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An Open-Air Approach

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One Step Forward

Walk talk therapy is exactly what it sounds like: it’s walking, talking, and it’s therapy. This holistic approach combines counseling, movement, and nature and incorporates my passion for working with both the mind and the body. This also brings me back to my roots as a former pilates and yoga instructor. Walking side by side in open-air can provide new opportunities for self-discovery.

Walk-and-talk therapy sessions are, in essence, walking meetings between client and therapist. While scientists have long known that a workout can temporarily boost serotonin levels and improve mood, the latest research shows that exercise can have a deeper and more lasting effect. One article in the American Journal of Preventive Medicine last year found a correlation between the intensity of exercise and a reduction in depression. A study published in the Journal of Neuroscience found that exercise increases the growth of neuronal brain cells, possibly elevating mood permanently. Advocates of this combined approach say that being active during the session helps clients to relax and open up, and some clients say they find it easier to talk while looking forward and walking, rather than staring the therapist in the eye. While many therapists recommend exercise, walk talk therapy puts it into action.

I come from a narrative therapy approach, regardless of the setting I am working in, and I offer the same treatment both in and out of the office. Often my understanding of clients is enhanced by being with them in the natural world. I gain a greater appreciation for clients by seeing them interact in different settings, or hearing observations about something outside.

Walk talk therapy is moving forward literally and figuratively. It helps clients get unstuck. Naturally, exercise creates endorphins, those feel-good hormones. So for someone who may be experiencing depression or grief, just being outside can help improve their emotional and mental state. Being outside changes someone’s frame of mind. You’re not in a confined space. You have the entire environment. The park becomes part of the therapy process. Toronto psychologist Dr. Kate Hays, author of “Working It Out: Using Exercise in Psychotherapy,” said the method has “a potential for much more openness and disclosure, capacity for insight, the ‘aha’ moments that we know are facilitated by physical activity.”

For many people, nature can be grounding. There is something about the environment that helps our nervous systems unwind. People who walk or run in natural environments report less anger and sadness directly after exercise than those who walk or run in “built” environments, finds a 2010 meta-analysis in BMC Public Health by Diana E. Bowler, PhD, of Bangor University in North Wales, and colleagues. In another series of studies reported in the June 2010 Journal of Environmental Psychology, participants said that being in nature made them feel more alive, beyond the effects of physical activity and social interaction in the outdoors, according to University of Rochester psychologist Richard Ryan, PhD, and colleagues. And studies beginning in the 1990s by psychologists Terry A. Hartig, PhD, Roger S. Ulrich, PhD, and others show that nature helps to quell anxiety and even heal the body. When we’re more open and more relaxed, it helps us access deeper parts of ourselves and our emotions — layers of ourselves that we often don’t have the opportunity to experience otherwise.

It’s not for everybody

There are some challenges. For one, keeping conversations confidential. I explain to all my patients before we begin our walks that they should be careful with anything they don’t want overheard. For some, getting therapy in an office is a better fit. Four walls create a boundary that provides more figurative and literal security for people.

Key reasons for combining exercise and therapy:

  • It encourages a patient to be more physically active for mental and physical reasons. Clients are more likely to exercise outside of sessions as well.
  • It helps a patient get “unstuck” when confronting difficult issues. It gets clients moving-both literally and figuratively.
  • It spurs creative, deeper ways of thinking often released by mood-improving physical activity
  • Walk Talk Therapy is conducted outdoors, being in nature can be meditative and grounding.
  • Research studies have shown that physical activity can enhance the mental and physical health of clients.  Physical activity has also been shown to reduce levels of depression and anxiety and can help to prevent depressive symptoms.
  • It is apparent that combining exercise and therapy accomplishes at least one important goal: helping people do two healthy things they might otherwise put off.

In all, Walk Talk Therapy allows both the client and the therapist to slow down, be mindful, be in the moment, and breathe. It’s about experiencing things in new and different ways.  Walk Talk Therapy allows clients to stay present and active in the process of change and healing.

For more information on WalkTalk Therapy Hanna Zipes’s website at hannazipes.com or e-mail at hannazipes@gmail.com

What is Advanced Resolution Therapy?

Imagine being able to make significant progress in healing from posttraumatic stress in one therapy session. Several mental health practitioners using accelerated resolution therapy (ART) have told me of such stories.

