Center for Health Services Research in Medicine, Department of Psychiatry and Psychotherapy, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
Department of Clinical Psychology and Psychotherapy, Friedrich-Alexander University Erlangen-Nürnberg (FAU), Germany.
Br J Clin Psychol. 2022 Jun;61(2):465-493. doi: 10.1111/bjc.12347. Epub 2021 Nov 17.
Bouldering has shown promising results in the treatment of various health problems. In previous research, bouldering psychotherapy (BPT) was shown to be superior to a waitlist control group and to physical exercise with regard to reducing symptoms of depression. The primary aim of this study was to compare group BPT with group cognitive behavioural psychotherapy (CBT) to test the hypothesis that BPT would be equally as effective as CBT.
We conducted a randomized, controlled, assessor-blinded non-inferiority trial in which 156 outpatients meeting the criteria of a depressive episode according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) were randomly assigned to one of the two intervention groups (CBT: N = 77, BPT: N = 79).
Intervention groups were manualized and treated for 10 weeks with a maximum of 11 participants and two therapists. The primary outcome was depressive symptom severity assessed with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Patient Health questionnaire (PHQ-9) at the beginning and end of the treatment phase as well as one year after the end of treatment.
In both groups, depressive symptoms improved significantly by an average of one severity level, moving from moderate to mild depressive symptoms after therapy (MADRS difference scores: BPT -8.06, 95% CI [-10.85, -5.27], p < .001; CBT -5.99, 95% CI [-8.55, -3.44], p < .001). The non-inferiority of BPT in comparison with CBT was established on the basis of the lower bound of the 95% confidence interval falling above all of the predefined margins. BPT was found to be effective in both the short (d = 0.89) and long term (d = 1.15).
Group BPT was found to be equally as effective as group CBT. Positive effects were maintained until at least 12 months after the end of therapy. Thus, BPT is a promising approach for broadening the therapeutic field of therapies for depression.
Physical activity is effective in the treatment of depression and current guidelines explicitly recommend it as a complementary method for the treatment of depression. Nevertheless, body-related interventions are still underrepresented in current treatments for depression. Bouldering psychotherapy (BPT) combines physical activity with psychotherapeutic content. Its concept relies on proven effective factors from CBT such as exposure training, problem solving and practicing new functional behaviours and is thus an enrichment and implementation of CBT methods on the bouldering wall. The positive effect of group bouldering psychotherapy (BPT) in reducing depressive symptoms in outpatients with depression is not inferior to the effect of group cognitive behavioural therapy (CBT). Additionally the 10-weeks BPT-programme significantly improved symptoms of anxiety and interpersonal sensitivity as well as health-related quality of life, coping, body image, self-efficacy, and global self-esteem.
抱石运动在治疗各种健康问题方面显示出良好的效果。在之前的研究中，与等待对照组和身体运动相比，抱石心理疗法（BPT）显示出降低抑郁症状的效果更优。本研究的主要目的是比较 BPT 组和认知行为治疗（CBT）组，以验证 BPT 与 CBT 同样有效的假设。
我们进行了一项随机、对照、评估者盲法的非劣效性试验，其中 156 名符合根据《精神障碍诊断与统计手册》（DSM-IV）诊断为抑郁发作标准的门诊患者被随机分配到两个干预组之一（CBT：N=77，BPT：N=79）。
干预组采用手册化治疗，治疗 10 周，最多有 11 名参与者和两名治疗师。主要结局是用蒙哥马利-阿斯伯格抑郁评定量表（MADRS）和患者健康问卷（PHQ-9）在治疗开始和结束时以及治疗结束后 1 年评估抑郁症状严重程度。
两组的抑郁症状均显著改善，平均改善一个严重程度水平，治疗后从中度抑郁症状转为轻度抑郁症状（MADRS 差值评分：BPT -8.06，95%CI [-10.85，-5.27]，p<0.001；CBT -5.99，95%CI [-8.55，-3.44]，p<0.001）。BPT 与 CBT 相比的非劣效性基于 95%置信区间的下限落在所有预先设定的边界之上。BPT 在短期（d=0.89）和长期（d=1.15）都有效。
BPT 组被发现与 CBT 组同样有效。积极的影响至少持续到治疗结束后 12 个月。因此，BPT 是拓宽抑郁治疗领域的一种很有前途的方法。
身体活动在治疗抑郁方面是有效的，当前的指南明确建议将其作为治疗抑郁的一种补充方法。尽管如此，身体相关干预在当前的抑郁治疗中仍然代表性不足。抱石心理疗法（BPT）将身体活动与心理治疗内容相结合。其理念基于认知行为疗法（CBT）中已被证明有效的因素，如暴露训练、解决问题和练习新的功能性行为，因此是对 CBT 方法在抱石墙上的丰富和实施。团体抱石心理疗法（BPT）可显著降低抑郁门诊患者的抑郁症状，其效果不劣于团体认知行为疗法（CBT）。此外，为期 10 周的 BPT 方案还显著改善了焦虑和人际敏感以及与健康相关的生活质量、应对能力、身体形象、自我效能感和整体自尊。
