Concept
Bouldering Psychotherapy 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 therapy concept of bouldering psychotherapy. In addition, participants are given access to in-depth materials describing the therapy.
The training material on this homepage is aimed at therapists who are experienced in the treatment of mental disorders, who also have climbing or bouldering experience in the supervision of groups, and who would like to integrate bouldering exercises into their therapy. For the implementation of Bouldering Psychotherapy, at least one person on the therapeutic team should be licensed as a psychological psychotherapist, and at least one person should be authorized to lead climbing or bouldering groups (at least DAV climbing supervisor, climbing experience grade 7 UIAA).
Treatment planning
The overall guide for group therapy for the treatment of depression is designed for a group of ten participants led by at least two therapists. If there is only one therapist, the group size should be reduced to a maximum of five participants. Some exercises can also be done as individual or partner exercises and singled out to enrich a treatment plan with practical exercises.
The manual contains ten sessions on different topics with corresponding exercises. In some sessions there are alternative exercises that can be done in addition or in replacement. If there is free time, there is always an opportunity for free bouldering after the exercises are completed. However, time is usually rather limited, so it is important to plan preparation time for yourself and the participants to arrive, change, and possibly rent shoes.
Some exercises require materials, which are listed under the heading "Materials". Overall, the following materials should be kept on hand for conducting Bouldering Psychotherapy:
- 2 rolls of tape
- Blindfolds/wipes
- 2 quickdraws (alternatively: string, wooden dowels, etc.)
- Materials to build an obstacle course, e.g., short ropes, scarves, straws, jumping cords, cardboard boxes, pirate eye patch
- Wool (easily tearable)
- Long roll of strong cord (laces)
- 12 clothespins, 4 clipboards
- Long rope
Therapeutic approach
The therapeutic approach is explicitly discussed at the beginning of the therapy. It is made clear to the participants that Bouldering Psychotherapy is their own personal time, which they can use for themselves to change something. It is not about performance (and not primarily about learning to boulder), but about trying things out for themselves and having experiences. There is basically no compulsion to participate in the exercises and participants should know and respect their limits in all exercises. However, openness to new experiences and the willingness to engage in new and unfamiliar things are a necessary prerequisite for change. It is important that the therapist does not create any pressure to perform, but rather accompanies the participants so that they can make experiences at their own pace. The participants' themes usually emerge after several exercises, so it is possible to wait and see whether insights emerge in a later exercise.
The therapy rationale of Bouldering Psychotherapy is based on the fact that the "problems from life" of the participants become visible and can be experienced in the "bouldering problems on the wall". The goal is to be able to directly try out potential solutions in the protected framework of therapy, which are then transferred to everyday life.
Overview of each session
Start phase (35 minutes, in the group room)
Mindfulness exercise | Each session starts with a mindfulness exercise. The mindfulness exercises change throughout the course of the therapy from externally oriented mindfulness (5-4-3-2-1) at the beginning, to internally oriented mindfulness (Body scan, Breathing meditation) in the last sessions. The guidance by the therapists should decrease steadily in the course of the therapy in order to train the participants increasingly in self-directed mindfulness. |
Checking in | Each participant briefly (!) describes the mood they are in at the moment. It is important to stay in the here and now and to limit overly long explanations. |
Session topic | The therapist briefly (!) introduces the topic of the session. To illustrate the topic, appropriate models or metaphors are provided for some sessions. A deepening of the topic should be avoided at this point, as this takes place during the therapeutic supervision in small groups during the bouldering exercises. |
Active phase (60 minutes, in the bouldering hall)
| Warm-up | As a group, participants perform a physical warm-up. To increase readiness and promote group cohesion, an optional group ritual can be introduced with participants during the first hour: participants form a circle, join hands, and count to zero from three. Then they jump in the air, bring their arms up in the air, and shout loudly "Bouldering, Yeah!". |
Group Exercise(s) Bouldering Exercise(s) | Each session includes at least one bouldering exercise and/or group exercise. For most exercises, participants are divided into two groups, each with a therapist in charge. The therapists should rotate between groups throughout the sessions so that the same therapist is not assigned to the same participants. Some exercises are done in groups of two, in which case one therapist will supervise several groups of two. If there are several exercises in the lesson, it is also possible to offer "stations", where one therapist supervises one exercise and the participants switch from one exercise to another. |
Final phase (25 minutes, in the group room)
| Final round | At the end, the therapists discuss with the participants what they experienced during the exercises and give them space to exchange ideas and reflect on what they experienced in the group. The therapists should keep in mind the experiences already discussed in the exercises in order to steer the discussion in the desired direction and to work out essential therapeutic aspects of the respective topic again. |
Relaxation exercise | To conclude the hour, a body-oriented relaxation exercise is guided. In the first four sessions participants are guided through the exercise called “The tree”, and in the following four sessions they are guided through the exercise called “The Mountain”. The participants can decide which exercise they want to do in the last two sessions. |
Bouldering exercises with therapeutic supervision
The bouldering exercises are accompanied by the therapists and, if possible, emerging issues are discussed directly on the wall. It should always be made possible to try it again in a different way (e.g. to do the exercise again with communication and the expression of needs) in order to try out and reflect on alternative behavior directly.
