Twelve years ago, when he was in his mid-40s, psychotherapist Andrew Keefe found himself in a very stressful job – working with survivors of torture – and really out of shape. Determined to improve, Keefe joined an outdoor fitness class. Hours of burpees and press-ups in London’s Finsbury Park helped him get physically fit, but he was fascinated to discover that his state of mind also completely changed.
“Afterwards I would be incredibly relaxed – blissful,” he says.
Keefe decided to join the growing number of psychotherapists who are adding qualifications in physical therapy and personal training to their CVs. As evidence of the complex and important connection between fit minds and bodies grows, more practitioners are learning how to treat both.
“I would like us to move beyond the idea of physical therapists and psychological therapists and just have ‘therapists’ whose training combines elements of both,” says Keefe.
“The knowledge of anatomy and physiology I’ve gained from training as a personal trainer has made me a better psychotherapist. It should be included in all therapeutic training. Imagine a course which qualifies you to be a psychotherapist and a physiotherapist.”
Some gyms are also looking at the body and mind. This year, Gymbox became the first fitness company to offer classes specifically to help mental fitness. Jess Parkinson, holistic master trainer for Gymbox, says the classes were added to the timetable because staff knew how much they were needed.
“One in four people experience a mental health issue, according to Mind,” she says. “The classes have been hugely popular, and the most encouraging thing is seeing people return when they feel the effects the exercises have. Feedback has been a joy, with members commenting on having a greater understanding of how to help themselves when they’re stressed or struggling with sleep.”
The link between mental and physical health is well established. The idea of social prescribing originated in the UK, and exercise has been available on the NHS as treatment for mild mental health issues since 2019.
The Soma Space, a practice opened this autumn in Oswestry, Shropshire, by psychotherapist Kevin Braddock and personal trainer Jo Hazell-Watkins, is one of the few centres that combine exercise and mental health training in a focused way.
Hazell-Watkins became interested after experiencing a breakdown. “My debilitating symptoms from PTSD were less acute when I’d exercised,” she says. “So I couldn’t understand why exercise’s impact on mental illness wasn’t made more explicit by doctors and therapists. Or, from the other end, the gyms themselves. Why is fitness imagery based around the aesthetics of losing weight or changing your physical state?”
After recovering, Hazell-Watkins qualified as a personal trainer with a focus on strength training – an exercise understood to have great benefit for PTSD. “It offers so much in building resilience, which flows into life outside the gym.
“With mental illness, we often feel ‘less’ in every part of ourselves, whereas physical strength makes you feel ‘more’ of everything – and the sense of achievement is practical and measurable,” she says.
There has been growing interest in using movement therapeutically to process memories driving trauma or depression, according to Keefe. “This has led to approaches including walking therapy, which took off in the pandemic, boxing therapy, trauma-informed weightlifting and mindful running.”
Hazell-Watkins has personal experience of how physical therapy can rewire the brain after PTSD. “There’s an assumption that PTSD flashbacks are cinematic somehow, but for me they were overwhelming sensations in my body which would floor me for hours,” she says.
“When you lift weights, you have to be fully present to lift safely. Breathing is fundamental, as is getting the form right: it’s literally rewriting or rewiring the neurological pathways with new positive patterns, and over time these new pathways start to take over from the more negative ones.”
Braddock is trained as a boxercise and fitness instructor as well as being a qualified psychotherapist. He also practises martial arts. He believes that what’s really needed is a fundamental change in how we view mental and physical states.
“We are still labouring under the Cartesian mind-body split – I think therefore I am,” says Braddock. “Practices such as tai chi and yoga seem to understand that physical movement creates psychological unity – what we might call mental health.
“Strength training can build a self-perception of strength as well as measurable improvements in actual muscular strength. This is especially valuable for people who think barbells and boxing gloves are only for big, muscly blokes and not for them.”