Lifestyle therapy including nutritional counselling and physical activity is just as helpful as traditional psychotherapy for reducing non-severe depression, according to a new study.
Researchers from Deakin University’s Food and Mood Centre say their world-first findings show dieticians and exercise physiologists could be trained and redeployed to be part of the mental health workforce, helping to alleviate staff shortages.
The researchers randomly assigned 182 people with mild to moderate depression to undertake either lifestyle therapy or cognitive behavioural therapy. Because the study was conducted during the Covid-19 pandemic, these group sessions were delivered online.
Each lifestyle therapy session was delivered by a dietitian and an exercise physiologist who gave participants evidence-based advice on moving more each day and improving their food intake in line with a modified Mediterranean diet. Participants were also given a Fitbit to encourage health tracking.
The other group received cognitive behavioural therapy (CBT), considered the gold standard in mental health care, delivered by two psychologists. The therapy included methods to manage unhelpful thoughts and behaviours, and participants were also given workbooks and self-soothing products such as stress balls.
Prof Adrienne O’Neil, the lead author, said “everything about the two therapies were matched in terms of the frequency, the length, the setting, the group sizes”.
“The only thing that differed was the therapists being from different disciplinary backgrounds, and of course, the content.”
At the end of the eight weeks, lifestyle participants experienced a 42% reduction in their depressive symptoms compared with a 37% reduction in depressive symptoms among psychotherapy participants.
The report also included a cost analysis which showed the lifestyle program was slightly cheaper to run owing to the difference in hourly rate of dieticians and exercise physiologists compared with psychologists.
While other trials have looked at the effects of exercise in combination with treatments such as antidepressant medications, O’Neil said this was the first time researchers assessed nutrition therapy integrated with exercise and compared it with CBT.
“Unlike other areas of medicine, like cardiology, endocrinology or diabetes care, where lifestyle modifications are really the cornerstone of self management, they have traditionally been perceived in mental health and psychiatry as being an add on,” O’Neil said.
“But in more recent years and with the publication of this trial, we can be more confident now that they belong at the heart of good psychiatric care.”
She is now conducting a trial to see if the interventions have a similar effect on those with severe mental health conditions.
Scarlett Smout, a research associate at the University of Sydney’s Matilda Centre for Research in Mental Health and Substance Use, said given the research was carried out during the Covid-19 pandemic, “we would want to see these findings replicated when participants were not undergoing lockdowns or related restrictions”.
The trial sample was also relatively small and skewed to females – as the study authors also noted, the findings would need to be replicated in a larger study, Smout said.
She said it was also important not to make broad extrapolations like merely “changing your diet [without expert advice] is just as helpful as seeing a psychologist”.
“Importantly, this study is not suggesting that people who are seeking mental health care should be sent away to self-manage their mental health with lifestyle changes.”
But Smout, who was not involved in the study, said the findings were promising.
“I think the authors’ suggestion that allied health professionals could be upskilled to deliver mental health intervention is exciting in the context of a mental health workforce that is so stretched,” Smout said.
“The ideal scenario would be that people could access both types of mental healthcare (lifestyle and psychotherapy based), not one or the other.”
