Why We Resist What Works

The research is unequivocal, even monotonous in its consistency: physical activity outperforms pharmaceutical interventions for most mental health conditions. It rivals or exceeds the efficacy of psychotherapy. The effect sizes are robust, the studies replicate across cultures and decades, and the mechanisms are increasingly well understood. Exercise works. Movement matters. The body, moving through space, reorganizes the nervous system in ways that our best medications and most refined talk therapies struggle to match.

And yet.

In my clinical practice, when I suggest to clients struggling with depression that they might try running, or that climbing could address their anxiety in ways our conversations cannot, I am often met with a particular kind of resistance. Not outright refusal—most people are too polite for that—but a subtle deflection. A yes-but. A maybe-later.

This resistance reveals something profound about how we've learned to think about psychological distress, about what counts as legitimate intervention, about where healing is permitted to occur.

We have been taught, as a culture, to prefer biochemical explanations. Depression is a serotonin deficiency. Anxiety is overactive amygdala firing. ADHD is dopamine dysregulation. These explanations feel reassuringly scientific. They locate the problem in brain chemistry (or genetics), something invisible and complex that requires expert intervention. They allow us to remain passive recipients of treatment rather than active agents in our own reorganization.

The movement research challenges this view. It suggests that healing might require us to move, to sweat, to feel our muscles burn and our hearts pound. It insists that the body is not merely the vehicle for the brain but is fundamentally entangled with every aspect of our psychological experience. It demands that we do something rather than take something, that we change how we inhabit the world rather than adjust our neurochemistry to better tolerate how we currently inhabit it.

The Nervous System Learns Through Doing

In my work exploring what I call the geography of healing—a framework mapping four developmental pathways from early disruption through trauma response to mental health adaptation to addiction—one pattern emerges with striking clarity: the nervous system organized these protective patterns through experience, and it can only reorganize through experience.

Consider the four trauma responses that form the foundation of these pathways:

• Flight (the elsewhere pattern, dissociation, addictions of escape)
• Freeze (the inward pattern, depression, addictions of solace)
• Orient (the onward pattern, anxiety, addictions of departure)
• Fight (the backward pattern, anger, addictions of defiance)

Each of these responses formed during critical developmental windows when the child's nervous system learned, through lived experience, how to navigate an environment that felt unsafe. The infant who learned that belonging was dangerous organized a flight response—not through conscious decision but through repeated somatic experiences of threat followed by relief through departure. The toddler whose autonomous exploration was met with punishment or chaos developed chronic hypervigilance—the orient response—because their nervous system learned, through direct encounter, that the world requires constant scanning for danger.

These patterns didn't form through cognition. They formed through the body moving (or not moving) through space, through the nervous system's direct encounter with constraints and affordances in the environment, through what felt safe and what felt threatening at a level far deeper than language or thought.

And here is what we keep forgetting: if the pattern formed through embodied experience, it can only be reorganized through embodied experience.

You cannot think your way out of a freeze response. You cannot cognitively reframe your way out of hypervigilance. You cannot talk yourself into feeling safe when your nervous system learned, beginning in infancy, that presence means danger or that stillness invites threat.

The nervous system needs new information, delivered in the language it understands: movement, sensation, the direct experience of meeting challenge and discovering capacity. It needs to learn, through doing rather than thinking, that the old protective pattern is no longer necessary.

The Vertical Puzzle: Why Climbing Works

Several years ago, I began taking groups of students and clients to a local climbing gym and to the crags in Squamish. Not as recreation, not as team-building, but as a specific exploration of the capacity for movement to encourage well-being. I've watched dozens of people—many of them caught in patterns of dissociation, freezing, hypervigilance, or defensive anger—encounter the climbing wall or the cliff and discover something their nervous systems had not previously known: they could meet a challenge and not collapse, could face fear and not flee, could be fully present in their bodies and survive.

Each climbing route is a problem to be solved—not intellectually but somatically. Your body must find solutions that your mind cannot predict. You reach, your weight shifts, one foot pivots while the other presses, your fingers grip textured resin (or stone), and somewhere in this intricate dance of constraint and possibility, your nervous system reorganizes itself.

