HMN 2025: How Therapeutic climbing lifts mood and sharpens focus for inpatients with depression, anxiety and OCD

Researchers at the University of Innsbruck and Schoen Clinic Roseneck report that structured therapeutic climbing sessions were experienced as emotionally lifting, mentally focusing, socially connecting, and physically strengthening by psychiatric inpatients with depression, anxiety disorders, or obsessive-compulsive disorder.

In Germany, many people with mental disorders live with symptoms that remain untreated for long stretches of time. Nearly one in every three people in the country meets the criteria for a mental disorder, compared to one out of eight people worldwide. Only 19% of affected people in Germany seek help, and many of those who reach out do not receive adequate care.

Across outpatient psychotherapy services, waiting lists of four to six months create long periods in which people remain symptomatic without structured support. Many live through those months with limited access to evidence-based treatments, even while needing interventions that can reduce symptom severity and improve daily functioning.

Exercise reduces mortality risk and, when used as a therapeutic tool, can reduce symptom severity and improve emotional state, well-being and quality of life. Studies linking physical activity and mental health show reductions in depressive symptoms and improvements in mood across large samples.

How climbing entered clinics

Therapeutic climbing and bouldering grew out of clinicians who brought their own favorite sport into psychosomatic and psychiatric care. Rope climbing and bouldering demand high levels of concentration and coordination and can be tailored to different fitness levels and clinical needs. Height exposure during rope climbing can trigger intense emotions, while the structured setting of a wall and safety systems allow work with those reactions. Group formats make climbing feasible in inpatient environments, where patients often engage in shared movement therapies.

Over the past decade, research has described a range of benefits associated with therapeutic climbing, from reductions in depressive symptoms and improvements in anxiety symptoms, to changes in self-esteem, self-efficacy, anxiety, affective state, body image, active and passive coping, interpersonal sensitivity and health-related quality of life.

In the study, “Therapeutic climbing as an adjunctive treatment for psychiatric inpatients: A qualitative study,” published in the Journal of Behavior Therapy and Experimental Psychiatry, researchers used semi-structured interviews to explore how inpatients in a psychosomatic clinic experienced a standardized therapeutic climbing group and which effects they attributed to it.

Participants came from a single psychosomatic clinic in Germany where medical staff screened out people whose health could make climbing unsafe. 17 inpatients joined the project, with an average age of 34. Main diagnoses followed ICD 10 categories and included depression (n=9), anxiety disorders (n=5) and obsessive compulsive disorder (n=3). Many carried additional diagnoses, such as further depressive or anxiety disorders, eating disorders, post-traumatic stress disorder, attention deficit hyperactivity disorder and hypochondriacal disorder.

Therapeutic climbing sessions took place on the clinic’s indoor wall and used rope climbing as the central method. Each group contained six patients and one sports therapist with an additional climbing training license. Sessions lasted 100 minutes. The structure followed an internal climbing therapy concept already in use at the clinic. Every participant attended four therapeutic climbing sessions.

Before the first session, each person completed standardized questionnaires that assessed symptom severity and other psychological variables. These same questionnaires returned after the fourth session, providing secondary quantitative information reported in supplemental material.

A mountain of emotions

Patients described a wide sweep of emotional reactions during and after therapeutic climbing. Fear appeared in several forms, including fear of heights, fear of making mistakes, general anxiety and tension during lowering or belaying. A few people mentioned frustration, stress, anger at themselves, shame, disgust, sadness or disappointment.

Reports of pleasant feelings dominated. Many spoke of joy, fun, relief, happiness, lightness and a sense of well-being after sessions. Reaching the top of routes or completing difficult moves created feelings of achievement and satisfaction, and several participants described pride in having tried tasks they once expected to avoid.

Trust grew across sessions in multiple directions. Participants spoke about trust in themselves, trust in partners and trust in the equipment. Responsibility for belaying sometimes felt stressful at first, especially for people who doubted their abilities. With experience, many described a shift toward comfort and confidence.

Receiving trust from partners also mattered, with participants feeling surprised at discovering that others could see them as reliable. Emotional changes unfolded over time, with early anxiety often giving way to curiosity, enjoyment or calmer mood by the end of each session.

