Bouldering Psychotherapy

Bouldering out of depression

Bouldering Psychotherapy (BPT) combines action-oriented elements of bouldering (climbing on short outdoor boulders or artificial climbing walls without a rope or harness) with psychotherapeutic interventions, including cognitive behavioral therapy and mindfulness as well as relaxation exercises. It was developed for group treatment of individuals with depression and its effectiveness has been demonstrated in several scientific studies. Specifically, when compared with established approaches to depression treatment, Bouldering Psychotherapy has been shown to be more effective than physical activity alone and at least as effective as cognitive behavioral therapy.

The BouldApy manual provides interested therapists who previously participated in our survey with digital access to the evaluated treatment guide of bouldering psychotherapy. In addition, participants are given access to in-depth materials describing the therapy.

To the Login

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19:43min - Abschnitt "Bouldern gegen Depressionen"

Origins of the project

The KuS (Climbing and Mood) project

The “Klettern und Stimmung” (KuS) project (Climbing and Mood) was launched in 2013 by two psychiatric nurses (Stefan Först und Matthias Schopper) and a psychotherapist (project leader Prof. Dr. Katharina Luttenberger). The original idea - namely to combine action-oriented elements of bouldering with psychotherapeutic approaches to treat depression - led to the development of a first version of bouldertherapy (KuS therapy). Although therapeutic bouldering or climbing is and has been offered at a variety of hospitals, up to this point there has been no comprehensive manual for its implementation in the treatment of depression, nor any high-quality studies to evaluate its effectiveness. KuS therapy was integrated into the treatment of outpatients at the Psychiatric Institute Outpatient Clinic of the University Hospital Erlangen (www.kletternundstimmung.de) and evaluated in a pilot study (2013-2015). The promising results of the pilot study enabled us to further develop the therapy and to test its efficacy in a large-scale multicenter study (KuS study). Further development focused primarily on enrichment with psychotherapeutic content and an expansion from 8 to 10 hours. Thus, Bouldering Psychotherapy (BPT) was born. BPT group therapies have so far been conducted mainly in the Erlangen/Nuremberg area, but also in the Munich area (Weyarn) and in Berlin, treating over 500 patients.

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The therapy

Bouldering Psychotherapy is a combination of psychotherapeutic techniques and sport activity through bouldering. In 10 units, various topics important for the therapy of depression are worked on. Unlike in classical behavioral therapy, this is not done in conversation, but in direct experience on the bouldering wall.

The manual

BouldApy

The manual offers interested therapists digital access to the evaluated therapy concept of bouldering psychotherapy. It contains detailed descriptions of the lessons and all included exercises. In the participants' area, more in-depth materials on the lessons can also be made accessible.

The manual is completely free of charge. However, in order to receive the access data, we ask you to participate in our survey in advance and to fill out a short anonymous online questionnaire about your professional background, qualifications and expectations for the manual (approx. 5-10 minutes).

The questionnaire, and further information on how to apply for access to the data, can be found here:

https://redcap.link/bouldapy

As a participant in a bouldering psychotherapy group, you will receive the access data from your therapist.

Networking

Congress on Therapeutic Climbing/Bouldering:
- June 27 - 28, 2025 in Erlangen
- More information will follow here

Email Distribution List:
If you are interested in connecting with other like-minded, we have created an open email distribution list that anyone can join who would like to exchange ideas about bouldering or climbing therapy. Through this, experiences with billing options or implementation modalities of Bouldering Psychotherapy can be shared. We will also join the email distribution list but will not moderate it. If you would like to join, you can find the link here: Therapeutisches Klettern Verteiler - Google Groups