ART is a relatively new brief therapy for treating a variety of behavioral health issues. Effective relief has been shown to be achieved even for combat veterans in only three to five sessions (Kip et al., 2013). It is now being used in a number of U.S. Army hospitals, such as Walter Reed and Fort Belvoir, and is expected to expand through the armed services rapidly. The Federal Substance Abuse and Mental Health Services Administration (SAMHSA) has recognized ART as an evidence-based treatment for depression and depressive symptoms, personal resilience and self-concept, and trauma and stressor-related conditions (PTSD) (Accelerated Resolution Therapy, 2015).

What Is ART?

ART is an eye-movement therapy. The person in therapy moves their eyes back and forth following the therapist’s hand, and the therapist gives specific directions before each set of eye movements. ART draws on a number of other established and evidence-based therapies, such as cognitive behavioral theory, gestalt, and eye movement desensitization and reprocessing (EMDR). However, it is unique in being a procedurally oriented therapy. Other therapies typically focus on the content of the person’s thoughts and emotions.

Since ART is procedurally oriented, the person in therapy doesn’t have to talk about what happened. This makes the approach great when working with people who may have trouble talking about their emotions, as might some individuals in the military. It also may be easier on the therapist, who doesn’t have to experience secondary (vicarious) trauma as a result of hearing about terrible things.

ART Is Said to Work Quickly

Very rapid healing is a hallmark of accelerated resolution therapy. Many therapists trained in ART report people can heal from a single traumatic event—such as an auto accident, assault, or witnessing an atrocity—in as little as one session. Some therapists report healing phobias in one session as well.

One consideration when choosing a therapy is how likely the person is to complete the full course of treatment. The longer a therapy takes to complete, the less likely it is the person will complete it. Because it is such a brief treatment, more people may be likely to complete a course using ART.

I recently watched the developer of ART, Laney Rosenzweig, heal a woman from two phobias in less than an hour. These very rapid results may seem unbelievable to someone familiar only with other therapies. Most of the evidence-based therapies for treating posttraumatic stress expect to take between 12 and 20 sessions to be effective. ART, meanwhile, has been shown to be effective in only three to five sessions in scientific studies of both military and civilian populations (Kip et al., 2012; Kip et al., 2013; Kip et al., 2014).  It was even shown to be effective working with a population of homeless veterans (Kip et al., 2016). Some of them didn’t complete treatment because they found jobs or housing, but despite this, a study found a success rate of over 50%.

One consideration when choosing a therapy is how likely the person is to complete the full course of treatment. The longer a therapy takes to complete, the less likely it is the person will complete it. Because ART is such a brief treatment, more people may be likely to complete a course using this approach to healing.

How Does ART Work?

Research is still pending, but eye movements used in ART are believed to have some link to the sort of eye movement seen in REM sleep, when the brain is believed to be processing the day’s events. We used to believe memories were fixed and that accessing one was like taking a book from a library, looking at it, and then putting it back. In fact, we have found accessing a memory makes it plastic; it can then be altered by the sort of techniques employed by ART. After four to six hours, the memory reconsolidates and the altered (new) memory is stored.

Who Can Benefit from ART?

ART has been used with a wide variety of people. Children as young as 4 have been treated with ART, and I recently utilized the approach to help a 16-year-old male with an IQ of 66. This method has been researched in both military and civilian populations, and similar effectiveness results have been obtained within both populations. (Kip et al., 2015).

Basically, three things are necessary for ART to be successful. The person receiving the treatment must be motivated to heal, capable of tracking the therapist’s hand with their eyes, and able to hold on to a thought.

How ART Differs from EMDR

Col. Charles Hoge, an Army psychiatrist who trained in both EMDR and ART, compared the two and noted 10 points of difference (Hoge, 2015). Some of the major ones are:

  • EMDR uses a variable number of eye movements, while ART uses a fixed number.
  • EMDR uses free association, while ART therapists are directive.
  • EMDR pays attention to content, whereas ART therapists focus on visual imagery and emotional sensations.
  • EMDR is content-oriented, while ART has a procedural orientation.

Why You May Not Have Heard of ART

If ART is so good, why haven’t you heard of it? There are two good reasons.

First, it’s new, having been introduced only in 2008 by its developer, Rosenzweig. Most other evidence-based treatments for posttraumatic stress have been around for over 25 years. Awareness is mostly spread by word of mouth, from one therapist to another, from one person in therapy to another. So far, fewer than 1,000 therapists have been trained in ART, and the vast majority of these therapists are located on the east coast of the U.S.

The second reason is sheer disbelief—based on the length of time it takes for other therapies to work, the ability to heal a person from one traumatic event in only a few sessions (or perhaps just one) simply seems unbelievable to many people, including therapists.

What’s Next for ART?

