109. The effect of sports tourism on emotional regulation and psychological mechanism of anxiety disorder patients

Abstract Background Anxiety disorders are often characterized by persistent hyperarousal, impaired emotional regulation, and hypersensitivity to threat cues. These features disrupt patients’ daily functioning and hinder long-term recovery. Although cognitive behavioral therapy and pharmacotherapy remain primary interventions, residual symptoms and high relapse rates persist, highlighting the urgent need for adjunctive approaches to enhance emotional resilience. In recent years, “sports tourism” – an approach integrating physical activities, natural environment exposure, and social interaction – has gained traction in mental health research. Evidence suggests it may improve anxiety by modulating cognitive and physiological processes related to emotional processing. However, its specific mechanisms remain unclear, and systematic longitudinal evidence is lacking. Therefore, the study compared the effects of the intervention and the changes of the related indicators of emotional regulation by random grouping and multi-time point measurement. Methods The study enrolled 312 patients with anxiety disorders meeting DSM-5 criteria and 156 healthy controls for baseline assessment. Participants were randomly assigned to one of three 8-week interventions: (1) a moderate-intensity outdoor activity-focused sports tourism program (n = 104), (2) an equivalent indoor aerobic exercise program (n = 102), or (3) a waitlist control group (n = 106). Key outcomes included emotional regulation behaviors (cognitive reappraisal task), threat attention bias (dot-probe task), and physiological arousal metrics. Anxiety symptoms were assessed using standardized scales at baseline, intervention completion, and 3-month follow-up. Statistical analyses employed mixed-effects models and Cox regression to compare intervention effects and examine the predictive role of emotional regulation changes in symptom trajectories. In addition, the speed of response in the task of emotion regulation was improved in the group of sports tourism intervention, which indicated that the efficiency of emotion processing was further improved. Results The experimental results demonstrated that, compared to the indoor exercise and waiting control groups, the sports tourism group showed significant improvements in cognitive reappraisal accuracy (p=.004, d = 0.47) and a marked reduction in threat attention bias (p=.011, d = 0.39). Heart rate variability data revealed more pronounced enhancements in autonomic nervous system flexibility (p=.008, d = 0.42) within the sports tourism group. Symptom assessments indicated a significant decrease in anxiety levels (p<.001) following intervention, with sustained benefits maintained during follow-up (p=.002). Further analysis revealed that increased heart rate variability (p=.01) and improved cognitive reappraisal ability (p=.03) were predictors of lower symptom levels and were associated with longer relapse duration in patients with residual symptoms. Discussion Sports tourism significantly enhances emotional regulation in individuals with anxiety disorders, with improvement effects comparable to those of experiential psychological interventions. The core mechanisms underlying its efficacy may involve enhanced cognitive reappraisal, reduced threat attention bias, and improved autonomic regulation. Research indicates that sports tourism can serve as an effective adjunct to anxiety treatment, providing valuable supplementation to individualized psychotherapy. By integrating physical activity, natural exposure, and social interaction, this approach may help identify subgroups more responsive to experiential interventions, paving the way for more precise and scalable early intervention strategies in the future.