Walk-and-Talk Therapy for Depression and Anxiety

Overseen By Gina M Besenyi, PhD

Age: 18+

Sex: Any

Trial Phase: Phase 2

Sponsor: Kansas State University

Disqualifiers: Active suicidal ideation, exercise risk, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Prior Safety Data This treatment has passed at least one previous human trial

Compensation: Varies

Number of Visits: 10

Duration: 10 weeks

60 Participants Needed

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial examines how outdoor walk-and-talk therapy can reduce depression and anxiety. Participants will either engage in weekly outdoor therapy sessions or receive educational materials about outdoor activities. The goal is to determine if being active in nature can improve mental health. It suits adults already in therapy for depression or anxiety who can safely exercise and are committed to staying in therapy for six months. As a Phase 2 trial, this research measures the treatment's effectiveness in an initial, smaller group, offering participants a chance to contribute to important mental health advancements.

Do I need to stop taking my current medications for this trial?

The trial protocol does not specify whether you need to stop taking your current medications. It is best to discuss this with your therapist or the trial coordinators.

Is there any evidence suggesting that walk-and-talk therapy is likely to be safe for humans?

Research has shown that walk-and-talk therapy is generally safe for people with depression and anxiety. Although specific safety data for this therapy is limited, studies indicate that walking during therapy is well-received. In one study, participants experienced less psychological distress and greater well-being after walk-and-talk sessions. Another study found that therapists conducted most of their sessions while walking, suggesting this method is practical and easy to manage. Overall, existing research suggests that walk-and-talk therapy is a safe option for addressing mental health issues like depression and anxiety. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Walk-and-talk therapy is unique because it combines physical activity with mental health counseling, offering a dual approach to treating depression and anxiety. Unlike traditional therapies that typically take place in an office setting, this method encourages movement and exposure to nature, which can enhance mood and reduce stress. Researchers are excited about this approach because it could make therapy more engaging and accessible, potentially leading to better outcomes for individuals who might struggle with conventional treatments.

What evidence suggests that walk-and-talk therapy is effective for depression and anxiety?

Research has shown that walk-and-talk therapy, which participants in this trial may receive, can effectively reduce symptoms of depression and anxiety. One study found that this therapy improved mental health and well-being more than traditional indoor sessions. Another study showed a decrease in mental distress and an increase in overall well-being. Additionally, walk-and-talk therapy uses techniques known to help with depression and anxiety. Overall, early findings suggest that this approach might be promising for those dealing with these mental health issues. ^{1 2 3 4 6}

Are You a Good Fit for This Trial?

This trial is for adults with depression and anxiety who are currently seeing a therapist. Participants should be interested in nature-based physical activity. Therapists must have the appropriate caseload and agree to training. People with conditions that limit outdoor activity or those unable to commit to the full 10-week program cannot join.

Inclusion Criteria

My therapist is part of the study and trained for it.

I have been diagnosed with depression or an anxiety disorder.

Willing to complete all study requirements

Exclusion Criteria

I am currently having thoughts about harming myself.

Planning to discontinue therapy in less than 6 months

Does not pass exercise risk screener

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Training

Therapists receive a 3-hour in-person training covering project aims, procedures, and benefits of nature-based physical activity for mental health

1 day

Treatment

Participants engage in a 10-week intervention with walk-and-talk therapy outdoors during weekly sessions and set goals for nature-based physical activity

10 weeks

10 visits (in-person)

Follow-up

Participants are monitored for changes in depression, anxiety, and nature-based physical activity after the intervention

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Walk-and-talk therapy

Trial Overview The study tests walk-and-talk therapy, where clients engage in outdoor sessions focusing on active strategies while discussing mental health issues. Over 10 weeks, half of the participants will receive this intervention; the other half won't, allowing comparison of changes in mental health and physical activity levels.

How Is the Trial Designed?

Group I: Intervention (immediate start) Experimental Treatment 1 Intervention

Participants will engage in walk-and-talk therapy during weekly sessions with their therapist and will set goals for engaging in nature-based physical activity on their own outside of therapy.

Group II: Waitlist control Active Control 1 Intervention

Participants will receive generic educational materials about nature-based physical activity and local parks.

Who Is Running the Clinical Trial?

Kansas State University

Lead Sponsor

Trials

39

Recruited

13,400+

REI Cooperative Action Fund

Collaborator

Trials

2

Recruited

1,600+

Published Research Related to This Trial

A feasibility study is being conducted to evaluate a 1-day training workshop for high-intensity cognitive behavioral therapy (CBT) therapists, aimed at improving their skills in working with clients who have personality difficulties alongside anxiety and depression.

