Walk-and-Talk Therapy Versus Conventional Indoor Therapy for Men With Low Mood: A Randomised Pilot Study

While psychotherapy is effective for treating depression, men are less likely than women to attend and more likely to drop out. The value of alternative therapeutic approaches for men needs to be investigated. In this randomised pilot trial, we investigated the feasibility and preliminary efficacy of outdoor 'walk-and-talk' therapy compared to conventional indoor therapy for 37 men with low mood (mean [SD] PHQ-9 score = 11.4 [5.0]; mean [SD] age = 44.1 [15.8] years). Over 6 weeks at the University of Newcastle participants received weekly 60-min sessions delivered (i) while walking along a 4-km route on campus or (ii) indoors in a psychology clinic, delivered by provisional psychologists using non-directive supportive counselling. Outcomes included validated measures of depression, anxiety, stress and overall psychological distress, male-type depression, mental well-being, behavioural activation and therapeutic alliance. At post-intervention, all pre-registered feasibility benchmarks were exceeded including recruitment capability, retention (89%), average attendance (walk-and-talk: 91%, indoor: 89%), proportion of sessions delivered in intended setting (walk-and-talk: 100%, indoor: 98%) and overall perceived acceptability of the therapy (walk-and-talk: 4.4/5, indoor: 4.2/5, where 1 = poor and 5 = excellent). Linear mixed model analysis demonstrated both groups achieved similar improvements in depressive symptoms (d = -0.02), but the walk-and-talk group reported greater improvements in overall psychological distress (d = -0.5), anxiety (d = -0.4) and stress (d = -0.7). In contrast, male-type depression improved more in the conventional indoor group (d = 0.6). Other outcomes were comparable between groups. Results indicate that walk-and-talk therapy may be acceptable and effective for men with depression. A powered trial to interrogate these effects and identify moderators of effectiveness is warranted. Trial Registration: Australian New Zealand Clinical Trials Registry number: ACTRN12622001318774.