For someone organized around the flight response, someone whose earliest learning was that safety requires departure, climbing offers a paradox: you cannot leave, but you are not trapped. The wall holds you, demands your presence, will not permit dissociation. You must arrive fully in your body to continue upward. The holds won't appear if you're checked out. The route won't solve itself if you're floating somewhere above your experience. And yet—critically—you chose this. You can step down at any moment. Presence is voluntary, survivable, even pleasurable.

For someone caught in freeze, someone whose system learned that passivity is the only option when needs cannot be met, climbing insists on agency. Nothing happens unless you initiate it. No one can climb the wall for you. Your will, your choice, your action—or no progress. The wall reflects back to you, with crystalline clarity, that you have power, that your efforts produce results, that reaching out leads somewhere. The old learning—that action is futile, that needs lead nowhere—meets new evidence, delivered through the body's direct encounter with a responsive environment.

For someone locked in chronic hypervigilance, the orient response that never settles, climbing offers a strange gift: a situation that genuinely requires all that vigilance but channels it toward something coherent. Every handhold must be assessed, every movement planned, every shift in balance attended to with precision. The hypervigilance that felt chaotic and purposeless in daily life suddenly has a legitimate focus. The nervous system learns: vigilance can be productive rather than perseverative, attention can be focused rather than scattered, activation can lead to competence rather than exhaustion.

And for someone carrying rage, someone whose developmental learning was that power must be defended at all costs or it will be crushed, climbing provides something essential: a challenge that does not humiliate, a difficulty that respects rather than diminishes, an experience of power that comes through mastery rather than domination. The wall does not crush your will. It meets you, holds you, requires you to be strong but does not punish your strength. You can be powerful without being defiant. You can assert yourself without fighting.

Facing Ourselves in Vertical Space

Here is what I have observed, again and again, in groups at the crag or the climbing gym: people have feelings. Not just pain or frustration, though those are present. They also feel joy, a dizzying kind of fun, and a sense of deep, pleasurable achievement as their bodies learn what their minds cannot teach them. And the patterns that have organized their entire lives—flee, freeze, scan, fight—encounter an environment that responds differently than the original environment that created the pattern. And so they learn.

The wall does not replicate the developmental trauma. The wall is challenging but fair. The wall demands presence but does not punish it. The wall requires risk but offers the possibility of mastery. And in this gap—between the original learning and the new experience—reorganization becomes possible.

This is the nervous system learning through doing. No amount of talk therapy can do it. The body must meet the challenge and discover through direct encounter that the old pattern—freeze, wait, give up—is not the only option.

Running from Ourselves, Running Toward Ourselves

Climbing is not the only movement practice that addresses trauma responses at the nervous system level. Running, despite its seeming simplicity, offers similar opportunities for reorganization.

When running, the body insists on rhythm, on breath, on a sustainable relationship between effort and capacity. After fifteen minutes, after thirty minutes, after the initial adrenaline fades and the body settles into its work, something shifts: not escape but engagement, not away-from but toward. The runner discovers, somewhere along the trail, that they have arrived in their body. They are here, fully present, and nothing catastrophic has occurred. Dissociation fades. Freezing eases up. Orienting becomes pragmatic rather than frantic. And fighting melts away into the purposeful stride and the will to push.

This is not metaphor. This is nervous system learning.

Over time, with attention to breath and pace, with practices that emphasize rhythm and speed, the runner learns: move steadily, purposefully, without the constant sense that something terrible is chasing you.

For a more detailed and nuanced picture of the role that running might play in mental health, trauma healing, and addictions recovery, visit the page below.

Beyond the Chair: Counseling in the Real World

When I suggest to the counsellors I supervise that they take clients climbing or running—meeting them on trails or at the gym rather than in the office—I often encounter a particular kind of professional skepticism. This, they suggest, is not real therapy. Real therapy happens in private rooms, in fifty-minute sessions, in conversations about feelings while sitting in comfortable chairs.

I understand this skepticism. I was trained in the same tradition. I spent years learning to facilitate insight through carefully calibrated interpretations, to track transference, to hold space for emotional expression through language.

But here is what I have learned: the body does not negotiate verbally.

For clients whose trauma occurred before language, whose protective patterns formed in infancy, talk therapy is working at the wrong scale. We can explore their histories, develop insight into their patterns, understand cognitively why they respond as they do—and the nervous system remains unchanged. The pattern persists because the pattern is not cognitive. It is somatic, embedded in the body's learned responses to threat and safety, encoded in neural pathways that do not respond to interpretation.

