Whole-body cryotherapy

1. Introduction

Version followed: whole-body cryotherapy/cryostimulation (WBC) and partial-body cryotherapy (PBC, "cryosauna") as described by the US Food and Drug Administration consumer update of July 2016, the Cochrane review by Costello et al. (2015), the international safety scoping review by Legrand et al. (2023) and the International Institute of Refrigeration (IIR) position paper on contraindications by Capodaglio et al. (2025). This is not a psychotherapy; it is a cold-exposure procedure delivered by other people (rehabilitation clinics, sports settings and commercial spas). This guide covers what it is, its evidence status, safety, and the psychotherapist's role when a client raises it.

What it is. Brief exposure of the body to extremely cold, dry air or nitrogen vapour in a purpose-built enclosure [source: FDA 2016; Cochrane 2015]. Two device families are described:

Whole-body cryochamber (WBC proper): a walk-in room, sometimes entered through a pre-chamber, cooled by refrigerated (electrically generated) cold air; the whole body including the head is exposed; the FDA notes some chambers hold several people at once [source: Legrand et al. 2023; FDA 2016].
Partial-body cryosauna or cryo-cabin (PBC): a single-person, open-topped, can-shaped cabin; the head stays outside at room air; liquid nitrogen is vaporised and injected into the cabin. Legrand et al. note PBC is often wrongly marketed as "whole-body", and that cryosaunas show more temperature variation inside the cabin than cryochambers [source: Legrand et al. 2023; FDA 2016]. PBC devices are smaller and more mobile and are used more with sports teams in the field; WBC chambers are used more in rehabilitation and athletic centres [source: Bouzigon et al. 2018].

European researchers increasingly use the term "cryostimulation" [source: IIR 2025].

Core idea of how change is claimed to happen. Providers and researchers propose that a short, intense cold stimulus triggers physiological responses (circulatory, inflammatory, hormonal; some authors propose increased BDNF) that might ease soreness, pain or mood [source: Legrand et al. 2023, introduction]. The FDA states it does not know how such cold affects blood pressure, heart rate or metabolism, and found "very little evidence" of safety or effectiveness for the conditions promoted (online claims include anxiety, depression, insomnia, chronic pain, fibromyalgia, migraine, arthritis, MS, Alzheimer's, asthma, weight loss) [source: FDA 2016].

Evidence status in brief.

Recovery after exercise: the Cochrane review (4 small lab-based RCTs, 64 mostly young male participants) found "insufficient evidence" that WBC reduces soreness or improves subjective recovery compared with rest; certainty "very low"; no trial actively monitored adverse events, which the authors call important because extreme cold is a potential hazard [source: Cochrane 2015].
Depression: one double-blind, sham-controlled RCT in medically stable adults with a depressive episode found greater improvement on depression scales when WBC was added to ongoing antidepressant medication [source: Rymaszewska et al. 2020]. This is a single trial, in a medically supervised research setting, as an add-on; it does not establish WBC as a treatment for depression [synthesis]. An earlier study by the same group (2008) is reported in the literature [uncertain: not verified].
Regulation: in the US no WBC device has been cleared or approved by the FDA to treat any medical condition [source: FDA 2016].

2. Framework

Because the psychotherapist does not deliver cryotherapy, the framework below is a referral-and-integration pathway for the therapist [synthesis, built on the safety sources cited]. Sessions are delivered by the provider as single exposures or as series; research protocols use repeated supervised exposures [source: Cochrane 2015; Rymaszewska et al. 2020]. No exposure parameters are given here: the IIR states that exposure settings must be chosen by the treating service to avoid risk after medical screening [source: IIR 2025].

Phase	Goal	Format	Move on when
A. Client raises it	Understand motive and expectations	Part of one therapy session	Motive and hoped-for effect are clear
B. Information and evidence	Shared, balanced picture of benefit claims and risks	10–20 minutes in session; written sources offered	Client can state what is and is not known
C. Safety screening and medical clearance	Identify contraindications; route to physician and prescriber	Brief screening conversation; referral letter if wanted	Client has spoken to their doctor, or decides not to go ahead
D. Provider choice	Help the client recognise safer and riskier providers	Session discussion using the red flags in this guide	Client can name what a careful provider does
E. Monitoring	Track mood, sleep, anxiety, adverse effects, and that established treatment continues	Brief check-in at subsequent sessions	Ongoing
F. Integration or stopping	Make sense of the experience; decide whether to continue	One review session	Decision made; adverse effects passed on

Who delivers: in the US mainly commercial spas and wellness businesses, which the FDA describes as using devices not cleared for any medical use [source: FDA 2016]; in Europe also rehabilitation and sports medicine centres working under medical screening frameworks (the Bad Vöslau consensus and IIR guidance) [source: Legrand et al. 2023; IIR 2025; Bouzigon et al. 2018].

