A Strength-Based Exercise Training Model of Psychotherapy: Can Principles Derived from Exercise and Sport Physiology Guide Behavioral Prescriptions for Physical and Mental Wellness?

Introduction

Psychologists and exercise and sport physiologists would agree that making changes in behavior has profound influence on health, functioning, and performance (Elder, Guadalupe, & Harris, 1999; Winett, Williams, & Davy, 2009). Exercise and sport physiology is concerned with how the human body reacts and adapts to acute and chronic physical stress (i.e., exercise; physical training) and extreme environmental conditions (e.g., heat, cold, altitude, zero-gravity, etc.) and how this knowledge can be applied to the enhancement of physical functioning, health, and athletic performance (Wilmore, Costill, & Kenny, 2008). Consistent with many psychotherapeutic interventions, exercise prescriptions are individually tailored, collaboratively developed, and grounded in a strength-based philosophy of enhancing functioning, health, wellness, and performance— i.e., increasing muscle strength, speed, flexibility, endurance, power, agility, and respiratory/cardiac functioning while also improving health outcomes (Albright, Franz, Hornsby, Kriska, Marrero, Ullrich, & Verity, 2000; Balady, Chaitman, Driscoll, Foster, Froelicher, Gordon, Pate, Rippe, & Bazzarre, 1998; Braith & Beck, 2008; Bryant & Green, 2003; Kohrt, Bloomfield, Little, Nelson, & Yingling, 2004; Ratamess, Alvar, Evetoch,

Housh, Kibler, Kraemer, & Triplett, 2009; Myers, 2008; Wilmore, Costill, & Kenny, 2008). The interventions used by exercise and sport physiologists (e.g., aerobics, anaerobic training, resistance/strength training, interval training, cross training, stretching, gymnastics) are also consistent with the skill-building emphasis of many evidence-based, health promoting psychological interventions (e.g., Cognitive-Behavioral Therapy, Dialectical Behavior Therapy, Acceptance and Commitment Therapy, Mindfulness-Based Stress Reduction, etc.) that are geared towards improving psychological strengths such as coping abilities, stress-tolerance, interpersonal effectiveness, psychological flexibility, and self-regulation (self-control) of cognition, emotion, and behavior (Grossman, Niemann, Schmidt, & Walach, 2004; Kashdan & Rottenberg, 2010; Lynch, Chapman, Rosenthal, Kuo, & Linehan, 2006; Moeller, Barratt, Dougherty, Schmitz, & Swann, 2001). They are also consistent with “positive psychology ” interventions that focus on increasing individual happiness and enhancing resilience, health, and well-being (Kobau et al. 2011; Seligman, Steen, Park, & Peterson, 2005).

In keeping with its scientific tradition, the field of exercise and sport physiology has advanced a number of universally accepted principles that have been found to maximize the effectiveness of exercise and athletic training programs (Wilmore, Costill, & Kenny, 2008). We propose that these principles are in many ways applicable to the practice of psychotherapy, and we discuss how psychotherapists may benefit by incorporating these principles to help guide their clinical practice. Through our discussion we 1) make a case for establishing a common language for strength-building interventions being applied in both fields, 2) introduce new concepts to the field of psychotherapy that may benefit from empirical inquiry, and 3) make recommendations based on successful principles in the field of exercise and sport physiology.

Just as the field of neuroscience has suggested directions to enhance clinical practice (Cappas, Andres-Hyman, & Davidson, 2005), we highlight how therapists may conduct their treatment planning to be more consistent with the individualized strength-based approach used by exercise and sport physiologists. Overall, integrating principles that bridge these two realms of healthcare and which guide interventions for both physical and mental wellness may make for a stronger theoretical perspective that can facilitate interdisciplinary science and practice.

