Training clients with depression
Personal trainers are uniquely positioned to both recognise the signs of depression and to help those suffering its debilitating effects.
Working with depression – is that my job?’ you may ask. It will definitely come into your job. If you work with people in any way at all, you will come across individuals who are depressed. About one in seven suffer from depression, one in eight take antidepressant medication.
As a personal trainer you are in a unique position to see a change in mood or notice someone who is stuck and can’t get motivated.
Depression is sometimes referred to as the common cold of emotional problems. Everyone feels ‘down’ or miserable at times, especially in the face of disappointment or loss. Usually, these feelings pass and we move on in some way. Gradually we take pleasure in the enjoyable aspects of our life again and the bad feelings fade.
When depression sets in, however, it feels impossible to shake off the feelings of gloom and misery, even when something good happens. Depression is a cluster of mental and physical symptoms which are more persistent than the occasional off-day. The physical signs are disturbances in sleep, appetite and energy levels, while the mental effects include loss of enjoyment, lowered motivation and increased feelings of failure and self-criticism.
At its worst, people describe difficulty concentrating and thoughts of ending their lives. If a client has either of these signs, encourage them to seek help from a doctor or psychologist. Sometimes people need professional treatment before they can apply the strategies that will help them to help themselves.
If your client lacks motivation or is persistently self-critical, you will need to sit down for a gentle talk to find out what their inner world is like. What do they want to achieve and what are the obstacles? Can your client explain what the important factors are behind their stated goals? A depressed client may be clutching at straws to verbalise a reason for wanting to achieve their goal, so tease out the underlying drivers with some open questions: How will this goal contribute to their lives? What do they want to feel inside? Does it fit with their values? What would family and friends think? Asking these questions can help your client to be authentic and true to themselves.
Then, together, design a program that has the best chance of cutting through the lack of motivation and giving the client a sense of achievement. Because depression creates a strong feeling of powerlessness, small successes can help to rebuild confidence.
Eating for mental wellbeing
Good nutrition has been shown to have a powerful effect on mental wellbeing, which equals or even surpasses the use of antidepressants (search ‘Julia Rucklidge’ on YouTube for an insightful Tedx Talk on this topic). Unless you’re a qualified nutritionist or dietitian, there are limits on how detailed your nutrition prescription to clients can be (see Perspective on page 6), but you can still offer general healthy eating advice. Encourage clients to reduce sugar and refined carbs, increase protein and fats and, most importantly for depression, increase the amount and variety of fruit and vegetables for the range of valuable micronutrients they contain.
Depressed clients can lose their appetite and graze rather than prepare adequate meals, or comfort-eat, bingeing on sugary foods which have a boom and bust effect on their energy: a spike, followed by a dip, followed by the urge for more sugar to get another boost. With their motivation likely to be low, you will need to be persuasive to encourage your client to make changes. Suggest a small experiment, for example going two weeks without adding sugar to food or drinks, if possible recording intake alongside mood (a simple 1-10 rating is clear to most people). Simply recording intake can often change eating patterns for the better.
Moving for mood elevation
As a fitness professional, you know that exercise plays a huge role in promoting a positive mood. Modern lifestyles are generally too sedentary for our bodies, which are designed to move. Physically, mentally and spiritually, it’s who we are. Someone struggling to get out from under the grey blanket of depression may also be aware that exercise would help – they may even have come to you for that very reason – but they need guidance to set the right goals and overcome the obstacles.
Take walking for example. A brisk 30-minute walk is a proven mood booster, promoting the development of an upright, open posture which in itself improves mood and confidence. Walking will get the client to breathe more deeply and fully, reducing anxiety and improving concentration. The effect of rhythmic movement on the body is centring and grounding. Walking relates us to our environment in a way which taps into millions of years of evolution, especially going barefoot on grass or sand.
Doctors say if only they could get their patients to walk regularly a good part of their work would be done. Clearly just saying ‘walk!’ is not enough. How can you help a client to implement a simple goal of walking regularly, so that they aren’t only active when they are training with you?
First, ask your client about times of success and enjoyment and notice the answers. Do they reflect an interest in statistics? In that case, your client will enjoy recording times and distances, possibly on a phone app. Does your client talk about good times with friends? This client might do well with a walking group or by finding a buddy to walk with. Someone who says ‘it just feels good’ may be kinesthetic and will enjoy a focus on good form and ‘doing it right’.
Adding other sensory stimulation, like listening to music, or walking in surroundings with natural sights, sounds and smells, such as the beach or bush, can also enhance enjoyment.
Having found something that gives your client the best chance of enjoying the activity, you will need to help them set goals in small steps. We are all motivated by success and your client, already handicapped by the lead weight of depression, needs to feel empowered. Your warm response to any progress will mean a lot.
Timing is also key. To increase adherence, exercise needs to fit into daily life. ‘No time’ is a commonly given reason for not exercising, so encourage your client to work it into their routine by walking to work, taking a lunchtime stroll or pushing the baby to the shops in the stroller instead of driving. Dog owners are diligent about making time for their pet’s daily walk – if only we all walked ourselves as conscientiously!
Once you have defined the goals, created an achievable program and made a time to check in, help your client to tune in to the process. In the case of walking, encourage them to stay focused on good posture, full breathing and greater body awareness. Connecting through our senses to the present moment creates a mindful, settling experience which can feel deeply centring and bypass negative thinking.
Jan Marsh M.A. (Hons), Dip Clin Psych is a clinical psychologist with 40 years’ experience working with clients from all walks of life. Her book Harnessing Hope (RRP $14.99) is available from exislepublishing.com.au
Lionel Padial is a performance and wellbeing coach.