By Joe Tatta, PT, DPT

The physical therapist’s role in mental health has existed since its inception. The physical therapy profession grew out of World War I (1914-1918) when ‘Reconstructive Aides’ were sent overseas and around the United States to help soldiers recover from physical injuries and battle neurosis. Battle neurosis is a type of post-traumatic stress disorder (PTSD) associated with depression, anxiety, and other traumatic symptoms. Physical therapists understand the connection between physical health and mental health. 

Today, doctoral-trained, licensed physical therapists are strengthening the relationship between mental health and physical health. Physical therapists are playing a larger role and taking action to improve individual’s and societies’ mental health and mental well-being.

American Physical Therapy Association (APTA) Policy on the Physical Therapist’s Role in Mental Health

In 2020, the APTA House of Delegates published position #P06-20-40-10: “It is within the professional scope of physical therapist practice to screen for and address behavioral and mental health conditions in patients, clients, and populations.” This has prompted physical therapists to intentionally address mental health as a key component of physical therapy care.

Physical therapists have many interventions which support mental health and well-being. From exercise and physical activity to lifestyle-related health behavior change and psychologically informed care, physical therapists can improve mood and boost patient’s ability to cope with distress related to depression, anxiety, trauma, and more.

How Physical Therapists Can Positively Impact a Client’s Depression

Physical therapists play a crucial role in positively impacting a client’s depression, leveraging their unique expertise in exercise prescription and whole-person care. Depression is a significant public health issue, affecting approximately 300 million people worldwide. It is commonly managed with antidepressants and psychotherapy, yet these treatments have limitations, including side effects, non-adherence, and relapse. Increasing evidence supports the role of exercise and physical activity as an effective intervention for depression. In mild to moderate cases, exercise is viewed by many as first-line depression care. In more severe cases of depression exercise and physical activity should be combined with psychotherapy and antidepressant medication for maximal impact.

Physical therapists are uniquely positioned to address depression by integrating exercise and movement into treatment plans. Research indicates that regular physical activity can reduce symptoms of depression by promoting the release of endorphins and other neurotransmitters that improve mood and reduce stress. Exercise also increases self-efficacy and resilience, empowering clients to manage their mental health proactively.

Physical Therapists Can Take a Biopsychosocial Approach to Depression Care

The biopsychosocial model employed by physical therapists is especially effective in treating depression. This approach considers the interplay between physical, emotional, and social factors in health and recovery. By fostering a therapeutic alliance, physical therapists can address the emotional and cognitive aspects of depression while simultaneously improving physical health. Studies suggest that interventions that combine physical activity with cognitive reappraisals and emotion regulation can lead to sustainable behavioral changes.

Furthermore, physical therapists can provide individualized treatment plans that cater to the specific needs and preferences of each client. This personalized approach increases adherence to exercise regimens, enhances motivation, and ultimately leads to better mental health outcomes. The use of technology, such as apps and wearable devices, can further support clients in tracking their progress and staying engaged with their treatment plans.

Despite the proven benefits, exercise and physical activity are still underutilized in treating depression. Barriers such as lack of awareness among clinicians and clients, limited access to facilities, and misconceptions about exercise as a treatment for mental health need to be addressed. Physical therapists can close the gap in depression care by advocating for exercise as a standard component of depression treatment, educating clients and healthcare providers about its benefits, and collaborating with mental health professionals to create integrated care plans.

How Physical Therapists Can Positively Influence a Client’s Anxiety

Physical therapists can play a pivotal role in managing a client’s anxiety through evidence-based interventions that incorporate physical activity and mindfulness techniques. Anxiety disorders, characterized by persistent and excessive worry, affect many individuals and can significantly interfere with daily activities. Research suggests that structured exercise programs, often prescribed by physical therapists, can reduce symptoms of anxiety. This is attributed to the release of endorphins, which are natural mood lifters, and a reduction in cortisol, a stress hormone (BMJ Sports Medicine).

A key element in this intervention is the development of a therapeutic alliance between the physical therapist and the client, fostering trust and safety, which are crucial for clients experiencing anxiety. Physical therapists trained in psychologically informed practice can utilize motivational interviewing and cognitive-behavioral strategies to encourage positive thinking patterns and enhance self-efficacy (PubMed). This approach helps clients confront and manage their fears related to movement, particularly in cases where anxiety coexists with pain or physical limitations.

Moreover, physical therapists can employ relaxation techniques such as diaphragmatic breathing and progressive muscle relaxation within therapy sessions. These techniques teach clients how to control their physiological response to anxiety, promoting relaxation and reducing the physical symptoms of anxiety such as muscle tension and rapid breathing (BMJ Sports Medicine).

Regular physical activity, tailored to the individual’s preferences and capabilities, can also provide a routine that helps mitigate anxiety by improving physical fitness and providing a distraction from anxious thoughts. This structured approach not only improves the client’s physical health but also contributes to their mental well-being.

