important, and so close to my heart, that it’s hard to do it justice.
Having accepted that I can’t cover everything that could be said about running and emotional wellbeing in one article, I will aim to give an overview of what is known about running and depression. I have opted to focus on depression rather than trying to cover all mental health difficulties at once.
Depression is extremely common and it is also a symptom of many other mental health problems such as bipolar disorder, psychosis and PTSD. It often goes hand in hand with anxiety. In addition, even those people who have never experienced clinical depression will have had times when their mood is lower than usual, and I believe that we can all benefit from coping strategies to manage our mood.
Symptoms of depression include low mood, loss of interest, lack of energy and changes in sleep and appetite. Full diagnostic criteria and information on recommended treatments can be found in the NICE guidelines. However, if you notice that you no longer feel like doing things you usually enjoy or you have any concerns about your mental health, then your GP will be able to work with you to make a diagnosis and/or refer you to the most appropriate source of support.
The World Health Organization estimates that depression will be the second leading cause of disability worldwide by 2020. Research has repeatedly demonstrated that physical activity can help alleviate the symptoms of mental health problems. When depression is at its most severe, the sufferer probably won’t be able to benefit from therapy to change their thought processes and get out of it.
Therefore, the recommended approach is to encourage them to schedule meaningful activity into their day (behavioural activation) to reduce the severity of the depression. Then, they can go on to benefit from cognitive work, ie restructuring damaging thought processes. If necessary, there is also the option of pharmacological treatments.
Behavioural activation (Veale, 2008 encouraging meaningful activities) is underpinned by the theory that avoidance of activity maintains low mood, while doing things helps to break a negative mood cycle. The challenge is that, when depressed, we tend to assume that activities won’t be enjoyable. Therefore, we avoid doing them, and so do not generate any positive experiences which would prove that the activity IS enjoyable. This enables us to continue to predict that we won’t enjoy anything and we spiral further into depression.
Zoe Margolis is one example of someone who found recovery through running. Following the end of a long-term relationship and some financial difficulties, she began to experience intense self-critical thoughts, feelings of worthlessness, poor sleep and was struggling to concentrate. At her lowest point, she began to self-harm and contemplated suicide. When medication and therapy did not seem to be lifting the blackness, she started to walk and then to run – something she had not done for several years. Zoe noticed that the endorphins produced by exercise boosted her mood in the short-term and that the sense of achievement, pleasure and improved physical health had longer-term benefits in helping her beat depression.
The experience of pleasure is an important aspect of recovery. Once a depressed person begins to experience pleasure from one activity, it may enhance their ability to gain pleasure from other activities, making life more enjoyable (Grillo, 2016). This means that the most beneficial exercise is likely to be the one that you enjoy the most.
As you are reading this, I assume that you enjoy running. In addition, there is evidence to suggest that nature has a positive impact on mood and that outdoor exercise has a greater effect on depression than indoor activities. In a review of 11 trials comparing indoor and outdoor exercise (Coon et al., 2011), exercising in natural environments was found to be associated with greater decreases in tension, confusion, anger and depression and with greater increases in energy.
As ultra runners, we spend a lot of time outdoors, and many of us are in our element surrounded by nature rather than on the roads. This may be why there are so many positive stories of great long distance runners being created from the depths of despair. For example, Rob Krar and Nikki Kimball have spoken publicly about their battles with depression and bipolar disorder respectively. After several episodes of suicidal depression, Kimball states that, ‘I can juxtapose anything that’s thrown at me during a race, to almost being dead’. She likens her ability to come out of depression to the experience of battling through low points to finish a race. (Bozeman Daily Chronicle, 2007)
The strength and courage required to emerge from rock bottom appears to be valuable in overcoming the mental challenges of extreme distances. Both Kimball and Krar are Western States 100 champions and have a string of other ultra triumphs to their names. There is something poetic about the cycle of using running and the great outdoors to help beat the lows of a depressed mind and subsequently using the experience of coming through those lows to drive oneself further as a runner.
Research suggests that, for mild depression, physical exercise is just as effective as medication. Studies have consistently shown that exercise is associated with improved physical health, life satisfaction, cognitive functioning and psychological well-being. For more severe depression, a combination of treatments may be required. The purpose of this article is not to suggest that running negates the need for professional support. If you have symptoms of depression, then please see your doctor.
I would view this as similar to the role of a healthy diet in maintaining physical wellbeing. If you are well, or even have a mild illness or slight vitamin deficiency, then eating a balanced diet is the best way to stay healthy. If you are anaemic, or lacking in another essential nutrient, then you may need to take a supplement as well as eating a healthy diet until your blood results are normal, and you can rely on diet alone. If you have diabetes or another long-term condition, then you will require ongoing treatment and monitoring, but will also need to back this up with healthy eating.
Mental health is no different. If you are healthy, or even a little bit stressed, then running may well be the perfect way to keep your mind in good shape. If you are feeling down on a regular basis, then you should discuss possible treatments and lifestyle changes, including physical activity, with your GP. You may require medication, therapy or both to help you through a difficult period, but the benefits are likely to be greater when combined with regular activity.
Some people may need longer-term support and treatment, but can also improve their chances of avoiding relapse by keeping active and doing things they enjoy. In short, running may be a part of the answer to how to promote mental wellbeing. It may require a leap of faith to kick-start your running, but once you have made it out of the door, the feelings of pleasure and achievement are likely to strengthen your will to repeat the process. It does get easier, and activity leads to motivation, which leads to more activity.
On this basis, William Pullen is pioneering an approach to psychotherapy that utilises physical activity and the outdoors. This Dynamic Running Therapy is still in its infancy, but it will be interesting to see if it becomes an established treatment. It is based on the evidence that exercise can help beat depression, and draws on evidence-based psychotherapy models such as solution-focused therapy and person-centered therapy. It therefore has a solid theoretical foundation, but there have not yet been independent studies into its effectiveness.
We are all vulnerable to mental health difficulties under certain circumstances. Some people may be more easily triggered, particularly if they have had difficult life experiences, but it can happen to anyone. The good news is, if you already know that running boosts your mood, you have some evidence of how to help yourself should you experience depression. If you’ve ever dragged yourself out of the door when you didn’t feel like it and ended up feeling better, or if you’ve experienced that ‘runner’s high’, then hold on to those memories. When you don’t feel motivated, then those are your evidence that running can help.
Everyone reading this is likely to know someone with experience of mental illness. In recent surveys by England Athletics and RunTogether, 74% of runners questioned felt running was good for their mental wellbeing and 89% reported increased happiness after running in a group. If running can offer some light in those dark moments and maybe even help prevent them, then we should all be shouting about this from the rooftops and encouraging others to run with us. If you can pass on your love of running to just one person, then you could be helping to confront this low mood epidemic.