3. Guiding principles

Not a psychotherapy and not a treatment for disease. Never present it as a cure for depression, anxiety or any physical illness; FDA warns that using it instead of proven treatment may leave a condition unimproved or worse [source: FDA 2016].
Medical clearance first. The IIR calls medical assessment and screening mandatory before any exposure [source: IIR 2025]; practically: send the client to their physician before they book [synthesis].
Never advise on medicines. Questions about medicines and cold tolerance go to the prescriber [synthesis].
Evidence honesty. Describe the evidence as very low certainty for recovery and limited (one RCT, add-on) for depression [source: Cochrane 2015; Rymaszewska et al. 2020].
Name the device. Ask whether it is a walk-in electric chamber or a nitrogen cryosauna; the hazards differ (nitrogen and oxygen displacement apply to nitrogen devices) [source: FDA 2016; Legrand et al. 2023].
Never alone. The documented death involved a person in a nitrogen chamber without anyone assisting; the client should only use a supervised device [source: Fox News 2015; MinnPost 2016].
Psychiatric caution. The IIR screening list includes psychosis, mental disorder and anxiety, and claustrophobia as subjective contraindications; this sits in tension with depression research and must be resolved by the treating physician, not the therapist [source: IIR 2025; Rymaszewska et al. 2020] [synthesis].
Client autonomy. Adults may choose wellness procedures; the therapist's role is informed choice and safety, not prohibition [synthesis].
Watch for substitution. Check that established treatment (medication, psychotherapy, medical care) continues [source: FDA 2016] [synthesis].
Pass on adverse effects. Any cold burn, blistering, severe headache, neurological symptom, chest pain or memory gap is a medical matter for urgent assessment [source: Legrand et al. 2023; O'Connor et al. via MDedge 2018] [synthesis].

4. Intervention inventory

These are the psychotherapist's interventions around cryotherapy. The sources describe the device, its evidence and its contraindications; the in-session procedures below are [synthesis] built on them. The therapist never operates, supervises or prescribes cryotherapy.

4.1 Exploring the client's interest and expectations

Purpose / when: whenever a client mentions trying, buying or already using cryotherapy, or a gym, spa, coach or influencer recommends it.
Steps: (1) Ask what they have heard and from whom. (2) Ask what they hope it will change (mood, pain, sleep, weight, recovery, "reset"). (3) Ask whether it would replace or add to current treatment. (4) Ask whether they know which device type is offered (walk-in chamber or cryosauna with head outside). (5) Reflect the hope behind the interest without endorsing the claim.
Example language (illustrative): "It sounds like you are looking for something that gives a quick jolt when the low mood sets in. What have you been told it does, and where did you hear it?"
Watch for: magical expectations ("it will fix my depression"); plans to stop medication or therapy; pressure from a package sale; working out whether the interest is a healthy wish for activity or avoidance of harder work. Working: the client can say plainly what they hope for and where the idea came from.

4.2 Balanced evidence conversation

Purpose / when: after 4.1, before any decision.
Steps: (1) Offer to share what reliable sources say. (2) Summarise: the FDA has not cleared any WBC device to treat any condition and found very little evidence [source: FDA 2016]; the Cochrane review found insufficient, very-low-certainty evidence for recovery after exercise [source: Cochrane 2015]; one RCT found an add-on benefit on depression scales in medically screened patients already on medication [source: Rymaszewska et al. 2020]. (3) Distinguish research settings (screened, supervised) from commercial ones. (4) Invite the client's reaction.
Example language (illustrative): "The honest picture is that the research is thin. One trial in people already taking antidepressants found extra benefit, but that was under medical supervision, and the US regulator has not approved these devices for treating anything."
Watch for: the client feeling lectured or shamed; keep it informational. Working: the client can restate both the possible benefit and the uncertainty.