Helpful guiding questions to accompany the exercises are generally:
- How was it for you?
- Do you recognize this from yourself or from other situations?
- How could you do it differently?
For most bouldering exercises, possible variations are listed in the description that can either increase the difficulty of the exercise or shift the focus to another area of experience. The variations can be additionally guided by the therapists if they have the impression that the therapeutic potential of the basic exercise is exhausted and the participants can no longer have new experiences through it. Whether and which variation should be performed is to be determined by the therapists, depending on the small group and individual level of the participants.
Since special conditions of the boulder wall are helpful or necessary for some exercises, the description or type of "Wall" can be found in each exercise, under which special requirements of the wall are listed (if available). Therapists should deal with this before the session, and prepare the wall accordingly, or have it prepared in cooperation with the staff of the bouldering gym.
Materials for participants
At the end of each lesson, a feedback sheet can be handed out to the participants, which they can fill out at home and return to the therapists if they wish. The feedback forms are read by the therapists, but are generally not discussed. They serve to encourage participants to re-engage with Bouldering Psychotherapy and to reflect on the experience of the boulder therapy session. For the therapists, they provide an overview of how the participants fared during the hour. If there are any abnormalities in one of the feedback forms, the therapists can address the respective participant in the next session.
There are written instructions for the mindfulness and relaxation exercises, which can be handed out to the participants after the lesson during which the corresponding exercise was taught for the first time.
In-depth material for therapists
Literature
Lukowski, T. Klettern in der Therapie. Ernst Reinhardt Verlag.
Kowald A, Zajetz A (Hrsg.). Therapeutisches Klettern. Anwendungsfelder in Psychotherapie und Pädagogik. Klett-Cotta.
Trainings
Erfahrungsfeld Klettern GbR Erfahrungsfeld Klettern (erfahrungsfeld-klettern.de)
Institut für therapeutisches Klettern e.u. (ITK) Therapeutisches Klettern | Ausbildungen im Bereich Therapieklettern
Dr. med. Thomas Lukowski Ausbildungskurs „Klettern in der Psychotherapie
DAV Ausbildungsprogramm (z.B. Kletterbetreuer*in) DAV-Ausbildungsprogramm 2023 - Startseite - DAV Ausbildungsprogramm 2023 (alpenverein.de)
Scientific studies
Luttenberger K, Stelzer EM, Forst S, Schopper M, Kornhuber J, Book S. 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. 2015;15:201. doi: 10.1186/s12888-015-0585-8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4548691/
Stelzer E-M, Book S, Graessel E, Hofner B, Kornhuber J, Luttenberger K. Bouldering psychotherapy reduces depressive symptoms even when general physical activity is controlled for: A randomized controlled trial. Heliyon. 2018;4(3):e00580. doi: 10.1016/j.heliyon.2018.e00580. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5968135/
Schwarz L, Dorscht L, Book S, Stelzer EM, Kornhuber J, Luttenberger K. Long-term effects of bouldering psychotherapy on depression: benefits can be maintained across a 12-month follow-up. Heliyon. 2019;5(12):e02929. Epub 2019/12/25. doi: 10.1016/j.heliyon.2019.e02929. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6911955/
Dorscht L, Karg N, Book S, Graessel E, Kornhuber J, Luttenberger K. 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. 2019;19(1):154. Epub 2019/05/19. doi: 10.1186/s12888-019-2140-5. 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 - PubMed (nih.gov)
Karg N, Dorscht L, Kornhuber J, Luttenberger K. Bouldering psychotherapy is more effective in the treatment of depression than physical exercise alone: results of a multicentre randomised controlled intervention study. BMC Psychiatry. 2020;20(1):116. Epub 2020/03/14. doi: 10.1186/s12888-020-02518-y. Bouldering psychotherapy is more effective in the treatment of depression than physical exercise alone: results of a multicentre randomised controlled intervention study (nih.gov)
Kratzer A, Luttenberger K, Karg-Hefner N, Weiss M, Dorscht L. Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial. BMC Psychol. 2021 Aug 26;9(1):126. doi: 10.1186/s40359-021-00627-1. PMID: 34446114; PMCID: PMC8393466. Bouldering psychotherapy is effective in enhancing perceived self-efficacy in people with depression: results from a multicenter randomized controlled trial - PubMed (nih.gov)
Schwarzkopf L, Dorscht L, Kraus L, Luttenberger K. 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 Serv Res. 2021 Oct 26;21(1):1162. doi: 10.1186/s12913-021-07153-1. Is bouldering-psychotherapy a cost-effective way to treat depression when compared to group cognitive behavioral therapy - results from a randomized controlled trial - PubMed (nih.gov)
Luttenberger K, Karg-Hefner N, Berking M, Kind L, Weiss M, Kornhuber J, Dorscht L. Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial. Br J Clin Psychol. 2021 Nov 17. doi: 10.1111/bjc.12347. Bouldering psychotherapy is not inferior to cognitive behavioural therapy in the group treatment of depression: A randomized controlled trial - PubMed (nih.gov)