The study will assess whether this training can enhance therapist confidence and potentially improve treatment outcomes for individuals with these comorbid conditions, providing a foundation for future larger trials.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Non-randomised feasibility study of training workshops for Talking Therapies service high-intensity therapists to optimise depression and anxiety outcomes for individuals with co-morbid personality difficulties: a study protocol. Warbrick, LA., Dunn, BD., Moran, PA., et al.[2023]

Cognitive-behavioral therapy (CBT) and interpersonal therapy have shown moderate effectiveness in treating depression over the past 50 years, but the overall effect size has not improved and may even be decreasing.

While these therapies can reduce depressive symptoms, there is no strong evidence that they prevent the onset of depressive disorders, indicating a need for new approaches in both treatment and prevention.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Editorial: Optimizing Depression Prevention: The Way Forward? Merry, SN.[2021]

A combination of talk therapy and medication was found to be the most effective treatment for depression and anxiety, but talk therapy alone, especially with 13 or more sessions, was nearly as effective.

While medications provided quicker symptom relief, they often required multiple trials to find the right one without side effects, with 40% of users reporting adverse sexual side effects.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Drugs vs. talk therapy: 3,079 readers rate their care for depression and anxiety. [2022]

In a study involving 225 depressed outpatients across various treatments, a strong therapeutic alliance significantly improved treatment outcomes for both psychotherapy and pharmacotherapy, including placebo.

The effectiveness of the therapeutic alliance was primarily influenced by the patient's contribution, rather than the therapist's, highlighting the importance of patient engagement in achieving better clinical results.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Krupnick, JL., Sotsky, SM., Simmens, S., et al.[2022]

In a study of 523 adults with major depressive disorder (MDD), those with non-social anxiety disorders experienced worse outcomes during cognitive therapy (CT), indicating that these comorbidities can reduce the treatment's effectiveness.

Conversely, patients with social anxiety disorder showed greater reductions in depressive symptoms during CT, but they also faced increased social avoidance, suggesting that tailored approaches may be necessary for this group.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Do comorbid social and other anxiety disorders predict outcomes during and after cognitive therapy for depression? Vittengl, JR., Clark, LA., Smits, JAJ., et al.[2020]

A randomized controlled trial with 121 participants showed that an Internet-based tailored guided self-help treatment for major depression was more effective than a standardized treatment, especially for individuals with higher baseline depression and comorbid symptoms.

Both tailored and standardized treatments led to improvements in depression, anxiety, and quality of life, with effects maintained at a 6-month follow-up, highlighting the potential of personalized approaches in mental health care.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Tailored vs. standardized internet-based cognitive behavior therapy for depression and comorbid symptoms: a randomized controlled trial. Johansson, R., Sjöberg, E., Sjögren, M., et al.[2023]

A randomized trial involving 74 participants with anxiety disorders showed that adding a home-based walking program to standard cognitive behavioral therapy (GCBT) significantly reduced levels of depression, anxiety, and stress compared to GCBT alone.

The results suggest that incorporating exercise into therapy could enhance treatment outcomes for individuals with panic disorder, generalized anxiety disorder, or social phobia, indicating a need for further research in this area.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Promoting walking as an adjunct intervention to group cognitive behavioral therapy for anxiety disorders--a pilot group randomized trial. Merom, D., Phongsavan, P., Wagner, R., et al.[2022]

A study involving 99 therapists found that those with experience in dance/movement therapy (DMT) were more likely to perceive the combination of DMT and cognitive behavioral therapy (CBT) as an effective treatment for anxiety disorders in children.

The actual use of the combined DMT and CBT approaches by therapists was influenced by their beliefs about efficiency, rather than their overall sense of efficacy in treating children with anxiety disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Combining Dance/Movement Therapy with Cognitive Behavioral Therapy in Treatment of Children with Anxiety Disorders: Factors Explaining Therapists' Attitudes. Weitz, N., Opre, A.[2022]

In a study of 80 psychiatric outpatients undergoing group cognitive-behavioral therapy (CBT) for depression, baseline characteristics such as symptoms of depression and quality of life were linked to patients' expectations for improvement, highlighting the importance of addressing these factors early in treatment.