Exploring exercise as an avenue for the treatment of anxiety disorders has revealed several mechanisms of change. These include extinction learning; modulation of neurotransmitter functioning, atrial natriuretic peptide and brain-derived neurotrophic factor; and modification of emotional action tendencies and self-efficacy. Physical therapists are in a unique position to address anxiety holistically by integrating physical interventions with psychological support, ultimately contributing to improved overall health and quality of life for their clients. By educating and empowering clients to take active roles in their treatment, physical therapists enhance the likelihood of positive outcomes in the management of anxiety.

How Physical Therapists Can Positively Impact a Client’s Sleep and Restoration

Physical therapists have a vital role in enhancing a client’s sleep quality and restoration, which are crucial for mental health. Sleep disorders and poor sleep quality are strongly linked to various mental health issues, including depression and anxiety. Physical therapists can impact sleep by integrating exercises and physical interventions that promote relaxation and reduce pain and physical discomfort, which are common barriers to good sleep.

Exercise, a primary tool in the physical therapist’s repertoire, has been shown to improve sleep by helping to regulate the body’s sleep-wake cycle, also known as circadian rhythm. Regular physical activity, especially aerobic exercises, can increase the amount of deep sleep a person gets by promoting the release of sleep-regulating hormones like melatonin. These effects, in turn, help decrease stress and anxiety levels, which often contribute to sleep disturbances (BMJ Sports Medicine) (PubMed).

Furthermore, physical therapists can teach relaxation techniques that directly contribute to improved sleep quality. Techniques such as progressive muscle relaxation, guided imagery, and controlled breathing help reduce the physiological arousal that often accompanies sleep disorders. By incorporating these techniques into therapy sessions, physical therapists provide clients with tools they can use independently to facilitate transition into sleep.

Additionally, physical therapists are equipped to counsel on sleep hygiene the term used to describe good sleep habits. Considerable research has gone into developing a set of guidelines and tips designed to enhance good sleeping, and there is much evidence to suggest that these strategies can provide long-term solutions to sleep difficulties. This not only improves sleep but also contributes to overall mental well-being.

More experienced physical therapists may have training in Cognitive Behavioral Therapy for Insomnia (CBT-I). Cognitive Behavioral Therapy for Insomnia (CBT-I) is an evidence-based approach that can help to treat insomnia.  CBT-I helps people identify and change the thoughts and behaviors that cause or worsen their sleep problems, and replace them with habits that support better sleep. CBT-I can be beneficial for people with or without other mental or physical health issues, and it’s considered safe for adults of any age and can be delivered by a variety of licensed health professionals.

Physical Therapists Can Use Mindfulness to Improve Mental Health

Mindfulness-based interventions (ACT & mindfulness meditation) constitute a family of treatments with significant support to improve mental health. These methods address conditions commonly treated by physical therapists such as chronic pain but have also been used to treat traumatic stress, depression, and anxiety, and used to promote exercise and physical activity. Mindfulness-based interventions can be used to support the creation of behavioral and mental health services in physical therapist practice.

ACT for Chronic Pain and Mindfulness-Based Pain Relief

A 2020 randomized controlled trial in the European Journal of Psychiatry found mindfulness-based approaches to be just as effective as traditional CBT. Mindfulness also has the potential to be more acceptable and enjoyable to patients, less stigmatizing, and cost-effective. Physical therapists can use these methods to support and promote services that optimize behavioral and mental health and enhance the well-being of society.

A 2021 randomized controlled trial in the European Journal of Pain found that internet-delivered acceptance and commitment therapy using microlearning interventions produced a broad range of outcomes for chronic pain, with positive results on pain interference, mood as well as pain intensity for longtime chronic pain sufferers. Outcomes were sustained at a 1-year follow-up. Microlearning techniques and interventions are a key part of the mindfulness-and-acceptance-based methods professionals learn through the Institutes courses.
Embedded inside the ACT for Chronic Pain and Mindfulness-Based Pain Relief course are dozens of specific microlearning exercises that easily fit into a busy physical therapy practice setting.

Use Physical Therapists to Close the Gap in Mental Health Care

The burden of mental illness in the United States is among the highest of all diseases, and mental disorders are among the most common causes of disability. Mental illness increases the risk of many types of physical health problems. Similarly, the presence of chronic conditions can increase the risk of mental illness.
Preventing mental illness and promoting good mental health involves the creation of services that support mental health and allow people to adopt and maintain healthy lifestyles. As such, physical therapists can serve in primary, secondary, and tertiary care in preventing, screening, managing, and addressing mental health and promoting mental well-being over the lifespan. This includes a range of professional behaviors that increase the chances of more people experiencing better mental health. Such programs, introduced across clinics, schools, workplaces, and communities often target stress, physical health, pain, and psychosocial factors when left unaddressed leading to poor mental health.

Learn more about interventions that support mental health here!