4.3 Safety screening prompts and route to medical clearance

Purpose / when: before any first use, and again if health or medicines change.
Steps: (1) Explain that a doctor should check suitability first. (2) Ask open questions about the areas the IIR lists for screening: heart and blood pressure (uncontrolled hypertension, recent heart attack, unstable angina, arrhythmias, valve disease, pacemaker), circulation (recent clots, peripheral arterial disease, Raynaud's, cryoglobulinaemia, vasculitis), lungs (cold-induced asthma, COPD), neurology (recent stroke, epilepsy, neuropathy, cognitive problems), endocrine (uncontrolled diabetes, hypothyroidism), kidneys, active cancer, skin wounds or ulcers, pregnancy, fever or infection, dehydration, severe anaemia, alcohol or drug use, and psychiatric conditions including psychosis and anxiety; claustrophobia and cold intolerance are listed as subjective contraindications [source: IIR 2025]. Legrand et al. propose adding migraine and attention to lipid disorders [source: Legrand et al. 2023]. (3) Do not judge eligibility yourself; any "yes" or "not sure" goes to the physician. (4) Medicines questions go to the prescriber. (5) Offer a short note to the GP or physician if the client wants one.
Example language (illustrative): "The international cold-therapy experts list a number of heart, circulation, breathing and mental-health conditions that need a doctor's check first. Would you be willing to ask your GP before you book?"
Watch for: minimising ("my blood pressure is fine, mostly"); intoxication or hangover plans; pregnancy; current psychosis or mania. Working: the client has a medical answer before the first session.

4.4 Choosing and checking a provider

Purpose / when: once medical clearance is given and the client still wishes to go ahead.
Steps: (1) Ask what device and setting it is. (2) Go through what a careful provider does: medical screening questionnaire or physician involvement; trained staff present throughout; continuous visual monitoring (windows or cameras) and an easy quick exit [source: Legrand et al. 2023]; dry skin and clothing and protection of extremities, since wet clothing has been linked to blistering [source: NPR transcript]; no claims of FDA approval or disease cure [source: FDA 2016]. (3) Ask the client to check licensing and to ask the provider how oxygen levels are monitored in nitrogen devices [synthesis]. (4) Agree the client will stop and leave if any rule is not followed.
Example language (illustrative): "Before you go, it might help to ask them three things: who will be with you the whole time, how they screen people medically, and what happens if you want out straight away."
Watch for: providers who let customers use the device alone, sell large prepaid packages for medical conditions, or claim approval. Working: the client can name at least two safety features they confirmed.

4.5 Preparing for claustrophobia, panic and trauma-related reactions

Purpose / when: clients with panic, claustrophobia, trauma histories involving confinement, or strong cold-related fear. Note claustrophobia and anxiety appear on the IIR screening list, so medical clearance comes first [source: IIR 2025].
Steps: (1) Explore what feels risky about an enclosed, intensely cold space and attendants watching. (2) Agree a stop rule and how the client will tell staff. (3) Rehearse the stop signal in session. (4) Suggest the client tells staff in advance they may want to exit early. (5) Treat any choice not to go ahead as a valid outcome.
Example language (illustrative): "You are allowed to change your mind at the door or in the first seconds. What words would you use to ask staff to open it?"
Watch for: dissociation, panic, using the cold to punish oneself or to "override" feelings; self-harm-like intent around pain or cold. Working: the client feels in control of the decision either way.

4.6 Monitoring during use

Purpose / when: at each session while a client is using cryotherapy.
Steps: (1) Brief check on mood, sleep, anxiety. (2) Ask about any skin changes, blisters, headache, dizziness, memory gaps, chest pain or raised blood pressure; Legrand et al. report urticaria, cold panniculitis, headache, dizziness, blood pressure elevation and, in case reports, intracerebral haemorrhage, aortic dissection and transient global amnesia [source: Legrand et al. 2023]. (3) Confirm prescribed treatment continues. (4) Note cost and financial strain.
Example language (illustrative): "Since the last session, any skin redness or blisters, headaches or anything that felt odd afterwards?"
Watch for: escalating use or chasing intensity; mood change unrelated to cryotherapy being credited to it. Working: stable or improving mood with no adverse effects and no dropped treatment.

4.7 Integrating the experience

Purpose / when: after a client has tried it, or decided against it.
Steps: (1) Ask what they noticed in body and mood, and what it meant to them. (2) Link any useful elements (a planned activity, leaving the house, a sense of accomplishment, social contact) to behavioural activation goals. (3) Explore lower-risk, lower-cost activities with similar meaning, cleared by their doctor. (4) Decide together whether to continue.
Example language (illustrative): "What you seem to value is the sense of doing something bold for yourself. Where else in your week could that feeling come from?"
Watch for: reliance on a single dramatic intervention; disappointment when effects are brief. Working: the client generalises the meaningful part to daily life.