Principles of Exercise Training & Proposed Application to Psychotherapy

1: The Principle of Individuality

Exercise and sport physiologists maintain that exercise routines must be individually tailored to be most effective (Wilmore, Costill, & Kenny, 2008). They use the term “exercise prescription ” to describe the process of using clinical assessment information to develop an individually tailored and systematic exercise regimen that will maximize physical gains and health benefits (Myers, 2008). According to the principle of individuality, people differ in the intensity of exercise training they prefer and tolerate (Ekkekakis, Hall, & Petruzzello, 2005; Myers, 2008). They also differ in how well they respond to a given exercise program, with heredity playing a significant role (Bouchard & Rankinen, 2001; Wilmore, Costill, & Kenny, 2008). Historically, variations in training response were attributed to varying levels of compliance with training programs; however, it is now known that even with the same type of training and full adherence to a program, conditioning outcomes will still vary among individuals (Wilmore, Costill, & Kenny, 2008).

The importance of being sensitive to trans-diagnostic individual difference variables (i.e., culture, religion/spirituality, level of reactance/resistance, treatment preferences, coping style, motivation for change) also guides the optimal delivery of psychotherapeutic interventions (Norcross & Wampold, 2010). Moreover, recent studies demonstrate a genetic influence on therapeutic responses to Cognitive-Behavioral Therapy (CBT) for Posttraumatic Stress Disorder (PTSD) (Bryant, Felmingham, Falconer, PeBenito, Dobson-Stone, Pierce, & Schofield, 2010), on risk of alcohol relapse following Alcohol Dependence treatment (Wojnar et al. 2007), and on the ability to extinguish conditioned fear responses in Panic Disorder (Lonsdorf, Ruck, Bergstrom, Andersson, Ohman, Lindefors, & Schalling, 2010). Thus, as is the case for exercise prescriptions, psychological treatments may be well or ill-suited to a given individual due to inherent and socio-cultural factors and preferences. Indeed, we are not all the same, and further developing the scientific and clinical principle of individuality in psychology practice may optimize the effectiveness of therapeutic interventions. Whereas individualizing care is currently a standard of practice in psychology, the field continues to emphasize the development and dissemination of disorder-specific evidence-based treatments (EBT) that may not be effective for particular subsets of individuals. Advancing recommendations for individually tailoring interventions to meet a range of needs may be a useful adjunct to the development and dissemination of EBTs.

2: The Principle of Specificity

The principle of specificity asserts that the particular training intervention must match the unique requirements of each athlete/fitness enthusiast in his or her targeted sport or competition (Wilmore, Costill, & Kenny, 2008). For example, the weightlifter whose goal it is to increase upper body strength and power will emphasize short bursts of lifting increasingly heavier weights with the arms, chest, and shoulders and would not expect aerobic training (e.g., running long distances) to create needed gains in upper body strength and power (Wilmore, Costill, & Kenny, 2008). This is not to say that aerobic training would not have overall health benefits; however, it would not be the primary focus of the training.

Whether the training goal is to increase strength or speed, develop explosive power, jump higher, or swim faster, exercise and sport physiologists focus on specific abilities needing improvement by conducting a needs assessment (rather than a diagnostic assessment) and tailoring the training intervention to the particular sport, competition, or activity in which improvement is needed (Wilmore, Costill, & Kenny, 2008). The needs assessment focuses on identifying the client’s goals (e.g., decrease body fat, punch harder, etc.) assessing the client’s current health status, understanding the particular requirements of the targeted sport, competition, or activity, and estimating the type of investment the client is willing to make to achieve his or her goals (Bryant & Green, 2003; Myers, 2008).

Similarly, psychotherapists work to enhance specific strengths (e.g., in emotion-regulation, attention control, cognitive flexibility, assertiveness, problem-solving, stress tolerance, etc.) to benefit functioning in specific spheres of living (e.g., school, work, family, etc.). Yet, this strength-training focus may be overshadowed by the push to deliver evidenced-based treatments for the elimination or management of specific disorders that can vary in etiology, presentation, and comorbid dysfunctions. We argue that for psychotherapeutic interventions to be most effective—and conceptually consistent with the strength-enhancing focus of exercise and sport physiology—it must focus on assessing needs and improving specific strengths (e.g., in emotion regulation ability) to benefit individuals with a wide range of mental disorders, including those without diagnosable disorders (e.g., Berking, Wupperman, Reichardt, Pejic, Dippel, & Znoj, 2008).