Literature on therapeutic climbing/bouldering

Background

Busch, M., Maske, U., Ryl, L., Schlack, R. & Hapke, U. (2013). Prävalenz von depressiver Symptomatik und diagnostizierter Depression bei Erwachsenen in Deutschland. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz, 56(5–6), 733–739. https://doi.org/10.1007/s00103-013-1688-3
Corrigan, P. W., Druss, B. G. & Perlick, D. (2014). The impact of mental illness stigma on seeking and participating in mental health care. Psychological Science in the Public Interest, 15(2), 37–70. https://doi.org/10.1177/1529100614531398
Jacobi, F., Wittchen, H., Hölting, C., Höfler, M., Pfister, H., Müller, N. & Lieb, R. (2004). Prevalence, co-morbidity and correlates of mental disorders in the general population: results from the German Health Interview and Examination Survey (GHS). Psychological Medicine, 34(4), 597–611. https://doi.org/10.1017/s0033291703001399
Kessler, R. C., McGonagle, K. A., Zhao, S., Nelson, C. P., Hughes, M. L., Eshleman, S., Wittchen, H. & Kendler, K. S. (1994). Lifetime and 12-Month prevalence of DSM-III-R psychiatric disorders in the United States. Archives of General Psychiatry, 51(1), 8. https://doi.org/10.1001/archpsyc.1994.03950010008002
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V. & Üstün, B. (2007). Depression, chronic diseases, and decrements in health: Results from the World Health Surveys. The Lancet, 370(9590), 851–858. https://doi.org/10.1016/s0140-6736(07)61415-9
Thornicroft, G., Chatterji, S., Evans‐Lacko, S., Gruber, M. J., Sampson, N. A., Aguilar‐Gaxiola, S., et al. (2017). Undertreatment of people with major depressive disorder in 21 countries. The British Journal of Psychiatry, 210(2), 119-124. https://doi.org/10.1192/bjp.bp.116.188078
World Health Organization. The International Classification of Functioning, Disability and Health: ICF. Geneva: World Health Organization; 2001.
World Health Organization. Global Burden of Disease. 2004 update Genf: World Health Organization, 2008.

