Walk-and-talk therapy versus conventional psychotherapy for men with depressive symptoms

Stress Evidence: RCT · Assessor-blinded parallel group randomised controlled trial comparing walk-and-talk therapy (walking outdoors with psychotherapy) versus conventional indoor therapy; 10 fortnightly 1-hour sessions over 20 weeks; primary outcome measured at 5 months post-baseline using DASS-21 scale; follow-up at 12 months 2026-08-28

Depression

A randomised controlled trial is testing whether outdoor walk-and-talk therapy—combining psychological support with physical activity in natural settings—offers men with depressive symptoms greater benefit and engagement than conventional indoor psychotherapy.

Conventional psychotherapy is effective for depression but often has lower engagement and higher dropout rates among men, possibly because indoor sitting-based formats may not align with typical masculine preferences for movement and outdoor activity. This assessor-blinded, parallel-group randomised controlled trial is comparing walk-and-talk therapy (10 fortnightly 1-hour sessions of psychotherapy conducted while walking outdoors over 20 weeks) against conventional indoor therapy (same dose, sitting indoors) for men with depressive symptoms.

The primary outcome is change in overall psychological distress measured by the 21-item Depression, Anxiety and Stress Scale (DASS-21) at 5 months post-baseline. Secondary outcomes include male-type depression symptoms, mental well-being, suicidal ideation, quality of life, and cost-effectiveness. Participants are assessed at baseline, 5 months (post-intervention), and 12 months (follow-up) using linear mixed models to examine the effect of treatment group, time, and their interaction. The trial is registered and approved by the University of Newcastle Human Research Ethics Committee. A key limitation is that results are not yet available—this is a study protocol describing the design, not outcome findings. The study addresses a genuine gap: men have lower help-seeking rates and higher suicide mortality than women, and treatment formats that better suit their preferences may improve engagement.

Takeaway

Walk-and-talk therapy may offer men with depression a more engaging alternative to indoor psychotherapy, but whether it delivers clinically meaningful benefit requires completion and publication of trial results.

The rationale here is practical: men are less likely to seek mental health support and dropout from conventional therapy more often, suggesting that the delivery format matters. Integrating psychotherapy with outdoor walking could address both the psychological need and the physical-activity preference simultaneously. The trial compares equal doses (10 sessions over 20 weeks) to ensure any difference reflects the modality, not treatment intensity. Secondary outcomes tracking male-specific depression presentations (e.g. irritability, anger, social withdrawal) and suicidal ideation recognise that depression in men often looks different from the textbook female presentation. Cost-effectiveness analysis will also determine whether any benefit justifies resource allocation. One caveat: outdoor settings introduce variability (weather, noise, privacy) that indoor therapy avoids, and some men may prefer confidentiality indoors. Results are expected in 2025.

Takeaway · Cadence

If you've felt hesitant about traditional therapy or prefer moving while talking through difficult things, this research suggests that walk-and-talk approaches might feel more natural. You might consider whether your current therapy setup (or hesitation to start) relates to the environment—some therapists now offer outdoor sessions, and even a short walk with a trusted person while discussing something on your mind can sometimes feel less formal and more sustainable. The research doesn't replace professional support, but it does suggest the setting itself can matter for engagement and wellbeing.

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References

Walk-and-talk versus conventional psychotherapy for men with depressive symptoms: study protocol of a randomised controlled trial. — BMJ open (Read the original)

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