The Sweat Therapy Theoretical Model explains the mechanism for how sweat practices work to cause therapeutic effects. The model begins with examination of cultural priming. Beyond a cultural predisposition toward the activity, four main factors are hypothesized to account for the psychotherapeutic benefits: (1) Exercise, (2) Self-Regulation, (3) Interpersonal Factors, and (4) Metaphorical Contextual Elements. These factors interact in a reciprocal manner to produce positive effects upon the body, mind, and spirit.

CULTURAL PRIMING

The practice of group sweating has been present throughout the world for thousands of years and is central to community life among many cultural groups. Different forms of indigenous sweat practices can be found across many geographically and culturally distinct regions of the world: (1) American Indian Sweat Lodge; (2) Finnish Sauna; (3) Greek Sweat Bath; (4) Irish Sweat House; (5) Japanese Mushi-Buro and Korean Jim Jil Bang; (6) Jewish Shvitz; (7) Islamic Hammam; (8) Mayan Sweat House; (9) Mexican and Central American Temescal and Inipi; (10) Roman Balnea and Thermae; (11) Russian Bania; and (12) Scythian Sweatbath; and (13) South African Sifutu. Many of these sweat practices have been present for more than 2,000 years. Before ever entering a sauna or sweat lodge, many participants already have beliefs and expectations about the experience. They are predisposed to the activity based upon its passing from one generation to another. Since sweat rituals have existed for thousands of years throughout the world, people will be attracted to it and are primed to receive benefits from it that are consistent with their cultural background. The more prominent the practice exists in the individual’s background, the stronger the priming.

EXERCISE

From clinical experience, sweating induces commonly observed effects of exercise on mental health, such as reducing anxiety, depression, and stress and improving body image, self-esteem, and sense of well being. The sweating experience produces profound physiological changes and perceptions of physical symptoms. Sauna is similar to exercise as it causes the stimulation of the sympathetic nervous system, activation of the hypothalamus-pituitary-adrenal hormonal axis, and an increase in noradrenaline. However, sauna is different from exercise in a few important ways. Unlike in typical forms of exercise, sauna causes an increase in B-endorphins and does not increase the concentration of adrenaline in the blood stream. Sauna also contrasts with the majority of exercise activities because it does not require muscle tension, the movement of large muscle groups, and attentional capacities to be focused on muscle coordination. Sauna is a unique form of exercise as it causes muscle relaxation and allows focal attention to be focused on another activity, such as group content and process. The state of arousal that accompanies being in exercise mode stimulates learning involved in the other three factors.

SELF REGULATION

Heat exposure in an enclosed area goes beyond being a form of exercise by creating an altered state of consciousness characterized by a dynamic balance between alertness and relaxation. At first, the heat is soothing and as the body begins to respond to the heat through sweating, the body’s muscles experience a release of tension, promoting a deeper state of relaxation. However, rather than slipping into a state of relaxation resembling rest or sleep, further heat exposure keeps the mind and body active through the process of sweating. As the heat becomes more intense, the participant is challenged to keep the mind relaxed, requiring meditative attentiveness. Walsh and Shapiro (2006, p. 3-4) defined meditation as the “family of self-regulation practices that focus on training attention and awareness in order to bring mental processes under greater voluntary control and thereby foster general mental well-being and development and/or specific capacities such as calm, clarity, and concentration.” One can allow negative thoughts and feelings related to the heat become the focus of their experience. Alternatively, one can focus on thoughts and feelings that help one to adapt, cope, and thrive when faced with adversity. Learning to endure the heat requires a form of meditation and leaves the person feeling a sense of accomplishment. This meditative attentiveness and sense of positive adaptation influence the depth of appreciation for metaphors and encourage problem solving.

METAPHORICAL CONTEXTUAL ELEMENTS

The contextual elements involved in group sweating include taking breaks, dimmed lighting, wearing sparse or no clothing, drinking large quantities of water, and the use of fire as a symbol. These contextual elements serve to maximize the therapeutic properties of heat exposure and are common to the many forms of sweat rituals used throughout the world. The psychological effects of sweat therapy may be partially accounted for by the metaphorical meaning stemming from the contextual elements of group sweating. The symbolism of fire can be understood across languages and cultures as the basis of heat and light, of warmth and illumination. A safe therapeutic atmosphere is represented by the gentle womb-like warmth of the enclosed sauna, which encourages relaxation and openness versus anxiety and defensiveness. Whereas many current social norms encourage us to keep distance from one another, especially when sweating, the sauna symbolizes closeness and promotes genuineness. Sitting together in a sauna symbolically promotes a safe and open therapeutic atmosphere, which may be considered the building blocks of effective group therapy. In addition to safety and openness, change is critical to any therapeutic endeavor. Mind-body purification occurs as a natural consequence of intense sweating; toxins are sweated out through the pores of the skin, bringing clarity to the mind and homeostasis to the body. The intense physical experience pushes us to become more introspective and appreciate personal, symbolic reactions to the heat. Intense heat comes to represent life’s greatest challenges while enduring the heat is a symbol of human will and resiliency. In addressing life’s challenges, taking breaks and drinking water are symbols of self-care and rejuvenation. The shared experience of sweating and enduring the heat promotes group members’ common humanness and a sense of existential togetherness. Through the symbolism of the shared, enclosed womb-like purification, group members come to accept and learn from one another. The experiential, symbolic process of group sweating appears to stimulate and reinforce the critical group therapeutic factors of cohesion and interpersonal learning.

INTERPERSONAL FACTORS

Socialization is a main purpose of the many forms of sweat rituals used throughout the world. Sweat practices have long been a place for the interpersonal exchange of trials and tribulations. Exercise, metaphor, and self-regulation seem to intensify group dynamics. At the same time, group interaction provides an opportunity for participants to process the experience. From clinical experience with sweat therapy, group members perceive the sweating experience as a moderate challenge to which they respond by seeking social support and engaging in thinking that promotes self-esteem (e.g.: “Although I’m uncomfortably hot, I am staying in the sauna because doing so will make me better in some way.”). The sweat condition prompts altruism which quickly translates into cohesion. Group members work together as a unit to get through the heat by offering towels and water to one another and showing frequent concern for one another’s ability to handle the heat. These seemingly simple expressions of sharing and concern for one another become part of the group norms and transcend into people showing greater care and concern for one another when discussing deeper topics. Self-Disclosure, Interpersonal Learning, and Group Cohesion were the most prominent group therapeutic factors identified for the sweat groups in two controlled/randomized studies. Sweating and interpersonal interaction are natural catalysts for one another.

References

Eason, E. A., Colmant, S. A., and Winterowd, C.L. (2009). Sweat Therapy Theory, Practice, and Efficacy. Journal of Experiential Education, Volume 32, 2 pp 121-136.