Moreover, the particular psychotherapy intervention should match the unique requirements of each client in his/her targeted sphere(s) of functioning (e.g., work; school; relationships). For example, one person’s interpersonal deficits may be directly related to a tendency to misinterpret social cues and primarily impact work situations (e.g., conflicts with co-workers and supervisors), whereas another’s interpersonal problems may more directly relate to poor social skills and primarily manifest in failed intimate relationships. Thus, as in exercise and sport physiology, the psychotherapeutic treatment would be informed not as much by diagnosis, but through an assessment of the specific functional deficit requiring improvement (e.g., social skills vs. information processing problem). The treatment would focus on strengthening the specific function(s) in the specific sphere of functioning for which it is needed (or desired) and match the client’s level of commitment to the intervention in terms of time, finances, effort required to complete behavioral assignments, willingness to tolerate discomfort or painful affect, etc. Thus, the principle of specificity may help guide targeted behavioral prescriptions for both physical and mental wellness.

3: The Principle of Reversibility

According to the principle of reversibility training the body through exercise will result in increased strength and endurance, but if the training decreases or stops, gains will diminish or be lost (Wilmore, Costill, & Kenny, 2008). For example, the bodybuilder’s muscle strength and size diminishes with a sedentary lifestyle, and the runner who was once able to trek long distances but does not maintain her exercise regimen will eventually lose this ability. Ultimately, a maintenance plan must be incorporated into any training program to prevent a reversion to pretraining levels (Wilmore, Costill, & Kenny, 2008).

This principle is consistent with the need to practice relapse prevention skills once a treatment goal has been achieved (see Marlatt & George, 1984 for a description of the relapse prevention model). In keeping with a strength-training model, however, the psychotherapeutic focus would be continuation of psychological strength building rather than prevention of relapse to maladaptive behaviors or states of mental illness as those without functional deficits or disabling psychiatric symptoms could also benefit from psychotherapy, i.e. wellness promotion and maintenance.

Therapists taking a strength-training approach to psychotherapy would explain to clients that newly developed psychological functions need to be regularly exercised for these gains to be maintained, and that discontinuing treatment abruptly through treatment drop-out or loss of motivation may result in a diminishment or loss of improvements. Maintaining continuous involvement in therapy until requisite skills are mastered and become second nature can increase the likelihood that a “loss of strength” will not occur, much in the same way as having a personal trainer increases the likelihood that exercise training principles will be followed and maximal gains accomplished. However, unlike individuals undergoing medical treatments requiring continual direction and monitoring by a medical professional, individuals undergoing psychotherapy may not necessarily need to stay in treatment perpetually; all that may be needed is for the client to exercise skills learned in therapy on a regular basis, though the exercise may be less frequent and/or intense. Eventually, the client may be able to master the skills sufficiently and make the necessary lifestyle changes needed to maintain compliance without the therapist’s aid. Much like an athlete who continuously trains muscles on her own no matter how strong, powerful, or fast they have become, the psychotherapy client who has achieved treatment goals (and the client no longer exhibits significant functional impairment) must continue to exercise skills learned in therapy on her own—regardless of how well he/she thinks they have been developed.

4: The Principle of Progressive Overload

According to the principle of progressive overload, muscle growth results from progressively increasing strain on the muscles beyond their normal level of use in a manner that does not cause injury (Wilmore, Costill, & Kenny, 2008). As the muscles strengthen to adapt to the new demand, the individual progressively increases training demands to stimulate continued muscle growth (Wilmore, Costill, & Kenny, 2008). While this may be a physically arduous process, muscles progressively grow in strength, speed, and endurance until training goals are met.

In applying the principle of progressive overload to psychotherapy practice we would suggest that a given skill must be exercised against increasingly more difficult or intense stimuli and/or performed or practiced in increasingly more difficult situations (e.g., like the weightlifter lifting increasingly heavier weight over time or the skier heading down increasingly more difficult slopes over time). We will use self-control as an example as researchers have conceptualized this function as resembling a muscle that fatigues with overextension but which could gain strength with exercise and sufficient periods of rest (Muraven, 2010; Muraven & Baumeister, 2000; Muraven, Baumeister, & Tice, 1999).

