None listed
Conditions
Brief summary
Background Depression is a highly prevalent mental illness that affects over 109 million men worldwide and one in eight Australian men every year. Characterised by persistent feelings of sadness and hopelessness, untreated depression is devastating for individuals, families, and communities. Due to COVID-19, the Australian prevalence of depression increased by 10% in 2020 alone. In Australia, men with depression are often referred to psychotherapy (also known as counselling). However, while effective for treating depression, psychotherapy often fails to engage men who most often report that the process ‘doesn’t feel right’. Given the dominant form of masculinity in Australia encourages men to suppress emotions, it is unsurprising many find it hard to be vulnerable with a relative stranger, in a formal and unfamiliar environment, for a substantive period of time. Recently, the Australian National Men’s Health Strategy highlighted the need to tailor existing mental health services to be more engaging for men. In contrast to traditional psychotherapy, which almost exclusively takes place indoors, ‘walk and talk’ therapy in natural settings has potential to engage men for several reasons. First, walking outdoors may represent a less confronting context (e.g., less direct eye contact, shared ownership of physical space). Second, the biophilia hypothesis suggests humans have a ‘biological attraction to natural environments’, and gain health benefits by simply being in nature. Finally, physical activity has a known anti-depressant effect, that can enhance the benefits of psychotherapy. Despite these benefits, no studies have examined the value of walk-and-talk therapy for supporting men. Study aims Primary aim: To test the feasibility of outdoor, walking-based psychotherapy for men with depression compared to usual care (seated indoor therapy). Secondary aim 1: To investigate the preliminary efficacy of outdoor, walking-based psychotherapy for improving the mental health of men with depression compared to usual care. Secondary aim 2: To investigate differences in perceptions of therapy and the therapeutic alliance between men who participant in outdoor, walking-based psychotherapy compared to usual care.
Interventions
Arm 1: Walk-and-Talk Psychotherapy
Intervention description and dose: Participants in the 'walk-and-talk' arm will receive 6x 60 minute outdoor walking psychotherapy sessions over 6 weeks (one session per week, 6 hours total contact). In the sessions, the therapist will follow a person-centered counselling approach using counselling micro-skills to address important issues identified by the participant. The sessions will take place while walking along a pre-approved route nearby the University
Arm 1: Walk-and-Talk Psychotherapy Intervention description and dose: Participants in the 'walk-and-talk' arm will receive 6x 60 minute outdoor walking psychotherapy sessions over 6 weeks (one session per week, 6 hours total contact). In the sessions, the therapist will follow a person-centered counselling approach using counselling micro-skills to address important issues identified by the participant. The sessions will take place while walking along a pre-approved route nearby the University of Newcastle's Callaghan Campus Psychology Clinic. Therapists: The sessions will be delivered by provisional psychologists completing their practicum placement at the University of Newcastle's Psychology Clinic - Callaghan Campus. All therapists will have received training in person-centered counseling approaches during their study. To prevent confounding, therapists will be allocated clients from each study arm (but each client will have the same therapist for the whole study). Mode: Face-to-face, outdoor walking therapy. Procedures: After booking in for their sessions at the beginning of the trial, participants will receive a text message reminder the day before each session. If they are unable to attend, they will have an opportunity to reschedule their session for an alternate time that week, where possible. Materials: If needed, participants and therapists will have access to insect repellant plus ponchos and/or umbrellas for use in mild wet weather. Neither group will receive informational materials during the study. Location: University of Newcastle, Callaghan Campus. Treatment adherence and fidelity: Therapists will keep a session log documenting participant attendance (Y/N) and whether the session could be delivered as intended (i.e., walking outside).
Sponsors
Dr Myles Young
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Blinded (masking used) (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
Male
Age
18 Years to 70 Years
Healthy volunteers
No
Inclusion criteria
- Identify as Male; - Aged 18-70 years; - Experiencing mild to severe depressive symptoms for at least two weeks (Patient Health Questionnaire - 9 item [PHQ-9] score = 5 or above); - Available to attend six therapy sessions at the University of Newcastle over 6 weeks; and Willing to participate in their assigned treatment group for the duration of the study period.
Exclusion criteria
- Significant risk of suicide (determine after psychologist consultation for any men reporting current thoughts of suicide or self-harm in study screening); - Currently receiving psychotherapy; - Have started a new medication or changed medication dose in the past 4 weeks; - Unable to speak, read or understand English; - No access to an internet connected smart-phone, tablet or computer to complete surveys; - Planning to move out of the area during the study period; - Not willing to be randomly allocated into either study group; or - Unable to walk for 1 hour.
Outcome results
None listed