// Training clients with depression
by Chad Timmermans
When consulting with personal trainers, I frequently get asked
questions about depression. One workshop on goal setting that I
prepared for a group of personal trainers ended up becoming about
depression after I was barraged with questions about the topic. The
trainers reported feeling unable to satisfactorily help people who were
experiencing depression, which was resulting in the trainers feeling
frustrated and cautious with clients.
As a trainer, and someone therefore whose business is helping people improve their lives, it is beneficial to develop a better understanding of depression in order to help you work with clients who experience this psychological condition.
In the field of personal training, many clients experience depression. It is possible that the rate of depression among clients of personal trainers could be higher than that of the general population. This is due to clients being a concentrated group who frequently experience issues with body image, difficulty in controlling weight, stress from work and other health related issues. Even within the general population, one in five people will experience severe depression at some point in their life.
THE BENEFITS OF EXERCISE
The benefits of exercise for people who have depression have been shown to be significant. Regardless of gender and age, exercise has continually been shown to be benefi cial, and occasionally as effective as antidepressant medication (Biddle & Mutrie, 2005). Exercise has beneficial results both immediately following the session, and in the long term. The most powerful way to assist someone with depression has been shown to be a combination of both exercise and psychotherapy.
The following story about a man with both heart disease and depression offers a good illustration of the benefits of exercise;
‘(He) was so despondent that he wanted to die. Because his heart was weak, he thought the best way to commit suicide without embarrassing his family was to run around the block as fast as he could until he killed himself. After several futile attempts at causing a fatal heart attack in this manner, he discovered to his surprise that he began to feel better and eventually chose to live instead of die’ (Sime, 2002).
THE RANGE OF DEPRESSION
The degree of depression experienced by diff erent individuals can range from mild to chronic, with mild depression being very common. At one point or another, most people have experienced a ‘depressive mood’, which may last for anywhere between a few days and a few weeks. Such a state of mind may be distinguished by symptoms including a lack of energy, loss of appetite or increased appetite, decreased pleasure in activities that were previously enjoyed, increased difficulty in carrying out daily activities and an inability to sleep or an increased need for sleep. Clinical depression, at the other end of the spectrum, is similar to a depressive mood, except it lasts for longer, is more severe and sufferers find it harder to experience a reprieve from symptoms. People who have depressive moods can often bring themselves back with a change in life circumstances, or simply through the passing of time, whereas clinical depression often requires assistance from a psychologist, and possibly medication.
As a personal trainer, you are in a position to potentially be of great benefit to a client who experiences depression. The main factor in helping someone recover from depression is to show them you understand what they are going through. Talk with them about how they are feeling and listen to what they have to say. Showing genuine interest and concern for the client will show them that you care. By building a professional relationship with them, and believing in them, you can help them rebuild their own self-belief. This is something that should be done gradually; if you try to help a client improve their situation before they are ready, then you may be of no assistance to them. In order to help a client move beyond their current situation, you first need to understand where they are mentally and emotionally. By understanding what they are experiencing, and where they are at, you will be able to show genuine empathy which can assist you in gaining the client’s trust and therefore helping them. The time needed to build this level of understanding may be substantial – for some it might take weeks, others months, and for some maybe even years. For more information on how to assist someone with depression, including fact sheets on depression and exercise, visit www.beyondblue.org
HOW TRAINING CAN HELP
In the interim, while you are building your relationship with the client, the way you train them can also be of assistance.
When training clients who experience depression you must take into account activities they enjoy, as well as their energy level. Firstly, it is good for clients to perform activities they take pleasure in and feel capable of completing. This builds satisfaction and self-belief. Secondly, most personal trainers tend to push their clients as hard as they safely can. Many trainers, and clients, view this level of intensity as an important factor in justifying the financial cost of hiring a personal trainer – clients are, effectively, paying for the motivation as much as the trainer’s knowledge. When dealing with people with depression, this may not be the case. The level of energy a client has at the end of a training session is important, so rather than have a client with depression leaving the session exhausted, you want them to leave invigorated. Rather than having the client exercise at maximal heart rate, try to keep them in the sub-maximal range (>75 per cent VO2 max). While they will still benefit from the increased heart rate, they will not tire as quickly. Additionally, try to do all the high intensity activities during the first half of the program, and then lower intensity activities, including stretching, in the second half.
This way the client has an opportunity to recover and leave the session energised, rather than exhausted. This increased vigour can then have a fl ow-on effect into the rest of their day and other parts of their life.
KNOW YOUR LIMITATIONS
Keep in mind, however, that you may not be the best person to counsel a client. As a personal trainer, clients tend to want to talk to you about their various problems, which is fi ne as long as you stay within the boundaries of your job title. This is especially pertinent if a depressed client is not under the care of a psychologist. It is good practice, and good care for a client, if you are able to refer them to a psychologist. Seeing a psychologist can significantly help a client understand their situation and thought patterns. Essentially, psychologists can help clients ‘think’ their way out of depression.
Psychoactive drugs like antidepressants can often be beneficial for clients. Many people report that depression takes the colour out of life; taking anti-depressants can help them bring this colour back. Then, when the individual starts feeling better, they can work at better understanding their thought patterns. Once the psychologist or psychiatrist feels the client is ready, they can begin reducing the use of drugs. An ironic cycle that often occurs is that even without seeing a psychologist, and just by taking anti-depressants, clients start to feel better. Many people then think they are doing well and decide to stop taking the drugs. Then, because the client’s thought patterns have not yet changed (due to their failure to see a psychologist), and the drugs have been removed, they crash back down to where they were, or even lower. The use of antidepressant drugs is a good thing for some people and should not be seen as a negative. If clients are under the care of a psychologist or psychiatrist then you, as a personal trainer, should reinforce the treatment that the client has been prescribed.
If you wish to learn more and develop your ability to work with clients who have depression, visit www.beyondblue.org Alternately, speak with your client’s psychologist or another psychologist and ask them to assist you in learning how to help.
Chad is a provisional psychologist with a private practice in Melbourne focusing on exercise and sport psychology. He is completing the research element of his masters degree in sport psychology and specialises in consulting with gyms and personal trainers on how to provide better services for their clients. For more information, call 0416 113013 or e-mail firstname.lastname@example.org
NETWORK • SUMMER 2008 • PP43-45