A therapist might have an individual beginning recovery from alcohol addiction exercise self-control strength by practicing control in an inpatient setting before having the client attempt to control alcohol consumption outside of the protected therapeutic setting. Consistent with the principle of progressive overload, strength-training sessions (i.e., alcohol-cue exposures) would be conducted infrequently at first (e.g., one to two times per week) and be of low intensity (e.g., last only a few seconds or minutes) and progressively increase in frequency and intensity to where exposures are being conducted four to five times per week and lasting progressively longer (e.g., 30 minutes to an hour). Building up self-control strength in a progressive fashion and practicing doing so in less difficult situations (e.g., as an inpatient) before attempting to exercise self-control in more difficult situations (e.g., as an outpatient) makes intuitive sense if we adopt this training principle. Trying to control intake of alcohol too early in treatment in too difficult a setting would be analogous to the novice weightlifter placing extremely heavy weight on a barbell when just starting to exercise before adequate strength and skill have been developed. According to this principle, the person in early recovery would need to work up to greater difficulty, just as the novice weightlifter would need to work up to heavier weight. Too much strain too early in treatment before adequate strength or skill have been developed could result in “psychological injury”—possibly in the form of symptom exacerbation, loss of motivation, resistance/reactance, and/or treatment drop-out—just as starting weight training with too much weight when not strong or skilled enough can result in physical injury, discouragement, loss of motivation, and/or cessation of exercise/athletic training. Other functions such as assertiveness, stress-tolerance, and attention may improve in a similar fashion. For example, a therapy client practicing assertiveness may begin in a situation with little risk, such as interacting with a waiter by sending poorly cooked food back to the kitchen, and work his way to a situation with greater risk, such as being assertive with an intimidating boss and asking for a raise. Other examples of progressive overload as applied to psychotherapeutic interventions may include graded exposure to anxiety-provoking stimuli or progressively increasing the difficulty of a cognitive-remediation task addressing working memory.

Moreover, following this principle may impact self-efficacy and motivation for change. For instance, people do not typically expect to begin exercise training by running for a full hour on a treadmill. By starting small, with increments that they are likely to achieve—for instance walking five to 10 minutes on the treadmill—they may stick with the exercise, increase their motivation for the new behavior, and feel more able to increase their time on the treadmill in the future.

Related to the principle of progressive overload is the need to overcome exercise plateaus (i.e., prevent habituation to the exercise training stimulus). Exercise and sport physiologists maintain that muscles eventually adapt or habituate to unchanging levels of physical stress (i.e., the same volume and intensity of a particular exercise week after week) and that this muscle adaptation will limit additional development (Bryant & Greene, 2003; Incledon & Hoffman, 2005; Ratamess, Alvar, Evetoch, Housh, Kibler, Kraemer, & Triplett, 2009). Overcoming adaptations and stimulating continued growth thus becomes the crux of training.

Plateaus can cause frustration and place individuals at risk for cessation of training (Incledon & Hoffman, 2005). In order to overcome plateaus and continue to strengthen, an individual must vary the training stimulus over time (i.e., in combinations of volume, intensity, and/or form) to continue to challenge the muscles (Ratamess et al., 2009). When a new plateau is reached, the individual must again make changes to achieve additional growth and so on. Of course, there may be a point where additional growth is not naturally possible or even desired, and it is at this point where the principle of reversibility must be followed.

While overcoming plateaus may sound relatively simple, in reality it can be a challenge to achieve. To overcome plateaus individuals often turn to a professional trainer or skilled training partner who can help push the individual beyond his or her normal training zone while ensuring proper technique and helping to reduce risk of injury (Bryant & Greene, 2003; Incledon & Hoffman, 2005). For instance, a training partner will help an individual move beyond a plateau and safely increase the number of repetitions of a chest press exercise by supporting the barbell for the individual. Without this help, the plateau would be more difficult if not impossible to overcome. Psychotherapists, group therapy members, and family and community supports may function in the capacity of the trainer by providing encouragement, guidance, and motivation. They support the individual, help alleviate frustration, and push the individual toward additional growth when it does not seem like additional treatment gains are being made or are possible. Among methods of breaking through plateaus, The American Council on Exercise® recommends changing the training frequency (either increase or decrease the frequency), altering the training exercises, and varying the number of sets the individual performs (Bryant & Greene, 2003).

