Resilience Therapy

Resilience Therapy is a measurement-led practice. It is a multi-faceted approach guided by the health data from your wearables and phone apps, so the work on your body and your mind actually shows up in the numbers. It explores the links between the sympathetic and parasympathetic nervous system, cardiovascular fitness, heart health, and psychological well-being.

Trevor recommends every client wear a Garmin watch; a simple app like HRV4Training will do to start, but the more information gathered, the better. See Choosing a wearable for a comparison of Garmin, Oura, Apple Watch and HRV4Training.

Medicine waits. This does not.

Your doctor is reactive, and that is the right design for what a doctor does. Something goes wrong, you present with it, and a treatment is issued against it. The system is built to respond to a problem that already exists, and it is very good at that.

This works the other way round. Nothing has gone wrong yet. Nothing needs fixing. The point is to build capacity now, and to keep a record good enough that when something does start to shift, it shows up as a line moving before it shows up as a symptom.

That is not a criticism of medicine. It is a different job. A doctor cannot see your heart-rate variability falling over eight months, because nobody measures it between appointments and nobody is looking. A year of your own daily numbers can show you that, and it can show it long before anything would send you to a clinic.

So there is no prescription here, and there is nothing to treat. Trevor is a trainer, not a physician, and he does not diagnose. What he does is build a programme, measure what it does to you, and change one thing at a time until the numbers move in the right direction. Anything clinical goes to your doctor, and the record makes that conversation a better one, because you arrive with data instead of a description.

Reactive care asks what is wrong. This asks what is changing, and what moved it.

What gets measured

Heart-rate variability first. Then resting heart rate, resting breath rate, blood oxygen, blood pressure and sleep, along with VO2 max and lactate threshold. That is the full autonomic, aerobic and recovery picture, not one number.

These numbers are tied to how people feel. Large studies find that lower resting heart rate, higher HRV, better sleep and slower breathing go with less depression, anxiety and stress, and that improving sleep improves all three.

Training guided by HRV

The same HRV data decides the training. On days your body has recovered, you push; on days it has not, you back off. Studies comparing this with a fixed plan find it builds fitness as well or better, often with fewer hard sessions.

Time outdoors

Trail running and hiking are also time in nature, and that counts on its own. Large reviews find nature-based activity reduces anxiety and depression, and rank exercise outdoors above exercise indoors for mental health.

How well-being is measured

Three of the most widely used screening questionnaires: the PHQ-9 for depression, the GAD-7 for anxiety, and the DASS-21, which adds stress.

Read more: screening that can be repeated

Those three share one weakness: repeat them often enough and the answers drift, because the person is answering the same nine or seven or twenty-one questions they answered last month. Adaptive testing is the way around it. A computerized adaptive test holds a large bank of items and picks a different small set each time, aimed at the person’s current severity, so the same score can be taken again and again without the practice effect that comes from re-reading a familiar list.

Two systems do this now, and both combine several domains in one sitting. The CAT-MH draws about a dozen items from a bank of roughly fifteen hundred and takes about two minutes per module, covering depression, anxiety, mania, substance use, psychosis, PTSD, adult ADHD, social determinants of health, and suicidality; it is validated against structured clinical diagnostic interviews (Gibbons et al., Annals of Family Medicine, 2019). It is a licensed clinical product. PROMIS, built by the NIH, is free and in the public domain, runs its depression, anxiety, sleep disturbance, and fatigue banks adaptively in three to seven items each, and puts everything on one T-score scale referenced to the US general population (HealthMeasures).

They connect to the three tools above rather than replacing them. PROsetta Stone publishes a conversion table from a PHQ-9 total to a PROMIS Depression T-score, so a history taken on the PHQ-9 still counts. PROMIS Anxiety run adaptively tracks closely with the GAD-7. The DASS-21 has been modelled the same way, and a simulated adaptive version cut the number of items by seventeen to forty-eight percent at the same reliability, though no working version exists yet (JMIR, 2023).

The reason this matters here: screening that can be repeated without wearing out is screening that can be taken as often as the wearable data is, instead of once at the start and once at the end. That is the whole point of measuring the nervous system continuously.

Why fitness matters for the mind

In a review of over four million people, high cardiorespiratory fitness cut the risk of depression by about thirty-six percent. It also predicts lower risk of heart disease and early death, and exercise improves mood and anxiety in people who already have heart disease.

Heart-rate variability, which your wearable already tracks, is the window onto this. It reflects the balance between the stress and recovery sides of the nervous system.

Read more: where polyvagal theory fits, and where it does not

Anyone reading about the vagus nerve runs into polyvagal theory quickly. It is worth knowing what it says and what has happened to it.

Stephen Porges proposed it in 1994. It describes the autonomic nervous system in three states rather than two: a ventral vagal state of safety and connection, sympathetic fight-or-flight, and a dorsal vagal shutdown when neither fighting nor fleeing is possible. It gave a generation of therapists a vocabulary for what a body does under threat, and it is where most talk of “regulating your nervous system” comes from.

It is also, right now, seriously disputed. In February 2026 Paul Grossman and thirty-eight co-signatories published an evaluation in Clinical Neuropsychiatry concluding the theory is untenable — that its evolutionary framing does not hold, and that respiratory sinus arrhythmia is not the clean readout of vagal activity the theory treats it as. Porges replied in the same issue that the critique attacks a version of the theory he did not propose. The argument is not settled and neither side is fringe.

None of which changes the training. The evidence that higher HRV tracks with better emotional regulation, and lower HRV with anxiety and depression, comes from studies that stand on their own — it does not depend on Porges being right about why. Slow breathing, aerobic base work, sleep and time outdoors move those numbers whatever the mechanism turns out to be. That is the honest position: the language of polyvagal theory is useful, its physiology is contested, and the programming here rests on the measurements rather than on the model.

The whole picture

Resilience Therapy isn’t a single intervention. It’s the system that connects them: fitness data, psychological screening, time in nature and recovery all feed one picture of how you’re doing, so nothing gets missed and nothing gets treated in isolation. Each of these moves the needle on mental health, and together they move it further.

Every study named on this site is listed on the references page.

Moving forward

Resilience Therapy runs on data that currently lives in too many places: HRV in one app, blood work in a PDF from a lab, blood pressure in a note on a phone, screening scores on paper. Putting that picture together is done by hand, every time.

So clients who train with Trevor get access to an app of his own: one row per day holding their HRV, resting heart rate, sleep, breathing rate and blood pressure, their training, and their screening scores, side by side. It is built to take the numbers straight off a client’s Garmin so nobody has to type anything in.

It comes with training. It is not for sale, it is not in an app store, and it is not offered to anyone who is not a client.

The point is that the connection between fitness, recovery, nutrition and mental health is the thing being treated, and right now nothing else shows that connection in one view.