These clients need experiences that speak the nervous system's language. They need to feel themselves be afraid and not collapse. They need to reach out and discover the world responds. They need to be challenged and discover they are capable. They need to be fully present in their bodies and learn that presence is survivable.

This cannot happen in a chair. It requires the real world, real challenges, real movement through space.

I am not suggesting that medication and talk therapy have no value. They can provide lifesaving interventions and crucial support at the right time, in the right circumstances. But for many people who are struggling, healing requires descent into the body, encounter with the environment, direct experience of meeting difficulty and cultivating capacity.

The Body and the Pathways of Addiction

One theme recurs across all four pathways in the work that I do: addiction maintains the trauma response. The substance or behavior that initially provided relief eventually becomes part of the self-reinforcing system that keeps the person locked in the original protective pattern.

Hallucinogens maintain the flight response by formalizing dissociation. Opioids maintain the freeze response by removing the urgency that might otherwise motivate reaching out. Stimulants maintain hypervigilance by keeping the nervous system activated. Alcohol maintains the fight response by disinhibiting rage.

What breaks this cycle is not better insight into the pattern. The person often understands, intellectually, exactly what is happening. What breaks the cycle is a nervous system experience that contradicts the foundational learning—the learning that said: flight is necessary, freeze is safest, vigilance prevents catastrophe, fighting back is the only way to maintain power.

Movement practices—particularly those that integrate challenge, presence, and agency—provide exactly these contradictory experiences. Climbing says: presence is survivable. Running says: you have capacity you did not know about. Bouldering says: challenge can be engaged rather than fled, problems can be solved through action rather than waited out, you can be in your body and be okay.

An Array of Choices

The exercise research is so consistent, so robust, so undeniable, and across a variety of activities: running, climbing, dancing, yoga, strength training, cycling, walking—any activity that provides sufficient opportunities for the body to learn. Movement works because it addresses the problem at the level where it exists: in the body's learned responses to threat and safety, and in the nervous system's organization around protection and possibility.

We resist this finding because accepting it would require us to fundamentally reorganize how we think about healing, about expertise, about what it means to help someone in distress. It would require us to acknowledge that the most powerful interventions are often the simplest, the most accessible, the most social. It would require us to leave our offices, to get uncomfortable, to accompany people into the real world where healing actually happens.

The body knows what it needs, has known it all along: it needs to move, to be challenged, to discover—through direct experience rather than verbal processing— that the old protective patterns are no longer necessary. It needs to climb, to run, to face itself in the vertical puzzle of holds and routes, in the rhythmic breath of miles accumulating, in the direct encounter with difficulty that reveals capacity.

This is the work. Not all of it, but much more of it than we have been willing to acknowledge. And until we are ready to meet people where their healing actually occurs—out in the world, in their bodies, moving through space—we will continue to wonder why our carefully crafted interventions so often fail to touch what matters most.

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Convergent Evidence

The 15 peer-reviewed articles below—from leading journals including The BMJ, American Journal of Psychiatry, British Journal of Sports Medicine, and Journal of Traumatic Stress—provide robust empirical support for the claims I've made in this post. The evidence demonstrates that exercise rivals or exceeds pharmaceutical and psychotherapy interventions for mental health (with effect sizes of 0.42-1.26), that movement practices address trauma at the nervous system level through bottom-up processing and autonomic regulation, and that climbing/bouldering shows specific therapeutic benefits beyond general exercise. The research establishes that somatic interventions are essential for pre-verbal and developmental trauma stored as motor patterns and sensations rather than verbal memories, that the nervous system learns through interoceptive conditioning independent of cognitive processing, and that running and endurance activities provide mental health benefits equivalent to antidepressants while superior for nervous system regulation. These findings collectively support a paradigm shift toward recognizing movement-based interventions as evidence-based frontline treatments for mental health and trauma, addressing neurobiological mechanisms that cognitive approaches alone cannot reach.

