Walk-and-Talk Psychotherapy for Men with Low Mood: A Pilot Study

INTERVENTION: Arm 1: Walk‐and‐Talk Psychotherapy Intervention description and dose: Participants in the 'walk‐and‐talk' arm will receive 6 X60 minute outdoor walking psychotherapy sessions over 6 weeks (one session per week, 6 hours total contact). In the sessions, the therapist will follow a person‐centered counselling approach using counselling micro‐skills to address important issues identified by the participant. The sessions will take place while walking along a pre‐approved route nearby the University of Newcastle's Callaghan Campus Psychology Clinic. Therapists: The sessions will be delivered by provisional psychologists completing their practicum placement at the University of Newcastle's Psychology Clinic ‐ Callaghan Campus. All therapists will have received training in person‐centered counseling approaches during their study. To prevent confounding, therapists will be allocated clients from each study arm (but each client will have the same therapist for the whole study). Mode: Face‐to‐face, outdoor walking therapy. Procedures: After booking in for their sessions at the beginning of the trial, participants will receive a text message reminder the day before each session. If they are unable to attend, they will have an opportunity to reschedule their session for an alternate time that week, where possible. Materials: If needed, participants and therapists will have access to insect repellant plus ponchos and/or umbrellas for use in mild wet weather. Neither group will receive informational materials during the study. Location: University of Newcastle, Callaghan Campus. Treatment adherence and fidelity: Therapists will keep a session log documenting participant attendance (Y/N) and whether the session could be delivered as CONDITION: Depression; ; Depression Mental Health ‐ Depression PRIMARY OUTCOME: Outcome: Fidelity (session location):; ; Measurement tool: Session log.; Completed by: Therapists.; Metric: Average proportion of sessions delivered in the intended setting (i.e., indoor vs outdoor).; Indicator of feasibility: At least 50% of sessions delivered in the intended setting. Each study arm will be evaluated independently.; [Post‐intervention (7 weeks post‐baseline)] Outcome: Participant satisfaction; ; Measurement tool: Participants overall satisfaction with therapy using a single item likert scale developed for this study (1 = Poor, 2 = Fair, 3 = Average, 4 = Good, 5 = Excellent).; Completed by: Participants.; Metric: Group mean.; Indicator of feasibility: Mean score at least 4 / 5. Each study arm will be evaluated independently.; [Post‐intervention (7 weeks post‐baseline)] Outcome: Participant session attendance; ; Measurement tool: Session attendance log.; Completed by: Therapists.; Metric: Average proportion of sessions attended by participants.; Indicator of feasibility: At least 50% of sessions attended on average. Each study arm will be evaluated independently.; [Post‐intervention (7 weeks post baseline).] INCLUSION CRITERIA: ‐ Identify as Male; ‐ Aged 18‐70 years; ‐ Experiencing mild to severe depressive symptoms for at least two weeks (Patient Health Questionnaire ‐ 9 item [PHQ‐9] score = 5 or above); ‐ Available to attend si Xtherapy sessions at the University of Newcastle over 6 weeks; and Willing to participate in their assigned treatment group for the duration of the study period. SECONDARY OUTCOME: Outcome: Change in anxiety symptoms. ; Measure: DASS‐21 Anxiety Subscale.[Baseline, and 7 weeks post‐baseline.] Outcome: Change in behavioural activation score. ; Measure: Behavioural Activation for Depression ‐ Short Form (BADS‐SF).[Baseline, and 7 weeks post‐baseline.] Outcome: Change in depressive symptoms. ; Measure: DASS‐21 Depression Subscale.[Baseline, and 7 weeks post‐baseline.] Outcome: Change in experiential avoidance. ; Measure: Acceptance and Action Questionnaire (AAQ‐II).[Baseline, and 7 weeks post‐baseline.] Outcome: Change in masculine depression symptoms. ; Measure: Male Depression Risk Scale ‐ 22 item.[Baseline, and 7 weeks post‐baseline.] Outcome: Change in mental well‐being. ; Measure: Warwick‐Edinburgh Mental Well‐being Scale.[Baseline, and 7 weeks post‐baseline.] Outcome: Change in overall negative emotional state. ; Measure: DASS‐21 Total Score.[Baseline, and 7 weeks post‐baseline.] Outcome: Change in stress symptoms. ; Measure: DASS‐21 Stress Subscale.[Baseline, and 7 weeks post‐baseline.] Outcome: Mean participant session satisfaction rating. ; Measure: Adapted version of the Session Rating Scale.[Post‐intervention (7 weeks post‐baseline). Participants will complete this brief measure after each session and the average score across all sessions will be compared between groups at post‐intervention.] Outcome: Participant perceptions of the therapeutic alliance. ; Measure: Working Alliance Inventory Short Form.[Post‐intervention only (7 weeks post‐baseline).] Outcome: Participant Retention ; ; Measurement tool: Study database. ; Completed by: Research team. ; Metric: Number of randomised participants who complete post‐intervention questionnaire. ; Indicator of feasibility: At least 80% of participants retained.[Post‐intervention (7 weeks post‐baseline).] Outcome: Recruitment capability ; ; Measurement tool: Study database. ; Completed by: Research team. ; Metric: Number of eligible participants randomised. ; Indicator of feasibility: 30 participants recruited for trial. ; [Baseline] Outcome: Restorative impact of therapy. ; Measure: Adapted Relaxation and Restoration Scale.[Post‐intervention only (7 weeks post‐baseline).]