Moved by movement: A person-centered approach to physical therapy in the treatment of major depression

Major depression (MD) is a common and debilitating condition. To expand knowledge on adjunctive treatment perspectives, this thesis explores a physical therapy approach in the treatment of MD. Specifically, in five studies, the thesis aims to: I) examine the quality of evidence for exercise in the treatment of MD; II) explore depression as an embodied phenomenon; III) evaluate the effects of add-on aerobic exercise or basic body awareness therapy in MD; IV) explore basic body awareness therapy as experienced by persons with MD; and V) explore experiences of physical therapist-guided aerobic exercise in persons with MD. Methods: Several methodological approaches were used: a systematic review of 14 randomized controlled studies (study I), a randomized controlled trial of 62 participants (study III) and qualitative studies using a hermeneutic phenomenological approach (studies II, IV) exploring the experiences of 11 and 15 participants, respectively, and content analysis (study V) exploring the experiences of 13 participants. Results: Study I showed that aerobic exercise, applied as an add-on strategy compared to treatment-as-usual, had a small significant effect on depression severity. The grading of the quality of evidence was low. Study II showed that the embodiment of depression is experienced as an ambiguous striving against fading, involving disabling features of feeling confined, estranged and burdensome, but also enabling moments of sensing life and belongingness. Study III showed that a ten-week intervention of aerobic exercise, guided by a physical therapist using a person-centered approach, significantly improved depression severity and cardiovascular fitness, compared to generic advice on physical activity. Basic body awareness therapy had a significant effect on self-rated depressive symptoms among participants who followed the protocol. In study IV, the participants’ experiences of basic body awareness therapy were understood as a process of enhanced perceptual openness toward oneself and others – a multidimensional opening toward life. In study V, the participants’ experiences of physical therapist-guided aerobic exercise were thematically interpreted as setting one’s own capabilities in motion, increasing a sense of aliveness and ability to act. In both study IV and V, the participants described the importance of a collaborative relationship with the physical therapist. To some participants, the sense of group coherence was also important. Conclusion: Overall, the findings of this thesis suggest that add-on physical therapy, in particular guided aerobic exercise, mediate changes in the depressed person’s symptoms and self-experience. Collaborative support from the physical therapist was essential in this process, involving an embodied dialogue, perceptive to both the participant’s abilities and vulnerability. Physical therapy has potential to take on a more important role in the primary care rehabilitation of MD, but larger studies with longterm follow-ups are needed