Paper

Bichler, C. S., Niedermeier, M., Hüfner, K., Gálffy, M., Gostner, J. M., Nelles, P., Schöttl, S. E., Sperner‐Unterweger, B. & Kopp, M. (2022). Climbing as an Add-On Treatment Option for patients with Severe Anxiety Disorders and PTSD: Feasibility analysis and first results of a randomized controlled longitudinal clinical pilot trial. International Journal of Environmental Research and Public Health, 19(18), 11622. https://doi.org/10.3390/ijerph191811622
Bichler, C. S., Niedermeier, M., Hüfner, K., Gálffy, M., Sperner‐Unterweger, B. & Kopp, M. (2022). Affective responses to both climbing and Nordic walking exercise are associated with Intermediate-Term increases in physical activity in patients with anxiety and posttraumatic stress disorder - a randomized longitudinal controlled clinical pilot trial. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.856730
Book, S. & Luttenberger, K. (2015). Ein neuer Weg in der Behandlung depressiver Symptome. DNP, 16(11), 30–34. https://doi.org/10.1007/s15202-015-0964-5
Buechter, R. B. & Fechtelpeter, D. (2011). Climbing for Preventing and Treating Health Problems: A Systematic review of Randomized Controlled Trials. PubMed. https://doi.org/10.3205/000142
Christensen, M. S., Jensen, T. B., Voigt, C. B., Nielsen, J. B. & Lorentzen, J. (2017). To be active through indoor-climbing: an exploratory feasibility study in a group of children with cerebral palsy and typically developing children. BMC Neurology, 17(1). https://doi.org/10.1186/s12883-017-0889-z
Crawford, J., Vallance, J. K., Holt, N. L., Bell, G. J., Steed, H. & Courneya, K. S. (2017). A pilot randomized, controlled trial of a wall climbing intervention for gynecologic cancer survivors. Oncology Nursing Forum, 44(1), 77–86. https://doi.org/10.1188/17.onf.77-86
Crawford, J., Vallance, J. K., Holt, N. L., Steed, H. & Courneya, K. S. (2016). A Phase I/II pilot study assessing the preliminary efficacy of wall climbing for improving posttraumatic growth and quality of life in gynecologic cancer survivors. Mental Health and Physical Activity, 11, 60–66. https://doi.org/10.1016/j.mhpa.2016.10.002
Dorscht, L., Karg, N., Book, S., Graessel, E., Kornhuber, J. & Luttenberger, K. (2019). A German climbing study on depression: a bouldering psychotherapeutic group intervention in outpatients compared with state-of-the-art cognitive behavioural group therapy and physical activation – study protocol for a multicentre randomised controlled trial. BMC Psychiatry, 19(1).
https://doi.org/10.1186/s12888-019-2140-5
Draper, N., Dickson, T., Fryer, S. M., Blackwell, G., Winter, D., Scarrott, C. & Ellis, G. (2011). Plasma cortisol concentrations and perceived anxiety in response to On-Sight rock climbing. International Journal of Sports Medicine, 33(01), 13–17. https://doi.org/10.1055/s-0031-1284348
Frühauf, A., Heußner, J. & Niedermeier, M. (2021). Expert Views on Therapeutic Climbing—A Multi-Perspective, Qualitative Study. International Journal of Environmental Research and Public Health, 18(7), 3535. https://doi.org/10.3390/ijerph18073535
Frühauf, A., Niedermeier, M., Sevecke, K., Haid-Stecher, N., Albertini, C., Richter, K. & Schipflinger, S. (2020). Affective responses to climbing exercises in children and adolescents during in-patient treatment for mental health disorders A pilot study on acute effects of different exercise interventions. Psychiatry Research, 291, 113245. https://doi.org/10.1016/j.psychres.2020.113245
Frühauf, A., Sevecke, K. & Kopp, M. (2018). Ist-Stand der Fachliteratur zu Effekten des therapeutischen Kletterns auf die psychische Gesundheit – Fazit: Viel zu tun. Neuropsychiatrie, 33(1), 1–7. https://doi.org/10.1007/s40211-018-0283-0
Fryer, S. M., Dickson, T., Draper, N., Blackwell, G. & Hillier, S. G. (2012). A psychophysiological comparison of on‐sight lead and top rope ascents in advanced rock climbers. Scandinavian Journal of Medicine & Science in Sports, 23(5), 645–650. https://doi.org/10.1111/j.1600-0838.2011.01432.x
Grzybowski, C. & Eils, E. (2011). Therapeutisches Klettern - kaum erforscht und dennoch zunehmend eingesetzt. Sportverletzung-sportschaden, 25(02), 87–92. https://doi.org/10.1055/s-0029-1245539
Heitkamp, H., Wörner, C. & Horstmann, T. (2005). Klettertraining bei Jugendlichen: Erfolge für die wirbelsäulenstabilisierende Muskulatur. Sportverletzung-sportschaden, 19(01), 28–32. https://doi.org/10.1055/s-2005-857953
Hodgson, C. I., Draper, N., McMorris, T., Jones, G. A., Fryer, S. M. & Coleman, I. (2008). Perceived anxiety and plasma cortisol concentrations following rock climbing with differing safety rope protocols. British Journal of Sports Medicine, 43(7), 531–535. https://doi.org/10.1136/bjsm.2007.046011
Hofferer, M., & Royer, S. (2001). Klettern mit Kindern mit Problemverhalten. Praktische Anwendung in der kommunikationspädagogisch-kindertherapeutischen Behandlung. Schweizerische Zeitschrift für Heilpädagogik(3), 7-14. http://bidok.uibk.ac.at/library/hofferer-klettern.html
Karg, N., Dorscht, L., Kornhuber, J. & Luttenberger, K. (2020). Bouldering psychotherapy is more effective in the treatment of depression than physical exercise alone: results of a multicentre randomised controlled intervention study. BMC Psychiatry, 20(1). https://doi.org/10.1186/s12888-020-02518-y
Kern, C. (2010). Klettern mit Multiple Sklerose. Therapieoption oder nur ein Traum? erleben und lernen. Internationale Zeitschrift für handlungsorientiertes Lernen, 18, 27–31. https://mediatum.ub.tum.de/1080172
Kleinstäuber, M., Reuter, M., Doll, N. & Fallgatter, A. J. (2017). Rock climbing and acute emotion regulation in patients with major depressive Disorder in the context of a psychological inpatient treatment: a controlled pilot trial. Psychology Research and Behavior Management, Volume 10, 277–281. https://doi.org/10.2147/prbm.s143830