4.8 Recognising and passing on adverse effects

Purpose / when: any report of injury or alarming symptom after a session.
Steps: (1) Ask what happened and when. (2) Blistering, stinging or pain after skin contact with nitrogen or cold, sudden severe headache, neurological signs, chest or back pain, confusion or memory loss: advise urgent medical assessment the same day [source: O'Connor et al. via MDedge 2018; Legrand et al. 2023] [synthesis]. (3) Encourage the client to report the event to the provider and, for device problems, to the national regulator [uncertain: not verified reporting route]. (4) Document and, with consent, inform the client's physician.
Example language (illustrative): "Blisters after cryotherapy can be a cold burn. I would like you to get that seen by a doctor today."
Watch for: shame or self-blame; delays in seeking care. Working: the client has been assessed and the event recorded.

4.9 Responding when cryotherapy replaces established treatment

Purpose / when: a client has stopped or plans to stop medication or therapy in favour of cryotherapy.
Steps: (1) Name the FDA concern that substituting unproven procedures can leave conditions unimproved or worse [source: FDA 2016]. (2) Explore reasons (side effects, cost, stigma). (3) Route medicine decisions to the prescriber. (4) Review risk, including suicide risk, using standard practice.
Example language (illustrative): "I hear the medication has felt like a burden. Can we make sure your prescriber is part of that decision, rather than making the switch on your own?"
Watch for: relapse signs, rising risk. Working: treatment decisions are made jointly with the prescriber.

5. Handling problems

The sources do not address psychotherapy problems directly; all responses below are [synthesis] unless a source is tagged.

Client is committed and dismisses the evidence. Do not argue. Return to safety: medical clearance, supervision, device type (4.3, 4.4). "You may well go ahead. Can we make it as safe as possible?" (illustrative).
Client feels judged or the alliance ruptures. Name it, apologise for the tone, restate respect for their choice and your concern for safety, then repair before more information.
Client wants the therapist to endorse or supervise it. Decline clearly: it is outside the psychotherapist's role and competence; offer to coordinate with their physician.
Client wants to use it alone or at home, or works at a cryotherapy business and uses equipment after hours. Treat as a serious safety issue: the documented Nevada death involved an employee in a nitrogen chamber without assistance [source: Fox News 2015; MinnPost 2016]. Advise never using any device unattended; for employees, encourage raising workplace-safety concerns with the employer or the labour safety authority.
Overwhelm, panic or a flashback in or after a session. Use grounding and stabilisation in therapy; review whether to continue; involve the physician if anxiety was a listed screening concern [source: IIR 2025].
Using cold as self-punishment or for intense sensation seeking. Explore function as you would self-harm; assess risk per standard practice; discourage the practice.
Eating-disorder or weight-loss motive. Weight loss is among the promoted claims [source: FDA 2016]. Screen for disordered eating; route to medical and eating-disorder care; do not set weight goals.
Non-adherence to medical clearance. Restate the reason, document advice given, and keep the door open.
Mood seems to improve and the client credits only cryotherapy. Note that one positive RCT was add-on to medication [source: Rymaszewska et al. 2020]; encourage keeping all treatment while the effect is observed.
Financial pressure from packages. Explore cost against benefit; consider whether sales pressure is affecting judgement.
Client reports a friend or relative harmed. Offer support, encourage medical care and reporting (see Harm account).

Harm account

What was actually done

Nevada, October 2015. Chelsea Ake-Salvacion, 24, the manager of the Rejuvenice cryotherapy business, was found dead inside a liquid-nitrogen cryotherapy chamber at the business on 20 October 2015 [source: CBS/AP 2015; NBC News 2015; Fox News 2015]. Reports place the business in Henderson, Nevada (Las Vegas area) [source: NBC News 2015]. She entered the chamber "without assistance" and was trapped for several hours; a co-worker found her the next day [source: Fox News 2015]. MinnPost, summarising reports, wrote that she apparently used the treatment on herself after hours with no one else present and was found frozen the next morning [source: MinnPost 2016]. Authorities said the spa was not licensed to operate [source: CBS/AP 2015]. The Clark County Coroner ruled the death a suffocation; a local TV report cited by Fox said oxygen levels had fallen to near 5 percent; the family's lawyer called it an accidental death from an oxygen-poor environment [source: Fox News 2015]. Nevada's Division of Industrial Relations expanded its investigation from workplace safety and equipment to the technology itself, and regulators shut the business's two locations, citing lack of workers' compensation cover [source: NBC News 2015; Fox News 2015].
FDA consumer warning, July 2016. The FDA's update said no WBC device was cleared or approved for any medical condition and that consumers may wrongly assume approval; Aron Yustein MD of the Center for Devices and Radiological Health: "That is not the case." [source: FDA 2016; MinnPost 2016].
Cold burn from equipment fault. A 71-year-old man, after several uneventful sessions for arthritis and back pain, developed stinging, pain, redness and blistering after a session; dermatologists at Thomas Jefferson University attributed it to a nozzle malfunction allowing liquid nitrogen to touch the skin (O'Connor et al., JAAD Case Reports 2019) [source: MDedge 2018].
Wet clothing. Sprinter Justin Gatlin was pictured with a cold injury to the leg after using a cryotherapy device in wet socks; the NPR interviewee Eric Rauscher described a blistering effect without permanent damage, while the host described it as frostbite [source: NPR transcript; date uncertain].
Other reported adverse events. A scoping review found 16 adverse events in 7 reports: most mild and transient (headache, dizziness, shivering, urticaria, cold panniculitis, raised blood pressure), and serious events in case reports only (intracerebral haemorrhage, moyamoya-type cerebral vessel narrowing, abdominal aortic dissection, transient global amnesia) [source: Legrand et al. 2023].

