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DBT, Fitness, and Depression


While exercise has not yet been shown to cure any mental health disorder on its own, there are mountains of evidence showing its benefits on mood, self-concept, and work ethic. Exercise has a huge effect on a teen’s emotional wellbeing and even improves cognition. It also has a host of physical benefits: it increases heart rate, reduces stress, improves sleep, lowers blood pressure, and increases energy.

How Exercise Helps with Depression

But what’s most incredible about exercise is that it actually reduces depression and anxiety. One study (Gordon, 2018) found that strength training improves depressive symptoms so much that it works as well as mainstream therapies like CBT and medication.

Carolina Dozal, M.S. PPS, a DBT-trained primary therapist at Evolve Tarzana, says the reason why fitness’ benefits are so well-documented is because it is, by nature, so challenging.

“It’s not easy to get up and go for a run if you’re so anxious or depressed that you can barely get out of bed. But once you do it, and you complete it, you feel better. You feel accomplished, proud of yourself, and want to keep going.” As a Nike-affiliated athlete who has completed marathons and triathlons, Dozal knows this from personal experience.

Additionally, exercise is physically strenuous. “It takes physical exertion to move your legs, get yourself running, to get yourself into a sweat, which is why it’s such a distraction,” adds Dozal. “It completely removes you from rumination and negative thoughts.”

Building Mastery

If you’re trying to get more movement into your day, starting small is fine.

“It doesn’t even have to be running. Even walking is fine. For a client with severe depression, walking can be a huge deal.”

At residential treatment centers like Evolve, clients often engage in fitness training or other exercise on a daily basis. But they start small. “We’ll start with walking or running one mile, then move on to two, and so on.

Dialectical Behavior Therapy (DBT) calls this theory building mastery. “Once we master something, we’ll increase the challenge in small increments, so we get better little by little. Teens can see, from the first to the fourth week, how much stronger they get, both physically and mentally, and how much stamina they build up.” One client, Dozal remembers, eventually completed a 13-mile run.

One thing that Dozal says is ideal, though, is going outside. “For myself and many of my clients, nature can be grounding. If you have a choice between running on the treadmill or running outside, go out.”

Dialectical Behavior Therapy and Exercise

DBT is a huge proponent of physical activity.

For example, Dialectical Behavior Therapy encourages teens to accumulate positive experiences as a way to reduce the chronic sadness associated with depression. Accumulating pleasurable activities is so important that one exercise in DBT (no pun intended!) is to brainstorm, and schedule, fun, and pleasurable activities for the week ahead.

For teens, one example of a rewarding activity could be exercise—in any form they want it, whether it’s yoga, running, basketball, or another sport they enjoy. Not only does such an activity feel good in the short term, it leads to enhanced recovery and limits the rates of relapse.

Exercise: Opposite Action for Depression

Another theory in DBT is opposite action. Opposite action involves doing the “opposite” of what you feel like doing when you’re distressed. So, for teens with depression, who find it difficult to even get out of bed, Opposite Action says get moving—even if you don’t feel like it.

Dozal sees this with her teen clients on a regular basis. “For some depressed teens, it’s a huge struggle to just start stretching. But once they start participating, you see how much of their mood completely changes. Anxiety goes down, depression goes down, self-esteem goes up.”

“It also builds a lot of motivation. Many teens want go home and continue the exercise work they started while in treatment.” This is a good thing, says Dozal, because exercise is one of the healthiest outlets a teen can have. “They set goals for themselves, and then they have something to strive for, something rewarding they can achieve.

“For most of our clients, that’s exactly what we want to encourage.”

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