Running as therapy: Dr. Deborah Parker shows how exercise is critical for managing borderline personality disorder
Dr. Deborah Parker, by way of Alberta, came to Halifax for a medical residency in psychiatry and stayed because she loves the east coast way of life, but also because she got the opportunity she always wanted – ‘running’ a program to help mental health clients use exercise as medicine.
Dr. Parker is co-lead of Nova Scotia Health Authority’s Borderline Personality Disorder (BPD) Treatment Program.
“I liked the brain, psychiatry, and the holistic approach to medicine that exists within psychiatry,” she said of her career choices, “but I was not impressed by how much of modern psychiatry relies on pharmaceuticals that have not changed much in decades.”
Dr. Parker points out that pharmaceuticals for certain disorders offer low success rates, while the positive aspects of exercise on mental health have been largely ignored.
However, after attending several workshops and scientific conferences, Dr. Parker has seen that exercise as part of a treatment plan is gaining steam. In fact, patients with Parkinson’s disease, dementia, depression, anxiety and other common brain disorders are all seeing positive outcomes from completing exercise interventions.
That’s why Dr. Parker decided to apply the same approach to NSHA’s BPD Treatment Program.
“Dialectical behavior therapy, which is the foundation of the therapy we use here, describes using exercise for two purposes,” she said, getting visibly excited describing the therapeutic uses of exercise.
“One as a crisis survival skill, when patients are in high distress and thinking of harming themselves. One of the tools is to do intense exercise, to get your heart rate up to 80 per cent of your max heart rate, to reduce the arousal,” she explained. “The other use of exercise is in emotion regulation and stress reduction.”
And so the running club was started.
“We have a small team, but a progressive team, that’s interested in trying new things,” she said.
Each year, a group of 15 to17 patients of varying ages from the BPD Treatment Program participates in a nine- or 10-week running program. Participants come to a minimum of two practices each week and are prescribed a third session to complete on their own.
This is the fourth year of the program. The end goal of the program is to complete a five-kilometre race, typically the Epic Canadian Run for Canada in July, but the ultimate goal is to get patients familiar with habitual exercise and help them build confidence to exercise on their own.
“We are so lucky to be located at the Nova Scotia Hospital site because it is on the Dartmouth walkway,” Dr. Parker said. “The path from the Purdy Building to King’s Wharf and back is five kilometers.”
Preliminary results are very promising. In a series of pre- and post-tests, participants rate their moods more positively post-exercise, and Dr. Parker’s team is hoping to prove that higher intensity exercise results in a more positive impact on moods.
Retention is high, too, with only one to three participants dropping out each cycle. Dr. Parker said that this is because the program is a group environment, which holds people more accountable, builds confidence and reduces low self-esteem about exercise, especially if they are nervous about it.
“The group really encourages one another, particularly when they are struggling,” she said.
In addition to this, there are built in incentives for program participants. Most profoundly, the BPD Treatment Program has a partnership with the Mental Health Foundation and Aerobics First, a fitness clothing and gear store that provide free shoe fittings and running shoes for people who complete five running practices.
“We are so grateful for the Mental Health Foundation and Aerobics First’s participation in this program and for their help in making patients comfortable and confident.”
Other incentives include guest speakers for the running participants. Nutritionists, physiotherapists, academics and other professionals will come in to talk about the positive impact of exercise and good nutrition on health.
Often, veterans of past running programs come in to talk to the current year participants as well, to provide motivation and mentorship.
Dr. Parker is passionate about running and physical activity. She feels it’s important to incorporate it as part of the treatment plan for people with BPD because people with this disorder typically experience very high highs and very low lows and benefit from the mood regulating properties of habitual exercise.
Dr. Parker said that the field of psychiatry is starting to talk about BPD more and that’s a really good thing. “When you only see people in crises, it’s very easy to have a bias that patients with BPD are difficult to work with. However, in an outpatient program, you can see a patient in so many other contexts, when they are just living life.”
BPD describes a pattern of instability in mood, relationships and behaviour. These often include relationship problems, intense negative emotions such as anger and hopelessness, as well as self-destructive behaviours such as suicidal thoughts and self-injury.
People with BPD also often live with other mental health conditions such as depression, anxiety, and substance-use problems.
Individuals in NSHA’s BPD Treatment program generally have received little benefit from other treatments, are frequent users of health care resources, and/or are at risk of having their symptoms worsen without specialized treatment.
“It’s important that mental health providers manage crises among people with BPD in a way that doesn’t reinforce crisis behavior,” Dr. Parker said. “Often times hospitalization can’t help individuals build the skills necessary to manage their intense emotions or distressing events that happen. This happens best with support and treatment in outpatient programs like ours, or skills groups that are available in Community Mental Health and Addictions. Helping individuals with BPD to use exercise more is one of many skills that we can teach to help.”
When asked how she would like to “get loud” for this year’s Mental Health Week, Dr. Parker said she wants the “the health system to get loud about incorporating exercise in more treatment programs.”