Climbing Is Entering the Treatment Toolbox for Depression
In Germany, psychiatrists are using bouldering to treat depression. A new study offers a clearer picture of what may be happening between the wall and the mind.
In Erlangen, Bavaria, about 12 miles north of Nuremberg, each session lasts two hours. The first 20 minutes take place in a separate room, with a mindfulness exercise, an introduction to the day’s theme, and some psychoeducation. Then the group heads into the climbing gym for 75 minutes of bouldering before wrapping up with relaxation and discussion.
On the wall, no one is working on footwork or trying to send a project. The exercises are designed to “trigger emotions, bring certain patterns to the surface, and create opportunities for new experiences,” the researchers explain. Fear, failure, self-confidence, difficulty asking for help: things that would normally be discussed in a therapist’s office are put into practice on climbing holds. The method is called Bouldering Psychotherapy, or BPT. And a new study published in BMC Medicine in May 2026 measured its effects in people with depression.
Bouldering Therapy
For the study, 128 adults experiencing a major depressive episode were randomly assigned to one of three groups. Forty completed 10 weeks of BPT, making up the bouldering group. Forty-four took part in a different group therapy program called WISE. The remaining 44 continued with their usual care and served as the control group. The bouldering sessions were held in groups of about 10 people and led by two psychiatrists, psychologists, or psychotherapists trained in the protocol. The authors describe BPT as “psychotherapy enhanced by physical exercise.” In other words, climbing is not a workout tacked onto therapy. It is part of the therapy itself.
After 10 weeks, depressive symptoms had decreased more among participants who received BPT than among those who continued with usual care.
Before participants were randomly assigned, 102 out of 128, or nearly 80 percent, said they hoped to end up in the climbing group. Twenty-five preferred WISE. Just one wanted to remain with usual care. That does not invalidate the comparison, since participants were ultimately assigned at random. But those preferences could still shape how people experienced the treatment. There is no real placebo here. Everyone knows whether they are spending two hours a week climbing.
With those caveats in mind, the results are encouraging. After 10 weeks, depressive symptoms had decreased more among participants who received BPT than among those who continued with usual care. The researchers measured symptoms using the MADRS, a scale commonly used to assess the severity of depression. The difference between the two groups was 4.2 points. It was statistically significant, but slightly below the five-point threshold the research team had set for a clinically important difference. In other words, there appears to be an effect, but it is modest. Enough to take the approach seriously, not enough to declare climbing a miracle treatment.
There is another way to look at the results. In the bouldering group, 29.7 percent of participants showed substantial improvement, compared with 21.1 percent in the control group. The one-year follow-up is harder to interpret. By then, 10 of the 44 people in the control group had started BPT themselves, so the two groups were no longer as cleanly separated as they had been at the start of the study. What the researchers could still see was that people who had completed BPT maintained the improvement they had shown after 10 weeks.
It also matters who was offered the treatment. Fifty-seven percent of participants were taking antidepressants, and 38 percent were already receiving psychotherapy. BPT was not being tested as a replacement for existing care, but as something that might add to it.
The protocol also excluded people with acute suicidality, meaning an immediate or very high risk of suicide, as well as people with recent self-harm, certain severe psychiatric disorders, or physical conditions that made climbing inappropriate. The results therefore apply to a specific population, not to everyone with depression.
Even in this closely supervised setting, the climbing was not entirely incident-free. One participant tore a ligament while climbing. Another experienced the return of a traumatic memory during a session. Therapists also reported one minor abdominal abrasion. Still, adverse events were no more common in the bouldering group than in the other groups.
Climbing vs. Nordic Walking
The 2026 study is not the first to test the idea. In 2025, a scientific review pulled together the research already published on climbing and depression. The researchers deliberately set a high bar for inclusion. Participants had to have at least moderate depression, the study had to include a comparison group, and changes in symptoms had to be measured using a recognized clinical scale. After screening the available research, only seven studies met those criteria, covering a total of 471 participants. All had been conducted in Germany or Austria, and most came from the same research network. So the subject is beginning to receive serious scientific attention, but the evidence base is still fairly narrow.
Fear, frustration, or the need to ask for help can show up almost immediately. Things that might normally be discussed in a therapist’s office can play out directly during the session.
Taken together, the studies point in a similar direction. After eight to 10 weeks, people enrolled in programs combining climbing, mindfulness, and psychotherapeutic work tend to show fewer depressive symptoms. In some studies, those improvements are still visible months later. But the size of the effect depends heavily on what climbing is being compared with. Against no additional intervention, or against exercise done alone at home, climbing-based programs perform better. Against another form of group treatment, the advantage becomes much smaller.
One study, for example, found that BPT was no more effective than group cognitive behavioral therapy, a form of therapy that works with patterns of thought, emotion, and behavior. In another, four weeks of top-rope climbing, where the climber is protected by a rope anchored above them, performed no better than four weeks of Nordic walking, a fitness-oriented form of walking with poles. The problem is that participants in these studies are never simply bouldering. They are exercising. They are meeting with the same group every week. They are working with therapists. They are paying attention to their emotions. They are often practicing mindfulness.
So when their symptoms improve, it becomes difficult to tease out how much of the benefit comes from climbing itself. That is exactly what therapists are now trying to understand.
On a boulder problem, you have to try, fail, try again, and change your approach. Fear, frustration, or the need to ask for help can show up almost immediately. Things that might normally be discussed in a therapist’s office can play out directly during the session.
Researchers also point to concentration, problem-solving, experiences of success, and interactions with other participants as possible factors.
The 2026 study tried to measure some of those mechanisms. Participants in the bouldering group improved in their ability to stay focused during physical activity. The effect was much less clear when it came to self-efficacy, the belief that you can handle a difficult situation.
So BPT appears to help, even though researchers still do not know exactly why. The 2025 review offers another clue. Climbing’s advantage is most noticeable when it is compared with no intervention or with an activity people do alone. Once the comparison group also takes part in a group activity, the gap narrows considerably. The authors put their hypothesis this way: “Maybe what matters most is not what people do, but how they do it.”
For now, there is no way to know how much of the improvement comes from bouldering itself, from physical activity, from being part of a group, or from working with therapists.
The next step is not so much proving that these patients can get better. It is figuring out why.