Exercise rivals pharmaceutical interventions for mental health

Recchia, F., Leung, C. K., Chin, E. C., Fong, D. Y., Montero, D., Cheng, C. P., Yau, S. Y., & Siu, P. M. (2022). Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 56(23), 1375-1380. https://doi.org/10.1136/bjsports-2022-105964

This network meta-analysis of 21 RCTs with 2,551 participants found no significant differences in treatment effectiveness between exercise and antidepressants for non-severe depression (SMD -0.12; 95% CI -0.33 to 0.10). Exercise showed equivalent efficacy to pharmacological interventions while supporting adoption as an alternative or adjuvant treatment. Published in a top-tier sports medicine journal (Impact Factor ~18), this represents gold-standard evidence directly comparing these interventions.

Noetel, M., Sanders, T., Gallardo-Gómez, D., Taylor, P., del Pozo Cruz, B., van den Hoek, D., Smith, J. J., Mahoney, J., Spathis, J., Moresi, M., Pagano, R., Pagano, L., Vasconcellos, R., Arnott, H., Varley, B., Parker, P., Biddle, S., & Lonsdale, C. (2024). Effect of exercise for depression: systematic review and network meta-analysis of randomised controlled trials. BMJ, 384, e075847. https://doi.org/10.1136/bmj-2023-075847

This comprehensive network meta-analysis included 218 unique studies with 14,170 participants, directly comparing exercise with psychotherapy, antidepressants, and control conditions. Moderate reductions in depression were found across all exercise modalities, with walking/jogging, yoga, and strength training showing the greatest effects when intense. The authors conclude these exercise forms "could be considered alongside psychotherapy and antidepressants as core treatments for depression." Published in The BMJ (Impact Factor ~107), this February 2024 study represents the most current and comprehensive evidence on exercise as a frontline intervention.

Singh, B., Olds, T., Curtis, R., Dumuid, D., Virgara, R., Watson, A., Szeto, K., O'Connor, E., Ferguson, T., Eglitis, E., Miatke, A., Simpson, C. E. M., & Maher, C. (2023). Effectiveness of physical activity interventions for improving depression, anxiety and distress: an overview of systematic reviews. British Journal of Sports Medicine, 57(18), 1203-1209. https://doi.org/10.1136/bjsports-2022-106195

This umbrella review (systematic review of systematic reviews) encompassed 97 reviews, 1,039 trials, and 128,119 participants. Effect size reductions in symptoms of depression (median ES = -0.43) and anxiety (median ES = -0.42) were comparable to or slightly greater than effects observed for psychotherapy and pharmacotherapy (SMD range = -0.22 to -0.37). The findings underscore the need for physical activity as a mainstay approach for managing depression and anxiety, with effect sizes 1.5 times larger than counseling or leading medications.

Exercise matches psychotherapy efficacy for mental health

The Noetel et al. (2024) and Singh et al. (2023) articles cited above provide robust evidence for comparative efficacy.

Kvam, S., Kleppe, C. L., Nordhus, I. H., & Hovland, A. (2016). Exercise as a treatment for depression: A meta-analysis. Journal of Affective Disorders, 202, 67-86. https://doi.org/10.1016/j.jad.2016.03.063

This meta-analysis of 23 RCTs with 977 participants examined exercise both as independent intervention and as adjunct to antidepressant medication. The study found a large significant effect (g = -0.68, p < 0.001) for exercise versus control conditions, with the authors explicitly stating that "exercise is comparable to psychotherapy and antidepressants for depression." As an adjunct to antidepressants, exercise showed a moderate significant effect (g = -0.50), demonstrating additional therapeutic benefit when combined with medication. Published in a leading psychiatry journal, this provides seminal evidence for exercise as evidence-based treatment rather than merely complementary therapy.

Movement addresses trauma at the nervous system level

Haeyen, S. (2024). A theoretical exploration of polyvagal theory in creative arts and psychomotor therapies for emotion regulation in stress and trauma. Frontiers in Psychology, 15, 1382007. https://doi.org/10.3389/fpsyg.2024.1382007

This theoretical paper explicates how Polyvagal Theory provides a neurophysiological foundation for movement-based trauma interventions. The author explains that approximately 80% of nerve signals travel from body to brain (bottom-up processing), with movement-based therapies activating bodily sensations that send "fresh signals" to the brain, bypassing the prefrontal cortex and targeting subcortical brain centers that process overwhelming stress. Movement interventions facilitate neural circuits that downregulate threat reactions by communicating "cues of safety," enabling individuals to shift from defensive states (hyperarousal or hypoarousal) back to the ventral vagal state of social engagement. This directly explains why body-centered interventions are particularly effective for trauma and stress-related emotion regulation problems.