Cognitive shifts

Concentration and focus appeared in every interview. Patients described full attention on the movement, holds and wall, leaving little room for ruminations, compulsions, worries or social comparisons. Several described moments of mental clarity and a temporary break from spiraling thoughts. Self-doubt remained present for many, often tied to fear of mistakes or concern about being observed by others.

Helpful strategies emerged as participants reported asking for help, accepting support, slowing down, breaking tasks into smaller steps and using more supportive internal dialog. People who struggled with fear beforehand noted that repeated exposure during climbing helped the fear subside, while those with strong expectation anxiety described relief once the actual experience proved more tolerable than imagined.

Social experiences

Climbing with a partner shaped many accounts. The group atmosphere often felt pleasant, supportive and cooperative. Patients described shared motivation, encouragement from others and moments of collective celebration when someone completed a route. Interactions during belaying required clear, direct communication, and several participants noted that this helped them feel more grounded and connected.

Some experienced challenges linked to social anxiety, especially discomfort with being watched, fear of judgment or tension when acting as the center of attention. Relationships within the group often deepened over time, stretching beyond climbing into casual conversations during meals or breaks. A few participants mentioned comparisons with others as a strain, though sometimes also as a motivator.

Physiological reactions

Patients described bodily signs of anxiety such as trembling, sweating, tension, rapid breathing and faster heartbeat. Many noted that these reactions softened across sessions as familiarity increased. Climbing felt physically strenuous for most people, though the strain often was of a positive tone, in the accomplishment of a good effort. Several described improvements in coordination or an emerging sense of physical strength, and one person reported better sleep after sessions.

Disorder-related observations

People with depression described moments in which climbing broke cycles of rumination, lifted mood temporarily or created experiences of physical and mental strength that contrasted with feelings of powerlessness. Social contact during sessions also countered patterns of withdrawal.

People with anxiety disorders described graded exposure to feared situations, including being in a group, receiving attention from others and experiencing bodily signs of panic on the wall. Some reported increasing comfort as sessions progressed.

People with obsessive compulsive disorder noticed brief periods in which compulsions loosened when attention narrowed to the climbing task. Touching holds, wearing shared equipment or limiting checking behavior provided opportunities to practice alternative actions. Experiences of success against compulsive impulses strengthened confidence in their ability to continue that work.

Participants with trauma histories described opportunities to renegotiate control by taking charge during climbing or by choosing moments to relinquish it. People with attention deficit hyperactivity disorder described longer spans of sustained attention or reduced inner tension following physical exertion.

Other themes extended beyond any single diagnosis. Relinquishing control, dealing with perfectionism, resisting avoidance, accepting praise, confronting body image concerns and refining self assessment emerged across interviews.

Carryover into daily life

Most participants expressed a wish to transfer experiences from climbing into everyday routines. Many pointed to increased self confidence, willingness to face fears, acceptance of limits, readiness to try new situations, trust in others, clearer thinking, improved frustration tolerance and use of physical activity to regulate tension. Many hoped to continue climbing as a hobby, describing it as a resource with value beyond the inpatient setting.

Conclusion and call for clinical trials

Researchers describe a pattern in which therapeutic climbing touched emotional, cognitive, social and physical domains at once. Patients portrayed experiences that blended effort, fear, curiosity, connection and achievement, forming a set of changes that extended beyond the wall.

Reports pointed toward shifts in self confidence, trust in others, concentration, coping strategies and engagement with disorder-specific difficulties. Many described moments of relief from rumination, anxiety or compulsions and noted brief periods of strength or clarity that contrasted with long-standing symptoms.

Researchers interpret these accounts as evidence that therapeutic climbing can activate factors commonly associated with effective psychotherapies, including mastery experiences, supportive interaction, new behavior in challenging situations and renewed access to personal resources. Patients expressed a clear wish to carry these experiences into everyday life and often viewed climbing as something worth continuing after discharge.

Researchers call for randomized clinical trials that test therapeutic climbing with attention to the patient’s described elements identified here, along with more in-depth qualitative work focused on specific diagnostic profiles.

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