How it caused harm

Asphyxiation (nitrogen devices). Vaporised nitrogen displaces oxygen in an enclosed space or room, causing hypoxia and possible loss of consciousness [source: FDA 2016]. Low oxygen can cause collapse without warning [synthesis]; a person alone cannot get out or be rescued. Most at risk: anyone using a nitrogen cabin unattended, staff self-using after hours, small or poorly ventilated rooms [source: Fox News 2015; MinnPost 2016] [synthesis].
Frostbite, cold burns and eye injury from the extreme cold, direct nitrogen contact (equipment faults) and wet skin or clothing [source: FDA 2016; MDedge 2018; NPR transcript].
Cardiovascular and neurological strain. The FDA notes the effect on blood pressure and heart rate is unknown [source: FDA 2016]; blood pressure elevation is reported, and serious haemorrhage and dissection cases had identifiable risk factors (hypertension, migraine, lipid disorders, excessive endurance exercise) or questionable exposure conditions in the review authors' view [source: Legrand et al. 2023].
Harm by substitution. People who use WBC in place of established treatment may fail to improve or get worse [source: FDA 2016].
Psychological sequelae for bereaved families and co-workers, and fear or shame in the injured, are not documented in the cited sources [uncertain: not verified].

Recognising it today

Claims that devices are "FDA approved" or that sessions treat depression, anxiety, arthritis, MS, Alzheimer's, migraine or weight [source: FDA 2016].
A nitrogen cryosauna (head out) marketed as "whole-body" cryotherapy [source: Legrand et al. 2023].
No medical screening questionnaire or physician route, or screening that ignores heart, circulation, breathing, neurological and psychiatric conditions [source: IIR 2025].
Customers or staff allowed in the device unattended; no window, camera or quick exit [source: Legrand et al. 2023; Fox News 2015].
Use with damp skin, sweat or wet socks; no protection of extremities [source: NPR transcript] [synthesis].
Unlicensed businesses, absent workplace safety cover, no oxygen monitoring in nitrogen rooms [source: CBS/AP 2015; Fox News 2015] [synthesis for oxygen monitoring].
Advice to stop medication or therapy in favour of "cryo" [source: FDA 2016].
How legitimate versions differ: research and rehabilitation settings screen medically against published contraindication lists, supervise continuously, choose exposure conditions to avoid risk, and use cryotherapy as an add-on rather than a replacement [source: IIR 2025; Legrand et al. 2023; Rymaszewska et al. 2020].

What to do instead and how to help those harmed

Safer alternatives (discuss with the client's doctor): for exercise soreness, the review cited by MinnPost suggested ice packs or cold-water immersion offer comparable effects at lower cost [source: MinnPost 2016] (cold-water immersion carries its own cold-shock risks and also needs medical clearance [synthesis]); for depression and anxiety, established psychological and medical treatments, behavioural activation and physician-cleared physical activity [synthesis].
Assessment of affected clients: physical injuries go to medical care first; then assess acute stress, guilt, health anxiety and trust in health providers [synthesis]. For bereaved relatives or co-workers, offer grief-focused support and watch for traumatic grief [synthesis].
Treatment considerations: stabilisation for frightening entrapment experiences; avoid re-exposure framing; coordinate with the physician [synthesis].
Ethical, reporting and legal duties: encourage reporting of device injuries to the provider and the national device regulator (in the US the FDA) [uncertain: not verified reporting route]; workplace deaths and injuries fall to labour-safety authorities, as in Nevada [source: NBC News 2015]; document advice given; do not endorse providers; refer legal questions to a lawyer [synthesis].

Sources

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