Climbing and bouldering as mental health interventions

Luttenberger, K., Stelzer, E. M., Först, S., Schopper, M., Kornhuber, J., & Book, S. (2015). Indoor rock climbing (bouldering) as a new treatment for depression: study design of a waitlist-controlled randomized group pilot study and the first results. BMC Psychiatry, 15, 201. https://doi.org/10.1186/s12888-015-0585-8

This pilot RCT with 47 participants examined an 8-week bouldering intervention (3 hours/week) versus waitlist control for depression. BDI-II scores improved by 6.27 points in the bouldering group versus only 1.4 in waitlist (p = .012; Cohen's d = 0.77 - moderate to large effect). Group allocation was the only significant predictor of depression change (p = .007). The study specifically references neurobiological research showing evolutionarily older brain systems (subcortical) that process overwhelming stress are not reached sufficiently through verbal/cognitive interventions. Bouldering provides a bottom-up approach starting with body and physical sensations to facilitate arousal and affect regulation. The Number Needed to Treat was 4, indicating strong clinical relevance.

Karg, N., Dorscht, L., Kornhuber, J., & Luttenberger, K. (2020). Bouldering psychotherapy is more effective in the treatment of depression than physical exercise alone: results of a multicentre randomised controlled intervention study. BMC Psychiatry, 20(1), 116. https://doi.org/10.1186/s12888-020-02518-y

This multicentre RCT with 133 outpatients compared a 10-week manualized bouldering psychotherapy program (2 hours/week) against home-based exercise. Bouldering psychotherapy reduced depression scores significantly more than exercise alone (8.4 vs. 3.0 points on MADRS; Cohen's d = 0.55, p = .002). The intervention also significantly improved anxiety (GAD-7: p = .046, d = 0.35), body image (p = .018, d = 0.42), and global self-esteem (p = .011, d = 0.45). This demonstrates that bouldering provides therapeutic benefits beyond general physical activity effects, suggesting unique mechanisms through problem-solving, immediate success feedback, mindfulness induction through required concentration, and social engagement in group format. These are rare, rigorous RCT studies demonstrating specific efficacy for climbing interventions.

Somatic interventions for trauma and pre-verbal trauma

Brom, D., Stokar, Y., Lawi, C., Nuriel-Porat, V., Ziv, Y., Lerner, K., & Ross, G. (2017). Somatic Experiencing for Posttraumatic Stress Disorder: A Randomized Controlled Outcome Study. Journal of Traumatic Stress, 30(3), 304-312. https://doi.org/10.1002/jts.22189

This is the first known RCT of Somatic Experiencing (SE) for PTSD, with 63 participants randomized to a 15-session SE protocol or waitlist control. SE focuses on creating awareness of inner physical sensations viewed as carriers of traumatic memory, using techniques including titration, pendulation, and resource development. Large effect sizes were found for PTSD symptom reduction (Cohen's d = 0.94 to 1.26) and depression (Cohen's d = 0.7 to 1.08), with 44.1% of participants no longer meeting PTSD diagnostic criteria post-treatment. SE modifies the trauma-related stress response through bottom-up processing, directing attention to interoceptive and proprioceptive sensations. The theoretical foundation of SE addresses preverbal trauma through its body-focused approach that bypasses the need for explicit verbal narrative and works directly with subcortical brain structures.

van de Kamp, M. M., Scheffers, M., Emck, C., Fokker, T. J., Hatzmann, J., Cuijpers, P., & Beek, P. J. (2023). Body-and movement-oriented interventions for posttraumatic stress disorder: An updated systematic review and meta-analysis. Journal of Traumatic Stress, 36(5), 835-848. https://doi.org/10.1002/jts.22968

This meta-analysis of 29 studies on body- and movement-oriented interventions (BMOIs) including sensorimotor psychotherapy, Somatic Experiencing, and body-oriented psychotherapy found a mean effect size of Hedges' g = 0.50 (95% CI [0.22, 0.79]) for PTSD symptom reduction. BMOIs work through regulating neurophysiological arousal, habituation to bodily sensations, improving interoceptive awareness, addressing hyperarousal and dissociation, and creating peaceful embodiment. The meta-analysis notes that BMOIs use bottom-up processing particularly relevant for developmental trauma as it addresses subcortical brain structures (brain stem and limbic system) rather than requiring cortical processing. The focus on interoceptive awareness is especially important for those with early developmental trauma who may have disrupted body-mind connections.

