Prior to combining psychotherapy with walking:
- Therapists should receive training from medical professionals on safe walking practice 
- Clients should be screened using the Physical Activity Readiness Questionnaire (PARQ) or another assessment to assess health risk and eligibility

Recommendations for Incorporating Walking into Therapeutic Practices

Different types of psychotherapy, like CBT or DBT, have yet to be tested in combination walk therapy. Therapeautic interventions combining walking with psychotherapy have not been manualized, but a general relational therapy approach was shown to improve symptoms.

Using Different Approaches to Psychotherapy With Walk Therapy

Potential solutions include:
- Using nearby or building indoor tracks 
- Organizing walking groups sessions for safety and support
- Using appropriate approaches like exposure therapy to address apprehension about public sessions (depending on individual needs)

Grand Valley State University

Pilot studies are being conducted on the feasibility and efficacy of psychotherapy sessions while walking. While it is currently being practiced, its outcomes have only recently gained research interest.

Walk Therapy: Assessing the Feasibility of Walking During Psychotherapy

Koziel, N., Vigod, S., Price, J., Leung, J., & Hensel, J. (2021). Walking psychotherapy as a health promotion strategy to improve mental and physical health for patients and therapists: Clinical open-label feasibility trial. The Canadian Journal of Psychiatry, 67(2), 153–155. https://doi.org/10.1177/07067437211039194

 Walking psychotherapy as a health promotion strategy to improve mental and physical health for patients and therapists: Clinical open-label feasibility trial

The reasoning for this combination therapy includes:
- Addressing the risk of more sedentary behaviors due to mental illnesses
- Efficiently reaping the benefits of psychotherapy and exercise at the same time
- Application for special groups (i.e. exposure therapy for those with PTSD)
- Cost-effective and easy to incorporate indoors & outdoors

Reasons for Walk Therapy

While it is still in clinical trials, researchers have used the Depression, Anxiety, and Stress Scale (DASS) to monitor self-reported systems and a pedometer to track changes in walking behaviors.

Measuring Progress in Walking Psychotherapy Interventions

Limitations for implementing walking during therapy sessions include:
- Poor weather conditions
- Unsafe environments
- Personal injury
- Lack of mobility
- Conditions like social anxiety or agoraphobia 


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