For psychotherapists, regularly altering patients’ therapeutic routines may also help challenge psychological/cognitive abilities, overcoming mental plateaus and ultimately stimulating greater psychological growth. Using a limited range of techniques (e.g., challenging maladaptive automatic thoughts) may lead to initial gains (perhaps enough to eliminate or manage troubling symptoms and eliminate a diagnosis), but without adding new dimensions to treatment, challenges to psychological abilities will be limited, leading to a lack of further wellness, psychosocial functioning, and overall quality of life. Indeed, one review (Hansen, Lambert, & Forman, 2002) indicated that while there is a dose-response effect when it comes to psychotherapy, “there is a limit at which point further treatment results in diminishing gains, especially for psychiatric symptoms” (p. 338). In order to stimulate continuous psychological growth—and consistent with ideas recommended by exercise and sport physiologists interested in continuous muscle growth and conditioning—additional and alternating methods of therapeutic stimulation may be required. Indeed, the success of Dialectical Behavior Therapy (DBT) for Borderline Personality Disorder (Linehan, 1993), a difficult-to-treat personality type, may have something to do with the integration of various cognitive-behavioral and mindfulness-based techniques and the incorporation of both individual and group treatment modalities. Moreover, even though patients may achieve initial symptom reduction and enhanced ability to regulate negative affect through DBT, they may still demonstrate social and functional impairment after treatment is completed (Levy, 2008). Following a course of DBT with alternative treatment modalities focused on the processing of emotions and trauma may lead to greater and more durable therapeutic effects (Sweeny, 2011). In effect, the subsequent treatment modality may help patients treated with DBT overcome a therapeutic plateau and achieve additional treatment gains.

Training in how to recognize when a client has reached a therapeutic plateau may also inform treatment planning by helping therapists and clients understand that a plateau is not a reason to end therapy, but an opportunity for implementation of new or varied interventions aimed at stimulating greater psychological growth. In all, the principle of progressive overload may also guide behavioral prescriptions for both physical and mental wellness.

5: The Principle of Hard/Easy

This quote eloquently describes the phenomenon whereby a significant “dose” of exercise is needed to get a desired effect but where excessive exercise without sufficient recuperation can result in a rapid decline in performance and physiological functioning (Kentta & Hassmen, 1998; Wilmore, et al., 2008). While regular exercise can be an invigorating, health-promoting, and rewarding experience, excessive training with insufficient rest can lead to chronic fatigue, sleep disturbance, reduced appetite, negative mood states, and even injury and immune system dysfunction (Kentta & Hassmen, 1998; Wilmore, et al., 2008). According to the principle of hard/easy, individuals need a period of rest between workouts to recover and achieve maximal benefits from a training program (Kentta & Hassmen, 1998; Wilmore, Costill, & Kenny, 2008). Unfortunately, when motivated athletes experience a decline in functioning, they and their coaches often wrongfully respond with an increase in the training regimen when what really is needed is a period of rest and recovery (Kentta & Hassmen, 1998 and citations within).

A similar phenomenon may be seen with psychotherapy. Psychotherapy is commonly an invigorating, positive, and enjoyable health-promoting experience, and adequate dosing of psychotherapy is needed to get a desired effect (Hansen, Lambert, & Forman, 2002). However, it can also be a stressful process when addressing certain types of problems (e.g., trauma; anger management, addiction) and using certain therapeutic modalities (e.g., exposure therapy). Moving too quickly or intensely without sufficient rest may hinder treatment progress and lead to exhaustion, distress, loss of motivation, and/or treatment dropout. Much like muscles need adequate rest following an intense exercise session in order to recuperate, the psyche and its many functions may also require a resting period following an intense therapy session or intensive treatment regimen.