Kratzer, A., Luttenberger, K., Karg-Hefner, N., Weiss, M. & Dorscht, L. (2021). Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial. BMC Psychology, 9(1). https://doi.org/10.1186/s40359-021-00627-1
Leichtfried, V. (2015). Therapeutisches Klettern- eine Extremsportart geht neue Wege. In F. Berghold, H. Brugger, M. Burtscher, W. Domej, D. B., R. Fischer, P. Paal, W. Schaffert, W. Schobersberger, & G. Sumann (Eds.), Alpin- und Höhenmedizin (pp. 107-117). Springer.
Ley, C., Barrio, M. R. & Koch, A. (2017). “In the Sport I am Here”: Therapeutic processes and health Effects of sport and exercise on PTSD. Qualitative Health Research, 28(3), 491–507. https://doi.org/10.1177/1049732317744533
Luttenberger, K., Baggenstos, B., Najem, C., Sifri, C., Lewczuk, P., Radegast, A. & Rosenbaum, S. (2024). A psychosocial bouldering intervention improves the well-being of young refugees and adolescents from the host community in Lebanon: results from a pragmatic controlled trial. Conflict And Health, 18(1). https://doi.org/10.1186/s13031-024-00615-3
Luttenberger, K., Karg-Hefner, N., Berking, M., Kind, L., Weiss, M., Kornhuber, J. & Dorscht, L. (2021). Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group Treatment of Depression: a Randomized Controlled trial. British Journal of Clinical Psychology, 61(2), 465–493. https://doi.org/10.1111/bjc.12347
Luttenberger, K., Stelzer, E., Först, S., Schopper, M., Kornhuber, J. & Book, S. (2015). Indoor rock climbing (bouldering) as a new treatment for depression: Study design of a waitlist-controlled randomized group pilot study and the first results. BMC Psychiatry, 15(1). https://doi.org/10.1186/s12888-015-0585-8
Mazzoni, E. R., Purves, P. L., Southward, J., Rhodes, R. E. & Temple, V. A. (2009). Effect of indoor wall climbing on Self-Efficacy and Self-Perceptions of children with special needs. Adapted Physical Activity Quarterly, 26(3), 259–273. https://doi.org/10.1123/apaq.26.3.259
Mehl, K., & Wolf, M. (2008). Erfahrungsorientiertes Lernen in der Psychotherapie - Evaluation psychophysischer Expositionen auf dem Hochseil im Rahmen eines multimethodalen stationären Behandlungskonzeptes [Experiential learning in psychotherapy. Evaluation of psychophysical exposure to a tightrope course as adjunct to inpatient psychotherapeutic treatment]. Psychotherapeut, 53, 35-42. https://doi.org/10.1007_s00278-007-0569-3
Mollenhauer, A., Doll, N., Renz, P., & Luntz, J. (2011). Therapeutisches Klettern in der Akutpsychiatrie [Therapeutic climbing for acute psychiatric patients]. Pflegewissenschaft, 9, 453-461. https://doi.org/10.3936/1101
Pott, C. (2020). Erster Kongress zum Therapeutischen Klettern. Physiopraxis, 18(2), 46-49.
Rodio, A., Fattorini, L., Rosponi, A., Quattrini, F. M. & Marchetti, M. (2008). Physiological adaptation in noncompetitive rock climbers: good for aerobic fitness? The Journal of Strength and Conditioning Research, 22(2), 359–364. https://doi.org/10.1519/jsc.0b013e3181635cd0
Schnitzler, E. E. (2009). Loslassen, um weiter zu kommen – Praxisbericht: Therapeutisches Klettern in der psychosomatischen Rehabilitation. Die Rehabilitation, 48(01), 51–58. https://doi.org/10.1055/s-0028-1100408
Schwarz, L., Dorscht, L., Book, S., Stelzer, E., Kornhuber, J. & Luttenberger, K. (2019). Long-term effects of bouldering psychotherapy on depression: Benefits can be maintained across a 12-month follow-up. Heliyon, 5(12), e02929. https://doi.org/10.1016/j.heliyon.2019.e02929
Schwarzkopf, L., Dorscht, L., Kraus, L. & Luttenberger, K. (2021). Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy – results from a randomized controlled trial. BMC Health Services Research, 21(1). https://doi.org/10.1186/s12913-021-07153-1
Steimer, J. & Weissert, R. (2017). Effects of sport climbing on multiple sclerosis. Frontiers in Physiology, 8. https://doi.org/10.3389/fphys.2017.01021
Stemberger, M., Schmit, E., Czepa, D., Kurnik, K. & Spannagl, M. (2014). Climbing therapy under PK-tailored prophylaxis. Hamostaseologie, 34(S 01), S13–S16. https://doi.org/10.5482/hamo-14-01-0003
Stelzer, E., Book, S., Graessel, E., Hofner, B., Kornhuber, J. & Luttenberger, K. (2018). Bouldering psychotherapy reduces depressive symptoms even when general physical activity is controlled for: A randomized controlled trial. Heliyon, 4(3), e00580. https://doi.org/10.1016/j.heliyon.2018.e00580
Thaller, L., Frühauf, A., Heimbeck, A., Voderholzer, U. & Kopp, M. (2022). A comparison of acute effects of climbing therapy with Nordic walking for inpatient adults with mental health Disorder: a clinical pilot trial. International Journal of Environmental Research and Public Health, 19(11), 6767. https://doi.org/10.3390/ijerph19116767
Trinks, S., Kern, C., & Peters, C. (2010). Therapeutisches Klettern in der Rehabilitation. Eine Bestandsaufnahme. Praxis Physiotherapie, 3, 158-162.
Velikonja, O., Čurić, K., Ožura, A. & Jazbec, S. (2010). Influence of sports climbing and yoga on spasticity, cognitive function, mood and fatigue in patients with multiple sclerosis. Clinical Neurology and Neurosurgery, 112(7), 597–601. https://doi.org/10.1016/j.clineuro.2010.03.006
Veser, S., Bady, M. & Wiesner, M. (2009). Therapeutisches Klettern bei Kindern mit ADHS – konzentriert durch Klettern. Ergopraxis, 2(04), 18–21. https://doi.org/10.1055/s-0030-1254350
Wallner, S. (2010). Psychologisches Klettern: Klettern als Mittel klinisch- und gesundheitspsychologischen Handelns [Psychological Climbing. Climbing as an instrument of clinical and health psychological treatment]. Psychologie in Österreich, 30(5), 396-403.
Wolf, M. & Mehl, K. (2011). Experiential Learning in Psychotherapy: Ropes Course exposures as an adjunct to inpatient treatment. Clinical Psychology & Psychotherapy, 18(1), 60–74. https://doi.org/10.1002/cpp.692

