Food and Mood researchers have published a world- first trial in Lancet Regional Health showing that lifestyle therapy is as clinically- and cost-effective as psychotherapy for helping relieve depressive symptoms in adults who experienced mental health distress during the COVID-19 pandemic.
Growing need for new mental health treatments emerges from COVID-19 pandemic
Since the COVID-19 lockdowns, mental health issues among the global population have soared at an alarming rate.
According to the Global Burden of Disease data, there have been an additional 50 million cases of depressive disorder globally since the COVID-19 pandemic. In Australia, national survey data has shown similar spikes, putting further pressure on our healthcare systems and mental health workers.
The surge has revealed a growing need for new clinically- and cost-effective mental health treatments, especially for people living in regional communities or where resources are scarce.
Pioneering trial tests the role lifestyle therapies can play in supporting mental health
At Deakin, growing research and evidence has been building to support the efficacy of lifestyle therapy – which involves interventions such as diet and exercises – to improve mental health.
In response to this need for new clinically- and cost- effective mental health treatments, the Food and Mood theme sought to directly compare lifestyle therapy to standard psychological care. With funding from the Australian Medical Research Future Fund, they embarked on the Curbing Anxiety and Depression using Lifestyle Medicine (CALM) trial, the first ever of its kind to make this comparison.
Lead researcher Professor Adrienne O’Neil said the CALM trial sought to determine whether lifestyle therapy would be as effective as psychotherapy for reducing depression, anxiety, and distress levels during and beyond the COVID-19 pandemic.
“Something we didn’t know before this study was to what extent lifestyle therapies could achieve the same results as conventional therapies in the context of mental health,” she said.
“The trial involved two eight-week programs – one with a focus on lifestyle medicine, the other on psychotherapy. Participants were randomly allocated into one of the programs and completed mental health assessments before, after, and over the course of the eight weeks.”
Prof O’Neil said the lifestyle program was run by accredited dietitians and exercise physicians, with goals drawn and adapted from her previous research on nutritional psychiatry. “The participants were encouraged to eat a modified Mediterranean diet, so lots of fibrous foods, vegetables, oily fish, good quality oils, and nuts and seeds, and given daily exercise routines,” she said.
“There were additional goals that people took on, but weren’t mandatory, such as reducing alcohol and smoking, and improving sleep.”
The psychotherapy program involved qualified therapists leading cognitive behavioural therapy (CBT) sessions and exercises. The intensity, frequency, and engagement of the program was matched to that of the lifestyle program. Both took place in groups over Zoom, due to the COVID-19 restrictions.
“Importantly, these were adjunctive trials, so participants continued the administration of their regular psychiatric care, such as medications and other treatments, alongside the program interventions,” Prof O’Neil said.
A scalable, cost-effective treatment for rising global depression rates
The world-first CALM trial was able to prove that lifestyle therapy is as clinically- and cost-effective as psychotherapy for helping relieve depressive symptoms in adults who experienced mental health distress.
Professor O’Neil said there were no differences between the two therapies when it came to the physical and mental health and quality of life of participants, and the cost- effectiveness and economic viability of the therapy.
“Lifestyle therapy was found to improve diet quality and reduce discretionary food intake,” she said. “Physical activity levels, however, changed less than expected. Psychotherapy participants showed better social support outcomes, which could be a byproduct of successful CBT in reducing social anxiety and emphasising the importance of reengaging with community, especially during COVID.”
“Lifestyle therapy was found to be slightly cheaper to deliver than psychotherapy due to differences in the hourly wages of clinicians, but both were largely comparable in terms of overall costs.”
Prof O’Neil said the trial highlighted that lifestyle therapy offers a scalable, cost-effective treatment, either as a first- line option or alongside other therapies.
“The results provide patients, clinicians and decision makers with greater options for mental health care, which is extremely important in the context of an overburdened mental healthcare system, especially when there are opportunities to upscale an existing allied health workforce,” she said.
The CALM study reached over 3.8 million people globally in 30 days through media appearances (print, online and radio).
CALM participant Teresa, aged 56, shared her experience in the Geelong Advertiser. She explained how she was feeling flat during the pandemic due to the impacts of social isolation, and that “things became quite grim.”
As part of the trial, she increased the amount she exercised and started to walk up to 10km most days. She told the Geelong Advertiser her outlook on life completely changed. “My mental health is the best it has ever been,” Teresa said. “The benefits of the CALM trial have continued, even through a recent bout of ill health. I have managed to sustain a significant improvement to my mental health.”
New trial to investigate suitability of lifestyle therapies for severe mental illness
Whether the lifestyle-based 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 the Centre has recently launched the HARMON-E trial.
“We’ve scaled it up to a national clinical trial, to determine if it’s suitable beyond the COVID-19 lockdowns for people with severe mental health disorders,” Prof O’Neil said.As a result of the CALM trial, the Food & Mood Centre is also upskilling dietitians and exercise physiologists in mental health through professional and public courses through its Food and Mood Academy, with the aim of alleviating some of the burden on the mental health care system.