While research investigating the beneficial effects of rest between therapy sessions or after a bout of intense therapy has not, to our knowledge, been conducted, we find support for this principle through research indicating that practicing small acts of self-control enhances self-control strength over time if the practice is interspersed with sufficient periods of rest (Muraven, 2010). Research tells us that providing too much psychotherapy can lead to physical and emotional exhaustion (or burnout) in clinicians (Ackerley, Burnell, Holder, & Kurdek, 1998; Farber, 1990), but whether similar decrements occur in clients from participating in too much psychotherapy in the absence of adequate between-session rest remains to be seen. Future research may find that psychotherapy failure results from “psychological overtraining”. It is possible that psychotherapists are wrongfully responding to unsatisfactory treatment gains by “increasing the dose” when what the client really needs is a short break from treatment.

Exercise and sport physiologists routinely investigate the patterns of activity and rest necessary to achieve optimal cardiovascular, respiratory, and muscular improvements (Wilmore, Costill, & Kenny, 2008). As such, a fruitful line of inquiry may be for psychologists to investigate the optimal patterns of therapy and rest needed to maximize psychological growth but that will also prevent psychological overtraining. Moreover, just as exercise and sport physiologists need to find the right training stimulus (in terms of mode, frequency, intensity, rate of progression, and periods of rest) for each particular individual (which is consistent with the principle of individuality), therapists may need to take on the challenge of finding the optimal patterns of therapy stimuli and rest for each particular client (Myers, 2008; Wilmore, Costill, & Kenny, 2008).

6: The Principle of Periodization

“Periodization” of exercise training ties together a number of the aforementioned principles (i.e., individuality; reversibility; hard/easy) and involves altering the training program at regular intervals over a period of time (e.g., six months, a year) and changing the intensity, volume, and form of the training (i.e., light, moderate, hard and back to light…)according to the particular phase of training (i.e., off-season; during a competitive season) the individual is in (Wilmore, Costill, & Kenny, 2008). Periodization is meant to provide a planned timeframe and structure of exercise training that maximizes gains while preventing overtraining and the loss of training gains (Fleck, 1999; Wilmore, Costill, & Kenny, 2008). It is also important for getting competitive athletes into their best shape for peak performance for upcoming competitions (Wilmore, Costill, & Kenny, 2008).

Incorporating this principle to psychotherapy practice may provide a framework with which to construct a long-term course of treatment that will maximize therapeutic gains, prevent reversion to pretherapeutic levels, and orchestrate changes in the treatment regimen (i.e., in terms of intensity and type of treatment) around anticipated times of increased psychological stress. Much like the relapse prevention model, which focuses on strengthening clients’ ability to plan for and cope with high risk situations that could lead to a relapse (Witkiewitz & Marlatt, 2004), periodization of psychotherapy training may help psychotherapists plan changes in the therapy routine (i.e., increase the frequency, intensity and/or mode of treatment) around situations in which a therapy client needs to “get into shape” for upcoming stressful, high-risk, potentially life-altering, or even life threatening situations. For example, a therapist may reinforce self-control skills with a woman in recovery from substance dependence as she prepares for the release from prison of her former drug dealer and potential contact with him. A therapist can plan improvements in affect-regulation skills with a woman who has a history of multiple depressive episodes following her husband’s death and who fears she will fall into a deep depression as she gets closer to the anniversary of her husband’s death. More intense therapy focused on improving assertiveness will help a man planning to ask his boss for a raise in a few months. Improving the ability to focus attention in stressful testing situations will be required for a child with an attention problem who has an important exam coming up in a few months. The ability to emotionally regulate will need work for the socially anxious student planning to ask another student to the prom at the end of the school year. Whatever the case, the client needs to “go into training” for the upcoming situation to strengthen the needed ability or abilities (e.g., assertiveness; self-control; social skills; self-regulation skills) much like an athlete would enhance the training to be in his/her best shape for an upcoming competition. The principle of periodization, therefore, may provide the basis and rationale for a long-term and planned timeline of psychological interventions (see Table 1).

Implications and Applications

Psychologists and exercise and sport physiologists would agree that making changes in behavior has a profound influence on health, functioning, and performance. The central thesis of this article is that the principles frequently employed by exercise and sport physiologists are applicable to the practice of certain types of psychotherapy (primarily positive psychology interventions, cognitive and behavioral forms of psychotherapy, and cognitive remediation therapies that have a skill-building emphasis) and that practitioners of psychotherapy may be able to benefit from incorporating these principles into their clinical practice. Moreover, we hoped to demonstrate that these principles might guide behavioral prescriptions for both physical and mental wellness and help build a foundation for interdisciplinary science and practice. Of course, additional evidence is needed before this conclusion can be generalized.