Patients' expectations for treatment outcomes were found to influence the quality of the therapeutic alliance and were positively associated with improvements in anxiety, quality of life, and interpersonal problems, suggesting that fostering hope and optimism in the initial therapy sessions can enhance treatment effectiveness.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Forecasting success: patients' expectations for improvement and their relations to baseline, process and outcome variables in group cognitive-behavioural therapy for depression. Tsai, M., Ogrodniczuk, JS., Sochting, I., et al.[2022]

A study of 58 anxious depressed outpatients receiving case formulation-driven cognitive-behavior therapy (CBT) showed significant improvements in anxiety and depression, comparable to results from randomized controlled trials of established therapies.

The approach, which included weekly outcome monitoring and adjunct therapies as needed, suggests that patients with multiple comorbidities can effectively benefit from tailored, evidence-based treatments.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Naturalistic outcome of case formulation-driven cognitive-behavior therapy for anxious depressed outpatients. Persons, JB., Roberts, NA., Zalecki, CA., et al.[2022]

After a 6-week intensive inpatient cognitive behavior therapy program, 59.4% of the 37 patients with depression and anxiety reported significant improvements in their condition, as assessed by clinical global impression.

Quality of life improved in several areas, including work, education, and social relations, although no significant changes were noted in marital relations, general health, or finances.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Quality of life in depression and anxiety disorders: an exploratory follow-up study after intensive inpatient cognitive behaviour therapy. Lenz, G., Demal, U.[2018]

An exercise program was found to be an effective treatment option for individuals with depression and anxiety, showing positive results in symptom reduction.

The study compared the effects of exercise with transdiagnostic cognitive behavioral group therapy (TCBGT) and indicated that exercise can be as beneficial as TCBGT for managing these mental health conditions.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effects of Exercise on Depression and Anxiety. A Comparison to Transdiagnostic Cognitive Behavioral Therapy. Ólafsdóttir, KB., Kristjánsdóttir, H., Saavedra, JM.[2019]

In a study involving 290 participants with major depressive disorder (MDD), both disorder-specific cognitive behavior therapy (DS-CBT) and transdiagnostic CBT (TD-CBT) showed large reductions in MDD symptoms, averaging over 45%.

The study found no significant differences in efficacy between the clinician-guided and self-guided formats of CBT, indicating that both approaches are effective for treating MDD and associated anxiety disorders.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Disorder-specific versus transdiagnostic and clinician-guided versus self-guided treatment for major depressive disorder and comorbid anxiety disorders: A randomized controlled trial. Titov, N., Dear, BF., Staples, LG., et al.[2022]

In a study of 369 outpatients with panic disorder and agoraphobia, comorbid depression did not significantly hinder the effectiveness of cognitive-behavioral therapy (CBT) in reducing anxiety symptoms, although there were slight reductions in clinician-rated outcomes immediately after treatment.

CBT was effective in improving depressive symptoms regardless of whether patients had comorbid depression, indicating that treatment for panic disorder and agoraphobia can also benefit patients' mental health overall.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Depression does not affect the treatment outcome of CBT for panic and agoraphobia: results from a multicenter randomized trial. Emmrich, A., Beesdo-Baum, K., Gloster, AT., et al.[2018]

Cognitive Behavioral Therapy (CBT) is an effective treatment for all levels of major depression, proving to be as effective and more durable than medication alone.

Combining CBT with medication can enhance treatment response and prolong benefits, especially when CBT is introduced after successful pharmacotherapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Cognitive behavioral therapy for depression. Sudak, DM.[2022]

Citations

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Walk‐and‐Talk Therapy Versus Conventional Indoor ... Results indicate that walk‐and‐talk therapy may be acceptable and effective for men with depression. A powered trial to interrogate these ...

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Walking and talking for well‐being: Exploring the ... Results showed a reduction in psychological distress and an increase in well-being for all participants from baseline to follow-up. Qualitative ...

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Walking Psychotherapy As a Health Promotion Strategy to ... DASS-stress mean scores decreased from 19.0 to 16.0 (MD 3.0, 95% CI: 0.3 to 5.6). No changes were observed for DASS depression (MD -0.9, 95% CI: −5.1 to 3.3) ...

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Walk it off! The effectiveness of walk and talk coaching in ... Results show that participants in the walk and talk group improved more on burnout, stress symptoms, general mental health, and wellbeing than those in the ...

5. withpower.com withpower.com/trial/phase-2-depression-1-2025-b29ae

Walk-and-Talk Therapy for Depression and Anxiety Research shows that cognitive-behavioral therapy (CBT), which is a part of walk-and-talk therapy, is effective in reducing symptoms of depression and anxiety.

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Walking Therapy: Integrating Movement Into ... A pilot study found that therapists could conduct 67% of trauma-focused sessions while walking, and participants experienced significant ...