Nervous system learning through embodied experience

Leech, K., Stapleton, P., & Patching, A. (2024). A roadmap to understanding interoceptive awareness and post-traumatic stress disorder: a scoping review. Frontiers in Psychiatry, 15, 1355442. https://doi.org/10.3389/fpsyt.2024.1355442

This comprehensive scoping review of 43 studies synthesizes research on interoceptive awareness—the sensory awareness originating from the body's physiological states. The review documents how the nervous system learns through interoceptive conditioning: internal bodily sensations can be conditioned by environmental events and influence behaviors without conscious cognitive processing. The article demonstrates that emotion regulation capacity is determined by the ability to perceive internal bodily cues through direct bodily awareness, not cognitive reappraisal. Body-based interventions like yoga programs and Basic Body Awareness Training showed significant PTSD symptom reduction alongside improvements in interoceptive awareness, with the review noting that improving interoceptive awareness is critical for PTSD recovery as it enables emotion regulation through embodied pathways rather than purely cognitive ones.

Javanbakht, A., Grasser, L. R., & Liberzon, I. (2023). Interoception in Fear Learning and Posttraumatic Stress Disorder. American Journal of Psychiatry, 180(7), 485-493. https://doi.org/10.1176/appi.focus.20230007

This neuroscience review published in the premier psychiatry journal demonstrates that fear learning can occur through interoceptive pathways even when individuals lack conscious awareness or declarative knowledge of the trauma. The authors document how internal bodily sensations themselves become conditioned stimuli that trigger learned fear responses without requiring cognitive interpretation, with learning happening automatically through body-to-brain signaling pathways (lamina I spinothalamic, vagal afferents). PTSD symptoms are maintained through disrupted body-to-brain interoceptive signaling that creates learned fear associations. Treatment must target these embodied learning pathways, as traditional cognitive approaches alone cannot access or modify these pre-cognitive, body-based fear memories.

The body's role in psychological healing

Hauke, G., Lohr, C., & Pietrzak, T. (2018). Embodied Cognition and the Direct Induction of Affect as a Compliment to Cognitive Behavioural Therapy. Behavioral Sciences, 8(3), 29. https://doi.org/10.3390/bs8030029

This article proposes integrating embodied cognition theory with CBT, demonstrating that body-based approaches can access "aspects which are difficult to grasp in lingual terms" through pre-verbal and pre-lingual processing. The brain uses motor and perceptual systems to simulate experiences, creating a "felt sense" that shapes cognition without requiring abstract thought. The authors present an Embodied Cognitive Behavior Therapy model where body-based synchrony between therapist and client strengthens the therapeutic relationship and promotes healing. Research shows that emotionally-focused treatment reducing negative mood via direct induction (through the body) also reduces frequency, intensity, and belief in negative thoughts and schemas, providing a "helping hand" through pre-verbal bodily information made conscious.

Movement for specific trauma responses

Price, M., Spinazzola, J., Musicaro, R., Turner, J., Suvak, M., Emerson, D., & van der Kolk, B. (2017). Effectiveness of an Extended Yoga Treatment for Women with Chronic Posttraumatic Stress Disorder. Journal of Alternative and Complementary Medicine, 23(4), 300-309. https://doi.org/10.1089/acm.2015.0266

This study examined 20-week trauma-sensitive yoga treatment for women with chronic treatment-resistant PTSD, specifically addressing dissociation. Participants experienced significant decreases in dissociative symptomatology—which notably did NOT occur in shorter-term yoga treatments—with large effect sizes for PTSD symptom reduction (d = -1.23) and depression (d = 0.7 to 1.08). Particularly noteworthy is that women with high levels of dissociation (typically predictive of poor treatment outcomes) showed improvement, suggesting trauma-sensitive yoga may be more tolerable for those with significant dissociative symptoms. Yoga fosters interoceptive awareness and body-mind connection, helping individuals reconnect with their bodies safely and reduce disconnection from physical experience.

