Walking sessions may have originated in Ancient Greece but present times demand their re-birth in mental health. We have been using them for many years now, especially in our residential treatment program but now it's time to talk more openly about them and to formalise them. Hopefully, our mental health colleagues across the world will adopt this practice.

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In our work we have used our Walking sessions usually in "informal" settings but always within a treatment plan that would usually involve a Befriending component.

However, we have been conducting more formal Walking sessions that may actually include different assessments, psychoeducation, and more formal behavioural or cognitive behavioural interventions.

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So, how do you do it?

You may find it difficult to get in sync during the first session (we have become extremely rigid with decades of in office sessions) but after the 2nd or 3rd session, if you have a clear plan about what you are trying to do with therapy, then it is easy to adapt and work through a Walking session.

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For assessment purposes, you will have the added benefit of actually observing your patient in real time. If someone is depressed, and they find it difficult to concentrate or walk, you will see this difficulty in real time, and they will also get to test their capacity to walk and talk. They may often be surprised that they can actually do a lot more than what they usually think they can do, and at the end of the session they will definitely feel better. If you need to do a more formal assessment, your mobile phone is always a handy companion. Instead of checking your facebook, you could be using your mobile phone to do a Hamilton depression assessment for example or other brief self-report tests that you can usually find online. No need to make notes or any ratings on the go, get your patient's consent to record the assessment on your mobile phone while you are walking.

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For different interventions again you get to see the patient in real time. Even more cognitive interventions like cognitive challenging or reframing can take place during your walking session. Try to work on such exercises after you get going for 10 to 15 minutes, so their minds are move activated. You need to know your techniques beforehand, and you need to be able to practice them while you are on the go. You will not have the luxury of manuals and books in front of you but your mobile phone is always there for you. Conducting relaxation training can be fun while you are on the go, doing grounding exercises with the outside environment can also be very rewarding. Even mindfulness can be practiced with open eyes. You can practice mindfulness with even more senses while you are out and about. You can easily conduct behavioural experiments in real time with your social anxious patients or engage a patient's agoraphobia with different crowds. No need to wait for them to report back to you what they have done. You do it together!

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However, all the above requires that you have done your homework, and have prepared your "structured walking session" pretty well. Otherwise, you could easily end up having aimless walking strolls together. Again, you will have to decide what you want to achieve and what you can actually accommodate in your therapy plan. With some patients "aimless walking strolls", even silent strolls, may be an important bonding activity.

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Behaviorism has always been more open to "out of office" therapy work, the Greek Walking Philosophers got this started really, and now it is up to us to re-introduce this practice to our patients in order to continue serving their needs while keeping everybody protected from the corona virus.

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Happy Walking.

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Dr Yanni Malliaris

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