Food and exercise can treat depression as well as a psychologist, our research shows. And it’s cheaper

All around 3.2 million Australians suffer from depression.

At the same time, few Australians meet recommended guidelines for diet or physical activity. What does one have to do with the other?

Our first trial in the world, published this weekshows that improving diet and increasing exercise can be as effective as psychological therapy for treating mild depression.

Previous studies (including our own) have found that “lifestyle” therapies are effective for depression. But they’ve never been directly compared to psychological therapies—until now.

In the midst of a rural shortage of mental health professionals, our research points to a possible solution. Because we found that lifestyle counseling was as effective as psychological therapy, our findings suggest that dietitians and exercise physiologists may one day play a role in managing depression.

What did we measure in our research?

During the prolonged COVID lockdowns, stress levels among Victorians were high. high and widespreadThere was limited provision of face-to-face mental health care.

Our trial focused on people living in Victoria with elevated distress, meaning at least mild depression but not necessarily a diagnosed mental health disorder. Typical symptoms included feeling sad, hopeless, irritable or tearful.

We have entered into a partnership with our local mental health care to recruit 182 adults and deliver group sessions on Zoom. All participants attended up to six sessions over eight weeks, facilitated by healthcare professionals.

Half were randomly assigned to participate in a program co-facilitated by a licensed practicing dietitian and an exercise physiologist. That group, called the lifestyle program, developed nutrition and exercise goals:

• eating a wide variety of foods
• choosing plant-based foods high in fiber
• including high-quality fats
• limiting discretionary foods, such as those high in saturated fats and added sugars
• engage in enjoyable physical activity.

The second group participated in psychotherapy sessions organized by two psychologists. The psychotherapy program used cognitive behavioral therapy (CBT), the gold standard for the treatment of depression in groups and when delivered remotely.

In both groups, participants were able to continue existing treatments (such as taking antidepressants). We gave both groups workbooks and basketsThe lifestyle group received a food parcel, while the psychotherapy group received items such as a colouring book, a stress ball and a head massager.

Lifestyle therapies just as effective

In each program we found similar results.

At the beginning of the trial, we gave each participant a score based on their self-reported mental health, and we measured them again at the end of the program.

Over eight weeks, those scores showed that depressive symptoms were reduced for participants in the lifestyle program (42%) and the psychotherapy program (37%). That difference was not statistically or clinically meaningful, so we could conclude that both treatments were equally good.

There were some differences between groups. People in the lifestyle program improved their diet, while those in the psychotherapy program felt they had increased their social support (that is, how connected they felt to other people) compared to the beginning of treatment.

Participants in both programs increased their physical activity. While this was expected of those in the lifestyle program, it was less expected of those in the psychotherapy program. This may be because they knew they were participating in a lifestyle research study and unconsciously changed their activity patterns, or it may be a positive byproduct of doing psychotherapy.

There wasn’t much difference in cost either. The lifestyle program was slightly cheaper to deliver: A$482 per participant, versus $503 for psychotherapy. That’s because hourly rates differ between dietitians, exercise physiologists and psychologists.

What does this mean for the staff shortage in mental health care?

Demand for mental health services is increasing in Australia, while the working age population is shrinking. is facing increasing shortages across the country.

Psychologists, who about half of it of all mental health services, can have long waiting times. Our results suggest that allied health professionals specialising in diet and exercise, with appropriate training and guidelines, can close this gap.

Lifestyle therapies can be combined with psychology sessions for multidisciplinary care. But diet and exercise therapies can be especially effective for people on the waiting list to see a psychologist, who may not have other professional support while they wait.

Many dietitians and exercise physiologists already have advanced skills and expertise in motivating behavior change. Most accredited practicing dietitians are trained in managing eating disorders or gastrointestinal disorderswhich are often associated with depression.

There is also a cost argument. It is generally cheaper to train a dietitian ($153,039) than a psychologist ($189,063) – and it takes less time.

Possible barriers

Australians with chronic conditions (such as diabetes) can access subsidized appointments with dietitians and exercise physiologists under several Medicare treatment plans. People with eating disorders can also access subsidized appointments with dietitians. However, mental health plans for people with depression do not support subsidized sessions with dietitians or exercise physiologists, despite peak bodies and encourage them to do so.

More training, continuing education, and Medicare subsidies are needed to support dietitians and exercise physiologists in treating mental health problems.

Our training and clinical guidelines are intended to assist clinicians who practice lifestyle-oriented mental health care within their scope of practice (activities that a health care provider may undertake).

Future directions

Our trial took place during COVID lockdowns and examined people with at least mild symptoms of depression who did not necessarily have a mental health disorder. We are aiming to replicate these findings and are now conducting A study is open to Australians with mental health conditions such as major depression or bipolar disorder.

This article has been republished from The conversation under a Creative Commons license. Read the original article.