Bachelor/Master's/Doctoral theses

Bady, M., Veser, S., & Wiesner, M. (2007). Klettern als Therapie [Unveröffentlichte Bachelorarbeit, Hogeschool Zuyd, Heerlen, Niederlande].
Kern, C. (2014). Entwicklung eines therapeutischen Kletterprogramms und Evaluation seiner Effekte auf Personen mit Multipler Sklerose. Dissertation, Fakultät für Sport- und Gesundheitsförderung, Technische Universität München
Papendieck, K. (2024). Klettern zur Reduzierung von Symptomen bei Menschen mit Depressionen
[Unveröffentlichte Bachelorarbeit, Ernst-Abbe-Hochschule Jena, Deutschland].

Books

Kowald, A. & Zajetz, A. K. (2014). Therapeutisches Klettern: Anwendungsfelder in Psychotherapie und Pädagogik.
Lukowski, T. (2017). KIT: Klettern in der Therapie. In Springer eBooks (S. 121–128). https://doi.org/10.1007/978-3-662-54544-7_5

The team

Project manager

Dipl.-Psych. Prof. Dr. Katharina Luttenberger

Psychological psychotherapist (behavioral therapy)

Bouldering therapist and climbing coach (DAV)

Research Assistant

Leona Kind

Psychologist (M.Sc.)

Psychological Psychotherapist in Training (Behavioral Therapy)

Research Assistent

Lola Herrmann

Psychologist (M.Sc.)

Psychological Psychotherapist in Training (Behavioral Therapy)