van der Kolk, B. A., Stone, L., West, J., Rhodes, A., Emerson, D., Suvak, M., & Spinazzola, J. (2014). Yoga as an adjunctive treatment for posttraumatic stress disorder: A randomized controlled trial. Journal of Clinical Psychiatry, 75(6), e559-e565. https://doi.org/10.4088/JCP.13m08561

This seminal RCT with 64 women found that 52% of the yoga group no longer met PTSD criteria versus 21% of controls (p = .013), with large effect sizes (d = 1.07) comparable to established psychotherapeutic and psychopharmacologic approaches. Yoga specifically addresses hyperarousal symptoms and affect dysregulation by activating the parasympathetic nervous system through breathing practices and helping participants tolerate physical and sensory experiences associated with fear and helplessness. The mindfulness and present-moment awareness cultivated through yoga reduces constant threat detection characteristic of hypervigilance.

Why talk therapy alone is insufficient for somatic trauma

The Brom et al. (2017) article on Somatic Experiencing explicitly contrasts SE with traditional talk therapies like CBT, explaining that trauma memories are stored as physical sensations that cannot be adequately accessed through cognitive approaches alone.

Warner, E., Spinazzola, J., Westcott, A., Gunn, C., & Hodgdon, H. (2017). The body can change the score: Empirical support for somatic regulation in the treatment of traumatized adolescents. Journal of Child & Adolescent Trauma, 11(2), 215-227. https://doi.org/10.1007/s40653-017-0158-8

This research establishes that Trauma-Focused Cognitive Behavioral Therapy "may not be appropriate for children with limited expressive and receptive language skills given its reliance on verbal processing." Preverbal and developmental trauma experiences are stored as "psychophysiological arousal and motor patterns" rather than verbal memories or images. Early trauma "exists outside explicit memories that can be re-narrated in counseling," with neuroscientist Allan Schore identifying that earliest preverbal memories are neither verbal nor stored as images but exist as motor patterns and sensations. The reliance on verbal processing in traditional talk therapy makes it inappropriate for treating early developmental trauma, which requires somatic/body-based approaches to access non-verbal memory systems.

Running and endurance activities for mental health

Verhoeven, J. E., Han, L. K. M., Lever-van Milligen, B. A., Hu, M. X., Révész, D., Hoogendoorn, A. W., Batelaan, N. M., van Schaik, D. J. F., van Balkom, A. J. L. M., van Oppen, P., & Penninx, B. W. J. H. (2023). Antidepressants or running therapy: Comparing effects on mental and physical health in patients with depression and anxiety disorders. Journal of Affective Disorders, 329, 19-29. https://doi.org/10.1016/j.jad.2023.02.064

This 2023 RCT with 141 patients compared antidepressant medication with group-based running therapy (≥2 times per week for 16 weeks). Mental health outcomes were comparable with similar remission rates (antidepressants: 44.8%; running: 43.3%; p=.881), but physical health outcomes strongly favored running with significant improvements in weight (d=0.57), waist circumference (d=0.44), blood pressure, heart rate (d=0.36), and critically, heart rate variability (d=0.48). The improvement in heart rate variability specifically indicates enhanced autonomic nervous system regulation and parasympathetic function, demonstrating that running therapy directly regulates nervous system function while achieving mental health outcomes equivalent to pharmacotherapy.

Schuch, F. B., Vancampfort, D., Firth, J., Rosenbaum, S., Ward, P. B., Silva, E. S., Hallgren, M., Ponce De Leon, A., Dunn, A. L., Deslandes, A. C., Fleck, M. P., Carvalho, A. F., & Stubbs, B. (2018). Physical activity and incident depression: A meta-analysis of prospective cohort studies. American Journal of Psychiatry, 175(7), 631-648. https://doi.org/10.1176/appi.ajp.2018.17111194

This large-scale meta-analysis of 49 prospective cohort studies with 266,939 participants found that people with high levels of physical activity had significantly lower odds of developing depression (adjusted OR=0.83, 95% CI=0.79, 0.88). Protective effects were consistent across all age groups and geographical regions, with mechanisms including increased neurogenesis, reduced inflammatory markers, activation of the endocannabinoid system, and improved hippocampal function. The prospective design establishes temporal precedence, supporting causal inference that running and aerobic exercise prevent depression development through multiple neurobiological pathways related to nervous system regulation.