SAMHSA has identified ART as a “promising” therapy for disruptive behavior issues and antisocial behaviors; phobias, panic, and generalized anxiety; and sleep and wake conditions. These areas all need to be investigated via further research.

In addition, many therapists are reporting success in treating substance abuse and obsessive-compulsive issues with ART, but this type of treatment requires two sessions a week in the early stages.

References:

  1. Accelerated resolution therapy. (2015, May 22). Retrieved from http://nrepp.samhsa.gov/ProgramProfile.aspx?id=7
  2. Hoge, C.W. (2015). Accelerated resolution therapy (ART): Clinical considerations, cautions, and informed consent for military mental health clinicians. Walter Reed Army Institute of Research. Retrieved from http://acceleratedresolutiontherapy.com/wp-content/uploads/2016/08/ART-vs-EMDR_by-Hoge.pdf
  3. Kip, K.E., D’Aoust, R.F., Hernandez, D.F., Girling, S.A., Cuttino, B., Long, M.K., … Rosenzweig, L. (2016). Evaluation of brief treatment of symptoms of psychological trauma among veterans residing in a homeless shelter by use of Accelerated Resolution Therapy (ART). Nursing Outlook, 64:411-223.
  4. Kip, K.E., Elk, C. A., Sullivan, K. L., Kadel, R., Lengacher, C. A., Long, C. J., … Diamond, D. M. (2012). Brief treatment of symptoms of post-traumatic stress disorder (PTSD) by use of accelerated resolution therapy (ART®). Behavioral Sciences, 2(4), 115–134. doi:10.3390/bs2020115
  5. Kip, K.E., Hernandez, D.F., Shuman, A., Witt, A., Diamond, D.M., Davis, S.E., … Rosenzweig, J. (2015). Comparison of accelerated resolution therapy (ART) for treatment of symptoms of PTSD and sexual trauma between civilian and military adults. Military Medicine, 180:964-971. PMID: 26327548
  6. Kip, K.E., Shuman, A., Hernandez, D.F., Diamond, D.M., Rosenzweig, L. (2014). Case report and theoretical description of accelerated resolution therapy (ART) for military-related post-traumatic stress disorder. Military Medicine, 179(1): 31-7, 2014. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24402982
  7. Kip, K.E., Rosenzweig, L., Hernandez, D.F., Shuman, A., Sullivan, K.L., Long, C.J., … Diamond, D.M. (2013). Randomized controlled trial of accelerated resolution therapy (ART) for symptoms of combat-related post-traumatic stress disorder (PTSD). Military Medicine, 178(12): 298-309. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24306011

This article can be found on: https://www.goodtherapy.org/blog/accelerated-resolution-therapy-art-quick-fix-for-ptsd-0301175

WHAT IS NARRATIVE THERAPY?

The Narrative Approach focuses on the stories in people’s lives. It is based on the idea that problems are manufactured in social, cultural and political contexts and that we can never forget that the individual is woven into the greater communities that hold them. People produce the meaning of their life from the stories that are available in that context.In a narrative approach, our lives and stories are seen as multi-storied. Often, by the time a person has come to therapy the stories they have for themselves and their lives become completely dominated by the problems that work to oppress them. These “problem-saturated” stories can also become identities (e.g. “I’ve always been a loser”).“Re-authoring” of people’s stories is a collaboration of stepping away from problem saturated stories to discovering the “untold” story which includes the preferred accounts of people’s lives: their intentions, hopes, values, desires and dreams.The opportunity to view our personal history as one story can help us more easily imagine alternative storylines. I have found that incorporating “teaching tales,” poetry, folklore and mythology can also help the individual imagine positive ways of re-authoring their biography. 
“Narrative Therapy is a respectful, collaborative and non-blaming approach to counselling and community work. This way of working is respectful of the knowledges people have about their own lives, their ways of facing challenges, and their hopes for themselves, their families and their future. It is called ‘Narrative Therapy’ because this approach examines the stories we tell about ourselves and the stories others tell about us. These stories assist us to make sense of the world, and powerfully shape the way we are seen in our own eyes and the eyes of society. This shapes our current and future responses and actions.The Narrative approach sees problems as separate to people and communities. Problems such as anxiety or depression are not the whole story of someone’s life, but often these labels impact identity and convince the person or their family that they do not have the skills to get through difficulties. During the therapeutic conversation, the impact of the problem is explored and acknowledged. In considering stories of skills, knowledges, hopes and values, new options for reducing the influence of the problem become more visible, and therefore, available.”   Reference: Morgan, A. (2000). What is Narrative Therapy: An easy to read introduction. Dulwich Centre Publications: Adelaide, SA. See the Dulwich Centre website