Psychotherapists’ adoption of an exercise and sport physiology strength-training model and application of exercise training principles to the practice of psychotherapy may prove helpful in conceptualizing psychotherapy as a nonstigmatizing approach to increase psychological strength and performance/wellness rather than as an approach to eliminating a mental disorder. Exercise, unlike psychotherapy, holds no such stigma as a process indicated only for the “physically ill”, unhealthy, feeble, unfit, maladjusted, or dysfunctional. Rather, it is an activity (and often a social one) that is commonly engaged in to increase strength, conditioning, health, and performance for the everyday person to the seasoned athlete.

The strength-training model is also consistent with strength-based and positive psychology models that not only seek to improve positive mental health, increase happiness and relieve suffering but also view satisfactory psychosocial functioning and well-being as much more than not having a mental illness or being at risk for developing one (Keyes, 2010; Keyes, Dhingra, & Simoes, 2010; Kobau et al. 2011; Seligman, Steen, Park, & Peterson, 2005). Indeed, one does not have to be ill or at risk of developing an illness to engage in physical exercise or to benefit from its positive health-promoting effects. The same model applies to mental health and wellness.

While it is not certain whether the principles that guide exercise training may be applied to psychotherapy in the manner discussed, the exercise and sport physiology training model of psychotherapy lends itself nicely to scientific inquiry, and there is an extant model in the form of scientific exploration of physical exercise training and the success of that arena of investigation. Psychotherapy has neurobiological effects similar to that of pharmacotherapy and results in detectable changes in brain structure and function (Cappas et al., 2005; Etkin, Pittenger, Polan, & Kandel, 2005; Linden, 2006). From an exercise and sport physiology perspective, one can argue that psychotherapy “strengthens and conditions” the brain much like exercise “strengthens and conditions” the heart, lungs, bones, and muscles. Indeed, researchers have provided preliminary evidence for an exercise-training model of psychotherapy by conceptualizing self-control as analogous to a muscle that initially fatigues with over-exertion but may gain strength over time with repeated exercise and adequate periods of rest (Muraven & Baumeister, 2000). Their method to improve self-control involves repeatedly exercising restraint over behavior in one area (e.g., regularly attending to one’s posture) to improve strength needed for self-control in other areas lending empirical support to a strength-training model of psychotherapy (Muraven, Baumeister, & Tice, 1999). Whether improvements in self-control and other psychological functions and abilities, such as emotional regulation; assertiveness; problem-solving ability; attention; memory, etc., are maximized if psychotherapeutic interventions are conducted in accordance with the principles derived from exercise and sport physiology remains to be seen.

With regard to prevention of behavioral problems, a recent issue of The American Psychologist described a Comprehensive Soldier Fitness Program (CSFP) as a strength-based approach to improve resilience (or psychological fitness) among Army personnel and their families by helping healthy individuals to be better prepared to face future life stressors through the provision of evidenced-based training (see Casey, 2011 and other articles in this issue). The program includes a United States Army Master Resilience Trainer (MRT) course where sergeants are trained in these techniques, and learn how to teach resilience skills to their soldiers in an effort to disseminate and improve attributes such as “mental toughness” and “mental agility” (p. 27) in a wide range of Army personnel (Reivich, Seligman, & McBride, 2011). The principles we describe here fit in well with the goal of improving “mental toughness”, “mental agility”, and attaining overall “psychological fitness” and may provide a helpful framework on how to best implement such resilience interventions and others like it.

A limitation of the model is the lack of a strong scientific base for the principles as applied to psychotherapy. However, the model is proposed as a starting point for scientific inquiry. It is our hope that psychologists, psychotherapists, and public health administrators see the potential benefits of applying exercise training principles to the practice of psychotherapy. Moreover, we are hopeful that researchers will begin to investigate these principles as they pertain to both physical and mental wellness.