This paper presents a study protocol for an assessor-blinded, parallel group randomised controlled trial comparing the efficacy of walk-and-talk therapy to conventional indoor therapy for men with depressive symptoms across 10 fortnightly sessions over 20 weeks.
Key Findings
Background
Walk-and-talk therapy integrates psychological support and physical activity in outdoor environments and is hypothesised to better align with men's preferences and masculine norms around emotional communication.
Conventional indoor psychotherapy is described as effective for treating depression but 'can be less engaging for men, leading to less satisfaction and high rates of dropout'
The trial is specifically designed to test whether walk-and-talk therapy offers 'clinically meaningful benefits over conventional indoor therapy' for men
The rationale is grounded in the potential mismatch between traditional therapy formats and masculine norms
Methods
The trial uses an assessor-blinded, parallel group randomised controlled design comparing two active psychotherapy conditions for men with depressive symptoms.
Participants are randomised to either (1) conventional indoor therapy (sitting down indoors) or (2) walk-and-talk therapy (walking outdoors)
All participants receive 10 fortnightly 1-hour individual psychotherapy sessions over 20 weeks regardless of group assignment
The trial is registered under ACTRN12624000794505 and approved by the University of Newcastle Human Research Ethics Committee (H-2024-0090)
Methods
The primary outcome measure is change in overall psychological distress assessed using the 21-item Depression, Anxiety and Stress Scale (DASS-21) at post-intervention.
Participants are assessed at three time points: 'pre-intervention' (baseline), 'post-intervention' (5 months post baseline), and 'follow-up' (12 months post baseline)
The primary outcome is specifically change in DASS-21 scores at the post-intervention time point (5 months)
The 12-month follow-up assessment allows examination of longer-term effects beyond the active treatment period
Methods
Secondary outcomes include male-type depression symptoms, mental well-being, suicidal ideation, and quality of life, with costing data collected for cost-effectiveness analysis.
Male-type depression symptoms are included as a secondary outcome, reflecting the study's focus on depression presentations specific to men
Suicidal ideation is included as a secondary outcome given its clinical relevance in male populations
Costing data collection enables a cost-effectiveness analysis comparing the two therapy modalities
Methods
Linear mixed models will be used as the primary statistical approach to examine group, time, and group-by-time interaction effects.
The analytical model examines the impact of group (conventional indoor vs walk-and-talk), time (baseline, 5-month, and 12-month), and the group-by-time interaction
This approach will be applied to both primary and secondary outcomes
Results will be published in an open access peer-reviewed journal and disseminated through conference presentations
What This Means
This paper describes the design of a clinical trial—not yet completed results—that will test whether 'walk-and-talk therapy,' which combines psychological counselling with walking outdoors, is more effective than traditional indoor sitting-based therapy for men experiencing depression symptoms. The researchers note that while standard indoor psychotherapy works well in general, men tend to engage with it less, report lower satisfaction, and drop out at higher rates. The idea is that conducting therapy while walking outside may feel less confrontational and may better fit how many men prefer to communicate about emotions.
In the trial, men with depressive symptoms are randomly assigned to one of two groups: standard indoor therapy or walk-and-talk outdoor therapy. Both groups receive the same number of sessions—ten one-hour sessions held every two weeks over five months. Researchers measure participants' psychological distress, depression symptoms, wellbeing, suicidal ideation, and quality of life at the start of the study, at five months, and again at twelve months. The costs of each type of therapy are also being tracked to determine which approach provides better value.
This research suggests that if walk-and-talk therapy proves effective, it could offer a more accessible and engaging option for men who might otherwise avoid or drop out of mental health treatment. Because men are known to underutilise mental health services and experience high rates of suicide, finding therapy formats that resonate with them could have meaningful public health implications. The trial results, when published, will help clinicians and health services make more informed decisions about how to deliver mental health support to men.
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Regan C, Dickmeyer A, O'Hara R, Halpin S, Smith J, Morgan P, et al.. (2026). Walk-and-talk versus conventional psychotherapy for men with depressive symptoms: study protocol of a randomised controlled trial.. BMJ open. https://doi.org/10.1136/bmjopen-2026-122564