Training Clinically Depressed Clients

Over the past few months, the entire world has been on lock-down. We are no doubt observing and seeing first hand the “packing on” of what media is referring to as “Covid-15.” (Putting on 15lbs while in quarantine). As a fitness professional, you are eagerly waiting the influx of clients eager to re-start their fitness transformation. But are you ready to handle what is likely to come?

As is the case with your current clients, the majority of them go to the gym, or decide to eat clean by choice. A small percentage of clients sign up for a transformations out of guilt or because a doctor has strongly recommended they take a step in a healthier direction. 

Then there are the few, who seem to have been “forced” into a health and fitness program. These are the individuals for whom exercise doesn’t come naturally, due to a variety of circumstances. Upon working with these clients, you consider them to be:

  • Non-compliant
  • Difficult
  • Resistant
  • Frustrating

What you may not realize is that these clients just might be coping with clinically diagnosed depression. With the pandemic of COVID-19, we will see the “few” who suffer from clinically diagnosed depression rise. The minority of cases you once dealt with – may soon become the norm.

We know, as a fitness professional, that there is nothing quite like the endorphin rush, brought on by the body’s natural ability to manufacture the feel-good chemical “serotonin.” Its appearance is always welcome, fuelling our body with energy and flooding our brains with the magic words “Dig deeper! Just Keep going!” Endorphins improve our natural immunity and may even reduce how our brains receive pain. This generally leads to a sense of euphoria and a positive mood. (Hence why many of us seek fitness as a full-time career!)

Now… let’s gain some perspective from someone suffering from depression. Imagine struggling through what you perceive to be a tough workout. Now, imagine that same scenario with a compromised serotonergic system, the process responsible for creating serotonin. Suddenly, it dawns on you that if there are no endorphins waiting to reward you upon completion of a tough workout, it seems easier to just give up halfway though. Unfortunately, in most cases of clinical depression, this is precisely what is taking place.

With depressed clients – serotonin production is reduced. Clients living with depression typically exhibit an increased secretion of stress hormones from the HPA axis. We know that regular exercise helps the body to lower the amount of these circulating hormones, leading to a reduction in depression symptoms. So what can we do to help our clients? We need to understand depression and how it works – on a deeper level. We need to learn more than what a typical health magazine may publish.

Post COVID-19, my recommendation is to be vigilant and pay attention to signs and symptoms of client’s who may be suffering in this manner.  A Decrease in the body’s serotonin levels have the potential of:

  • Creating an inability for our clients to think out and execute their training program. 
  • Increasing clients loss of patience.
  • Clients being easily upset or annoyed.
  • Clients being unable to control impulsive thoughts and actions. 

When a clinically depressed client does not wish to exercise, they simply will not engage; the brain is sending the signal to stay on the couch. (Which is what they may have been doing the past few months during COVID-19). Remind yourselves that this is not your doing, or indication that you are a “bad trainer,” but rather the illness dominating your client.

Developing a fitness program for a client who is living with a depression is clearly going to replicate a similar plan to which you are already accustomed to creating. But you must remain aware of several more powerful characteristics of depression that exist:

  • Loss of interest, motivation and energy.
  • Increased fatigue.
  • Diminished self-worth and self-confidence.
  • Fear of movement.
  • Social anxiety.

These characteristics have significant potential of interfering with participation in (and enjoyment from) exercise.

Positive social support (such as camaraderie found in your gym/ team or FaceBook group) will be a play a factor in your depressed clients ability to stay resilient and accountable to their plan. An absence of social support is often correlated with higher levels of stress and depression. By encouraging other clients to interact with each other, may be help depressed clients feel more comfortable socially, increasing their chances of slowly integrating as a member of the community.

When conducting an intake prior to designing a protocol, help the client take an inventory of their perceived barriers towards exercise/diet compliance. This may lead into a discussion about possible strategies that could assist them in overcoming these barriers – problem solving, activity planning etc. (Here is where you use your CBT-Fit skills!)  

Empathy, validation, praise and encouragement are necessary during all phases of a transformation, but especially when a client struggles or doubts their ability to accomplish a desired change.

Providing regular progress feedback to such clients is important. Emphasize the short-term benefits after single exercise session, such as improvements in:

  • Mood
  • Stress levels
  • Energy levels
  • Distraction of negative thoughts
  • Ability to concentrate and focus

Helping depressed clients set realistic and achievable goals, will lead to successful experiences; which in turn will give the client the courage they need to push through.  A text message or brief email sent in between appointments can serve as an uplifting and encouraging reminder that you believe in their ability. Knowing that their trainer is waiting for them and is looking forward to the workout or coaching call can go a long way towards feeling of self-worth and self-efficacy.

Over the next few months, as we create a new “normal,” think about greeting clients with your heart and mind before your strength and education even enter the discussion. You just may discover that some people don’t care how much you know, but want to know how much you care.

References:

http://www.webmd.com/depression/features/exercise?page=2

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2077351/http://www.health.harvard.edu/mind-and-mood/exercise-and-depression-report-excerpt

https://www.psychologytoday.com/blog/prefrontal-nudity/201111/boosting-your-serotonin-activity

Picture of Jill Bunny

Jill Bunny

As CEO of CBT Meets Fitness, Jill Bunny provides the vision and leadership to further our mission: to improve mental health & fitness worldwide through excellence in Cognitive Behavioral Therapy. She manages internal operations and oversees the creation of new programs. She also manages the expansion of existing programs to increase access to CBT training and certification programs for health & fitness professionals in North America. She holds a degree in Kinesiology, from the University of New Brunswick, along with Functional Medicine certification from IFMHC, and CBT qualifications from the University of Laurier, Penn State & Beck’s Institute in the US.

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CBT Meets Fitness is the bridge between psychotherapy + fitness.

We are comprised of educated professionals specializing in cognitive behavioral therapy (CBT) for things like depression, anxiety, and numerous other psychological concerns pertaining to weight loss, athletics, as well as dieting & exercise. Our experts use clinically-proven methods, which make us the premier online CBT fitness treatment centre in North America. At CBT Meets Fitness, we are proud to serve women & athletes across the globe with evidence based skills to help with the missing mental piece of health & fitness transformations and athletic success.

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