All of these approaches to therapy serve to _channel_ awareness in particular ways, to provide a point of focus for the mind. They are all processes that eliminate distractions and enable you to direct your awareness in ways that are basically different from normal, everyday waking consciousness. Special kinds of absorption or concentration characterize the therapeutic uses of exercise, biofeedback, relaxation training, hypnosis, and meditation. THE PSYCHOTHERAPY OF EXERCISE _For some individuals who already are or who are willing to become physically fit, sustained vigorous exercise can significantly decrease symptoms of tension, anxiety, and depression._ It is my contention that, just as prayer, meditation, dream analysis and some drug experiences open doors into these areas not usually accessible to us, under the appropriate circumstances slow long-distance running opens similar doors. The subjective experience of the runner appears the same, and he becomes revitalized or reenergized in a psychological {205} or spiritual or creative sense.... It is clear to me that this is a distinct form of psychotherapy. Thaddeus Kostrubala, _The Joy of Running_ Many studies have been made and a small mountain of literature has accumulated about the physical effects of exercise. However, little attention has been paid to its psychological aspects, particularly in connection with the kinds of symptoms and problems that bring people to psychotherapy. Psychiatrist Thaddeus Kostrubala (1930- ) has been one of the pioneering contributors to the study of exercise as a form of psychotherapy. Dr. Kostrubala is a dedicated runner who has completed many marathons and who uses running as a therapeutic approach in his practice. Much of the modest amount of research on the psychotherapeutic value of exercise has focused on running, probably for the following reasons: First, slow long-distance running seems to be an anatomically natural activity for us, with our species' two relatively long legs. Second, running appears to be an especially effective way to derive specific therapeutic benefits from an aerobic activity. And, of course, running has recently become very popular. Most exercise physiologists claim that the physical, and very likely also the psychological, effects of other aerobic forms of exercise, such as bicycling, swimming, and cross-country skiing, are essentially equivalent to running. So, until we know otherwise, we will assume that what is true of running is likely to be true of other types of exercise that make similar demands on the body, and we will focus here on running. Dr. Kostrubala has attempted to describe a particular approach to running that seems to have definite psychotherapeutic value. More is involved than donning a pair of running shoes and starting out, as we will see.