Food & Mood researchers have published a world-first trial in Lancet Regional Health showing that lifestyle therapy is equally as clinically and cost-effective as psychotherapy for helping relieve depressive symptoms in adults who experienced mental health distress during the Covid-19 pandemic.

Led by Professor Adrienne O’Neil, the Curbing Anxiety and Depression using Lifestyle Medicine (CALM) trial was funded by the Australian Medical Research Future Fund in response to heightened levels of distress amongst Victorian’s during Covid-19 lockdowns.

The trial was delivered using group-based videoconferencing over the span of eight weeks. 182 participants were randomly assigned to either:

  1. Lifestyle therapy run by an Accredited Practising Dietitian and Accredited Exercise Physiologist.
  • Example nutrition content and activities included: key foods and nutrients for mental health, creating healthy convenient meals and snacks, shopping lists, mindful eating and recipe modification.
  • Example physical activity content included: practical physical activity ideas including home exercises, physical activity “snacks”, barriers and enablers to physical activity, mindful physical activity and exercise support groups.
  • A hamper containing food produce, a TheraBand and Fitbit were provided to participants.

OR

  1. Psychotherapy run by Clinical or Provisional psychologists:
  • Based on cognitive behavioural therapy (CBT), example content included educating participants to develop skills in self-awareness, identifying and managing unhelpful thoughts and behaviours, and practicing self-management strategies.
  • A ‘self-soothe’ box was provided to participants containing items such as a colouring book, head massager and stress ball.

Both programs were supported by workbooks containing resources and home activities during their sessions. Their group facilitators had advanced training in health coaching, motivational interviewing, goal setting and mindfulness, and completed mental health first aid training. Find out more about what each group entailed, by clicking here to access our published protocol paper.

Study findings

At completion, lifestyle participants experienced a 42% improvement in their depressive symptoms compared to a 37% improvement in depressive symptoms among psychotherapy participants. The cost of delivering lifestyle therapy was slightly cheaper than psychological care but largely comparable once other costs were factored in.

Those participating in the lifestyle therapy program improved the quality of their diet and reduced their “discretionary” food intake (such as foods high in added sugar and salt). Interestingly, they didn’t change their activity levels as much as we expected. It is possible participants improved the quality or enjoyment of their physical activity, which we know is important for mental health, even while the total amount of activity remained the same. In comparison, those participating in the psychotherapy program appeared to improve their social support outcomes.

We also found that participants with greater depressive symptoms at the beginning of the study benefitted the most – regardless of the therapy used. This suggests that more trials are needed to see if these findings can be applied to people with severe mental disorders.

It’s important to note that participants who entered the study on an existing treatment (e.g. anti-depressant medication, counselling) continued with that care in addition to receiving either the lifestyle or psychotherapy intervention as part of the trial.

Real world impact

As rates of distress and depression across the world continue to climb, demand is high for mental healthcare – placing pressure on existing services and workforces.

There is a need for new, scalable, and clinically and cost-effective mental health treatment options such as those we tested here, especially for those living in regional communities, or where resources are scarce.

Using lifestyle therapy may provide a new treatment option for consumers, families and clinicians. For some people, it can be in addition to other treatments such as medication or psychotherapy. For others, it could be the first option to treat mood disorders, as is already recommended in guidelines published by the RANZCP– the peak body for psychiatrists in Australasia.

Our study shows there may be scope to upskill Accredited Practising Dietitians and Exercise Physiologists with specialised mental health training and evidence-based guidelines. This could be offered to people who are experiencing mental health concerns at a comparable cost to psychologists. The Food & Mood Centre offers a range of courses to promote professional development in this new area of clinical practice as well as free courses open to the general public.

Looking ahead

Whether this approach is as appropriate as psychological therapy for people with more severe symptoms (i.e. major depressive disorder or bipolar disorder) is not yet known, which is why we are running the HARMON-E trial.

Similar to CALM, the HARMON-E trial provides eligible adults eight weeks of free lifestyle therapy with allied health professionals or psychotherapy with psychologists using group-based, videoconferencing.

If you’re interested in participating or are a healthcare professional interested in referring your patients, click here to read more about the trial.

Written by Sophie Mahoney and Prof Adrienne O’Neil. Sophie Mahoney is an Associate Research Fellow and Accredited Practising Dietitian at the Food & Mood Centre, currently working on the HARMON-E trial. Professor Adrienne O’Neil is a behavioural scientist who specialises in promoting the use and quality of evidence-based lifestyle medicine and rehabilitation in mental health and cardiac settings.

This research project was funded by the National Health and Medical Research Council’s Medical Research Future Fund – COVID-19 Mental Health Research Australian Government Department of Health (GA133346).