In clinical psychology, treatments are rarely used in isolation. When exercise is prescribed alongside standard treatments like medication or psychotherapy, it is called an adjunctive treatment.
For psychology entrance exams, it is important to understand why combining treatments often leads to better outcomes for patients with major depressive disorder. Combining treatments targets depression from multiple angles at once.
Exercise and Medication (SSRIs)
Selective Serotonin Reuptake Inhibitors (SSRIs) are the most common medications for depression. They work by increasing serotonin levels in the brain. Exercise also boosts mood-regulating chemicals, including serotonin, dopamine, and endorphins.
When a patient combines exercise with SSRIs, two major clinical benefits occur:
- The Synergistic Effect: Both SSRIs and exercise increase BDNF (Brain-Derived Neurotrophic Factor). BDNF is a protein that helps the brain grow new neural connections, a process known as neuroplasticity. When used together, medication and exercise have a synergistic effect. This means their combined benefit is greater than the sum of their individual effects.
- Managing Side Effects: Antidepressants can sometimes cause unwanted side effects, such as weight gain, lethargy, or sleep disturbances. Regular exercise naturally combats these side effects by burning calories, increasing daily energy levels, and regulating sleep cycles.
Exercise and Cognitive Behavioral Therapy (CBT)
CBT is a type of talk therapy that focuses on changing negative thought patterns and behaviors. Exercise pairs perfectly with CBT for several reasons:
- Behavioral Activation: Depression often causes people to withdraw and stop doing activities. CBT uses ”behavioral activation” to encourage patients to engage in rewarding activities. Exercise is a highly effective form of behavioral activation that breaks the cycle of inactivity.
- Building Self-Efficacy: Self-efficacy is a person’s belief in their ability to succeed in specific situations. Depression often destroys self-efficacy. When a patient sets a small exercise goal (like walking for 20 minutes) and achieves it, their self-efficacy grows. This newfound confidence carries over into their therapy sessions, making them more engaged and willing to do the mental work required in CBT.
The Biopsychosocial Model
Combining treatments is a perfect example of the biopsychosocial model in action. This is a core concept in psychology that you will likely encounter on your entrance exam. The model states that health and illness are determined by a complex interaction of biological, psychological, and social factors.
When we combine treatments, we address all three areas:
- Biological: Medication and exercise change brain chemistry and promote neuroplasticity.
- Psychological: CBT and exercise improve self-esteem, self-efficacy, and coping skills.
- Social: Group therapy or group exercise classes (like yoga or team sports) reduce the social isolation that often accompanies depression.
Key Terms for Your Exam Review
To analyze clinical studies effectively on your exam, make sure you understand these terms:
- Adjunctive Treatment: A secondary treatment used alongside a primary treatment to maximize results (e.g., adding exercise to an SSRI prescription).
- Synergistic Effect: When two treatments work together to produce an effect greater than they would alone.
- BDNF: A protein boosted by both SSRIs and exercise that helps the brain adapt and grow.
- Behavioral Activation: A CBT technique that encourages patients to engage in activities, like exercise, to improve mood.
- Self-Efficacy: The belief in one’s own ability to complete tasks and reach goals.