Lifestyle Intervention: An Essential Adjunct to Psychotherapy
Over the last three decades psychological disorders have continued to be a leading cause of global disease burden with a significant international increase in the prevalence of difficulties such as anxiety and depression (Mental Disorders Collaborators, 2025). Even with advancements in psychotherapeutic (counselling) and pharmacological intervention (medicine) many individuals aren’t able to recover from treatment as usual (Patel et al., 2018). Highlighting gaps in both evidence and effective implementation of treatment interventions as well as deficits in the primary prevention of mental illness. New approaches that focus on the prevention and treatment of psychological disorders that can be delivered in conjunction with or instead of traditional approaches are fundamental for the reduction of the global and growing mental health burden (Firth, 2020). Correspondingly, an emerging body of compelling evidence links the emergence of various psychological disorders to lifestyle factors (Briguglio et al., 2020; Firth, 2020; Van Dammen et al., 2018).
Advocacy for a more integrative approach that includes lifestyle change as a standard component for the treatment and prevention of disorders such as anxiety and depression is emerging. Interventions that target the six pillars of lifestyle medicine throughout the psychotherapeutic process are essential, this blog-post briefly outlines what these are and supporting research.
Evidence
The relationship between lifestyle factors and the emergence of psychological disorders has been highlighted throughout literature. From this, the utility of lifestyle medicine (LM), that is the implementation of evidence-based lifestyle therapeutic approaches for the prevention and treatment of lifestyle related chronic diseases and psychological difficulties has been the focus of an emerging evidence base (Abascal et al., 2022; Bodai et al., 2018; van Dammen et al.,2018). The six pillars of LM have been highlighted as follows: nutrition, physical activity, restorative sleep, stress management, social connection and the avoidance of risky substances (Abascal et al., 2022).
Lifestyle factors have been described by some as “predictors of psychological flourishing”
These modifiable factors can be targeted to reduce both physical and psychological difficulty simultaneously via the exploitation of the certain but not yet causally defined interplay between genetic, epigenetic and environmental factors underlying psychological difficulty (Abascal et al., 2022). It is postulated that in some cases, the development of disorders such as depression and anxiety can be entirely prevented through healthy and protective lifestyles, highlighting the utility of expanding and establishing such research and treatment methods (Ljungberg et al., 2020; Zaman et al., 2019).
The Royal Australian and New Zealand College of Psychiatrists state that lifestyle intervention should be at the frontline of prevention and treatment. This article will focus primarily on three relevant lifestyle factors: healthy eating, physical activity and sleep hygiene.
DIET
Food has an inextricable link to the functioning of our brains and bodies; numerous studies have already highlighted the link between diet and the development of depression and anxiety (Farzi et al., 2019; Gibson-Smith et al., 2018; Marx et al., 2021; Mozaffarian et al., 2019). Specifically, a highly processed diet, high in sugars, non-animal-based fats and low in nutritional value enhances the risk of depression (Salari et al., 2019). Many underlying mechanisms/pathways have been proposed to explain this relationship inclusive of inflammation, the microbiota-gut-brain axis, epigenetics, hormonal disruption, oxidative stress and obesity to name a few (Marx et al., 2021). These mechanisms are complex, multi-faceted and interacting and will vary dependent upon the individual.
Additionally, the relationship between diet and psychological difficulty can be bi-directional, for example depression and anxiety can result in defence mechanisms such as emotional eating and low motivation (Farzii et al., 2019; Pols, 2018). Pharmacological intervention for some is obesogenic (causes obesity), again adding another layer of complexity regarding the relationship between psychological difficulty, lifestyle and optimal treatment strategies (Rajkumar, 2023). That is, medications provided by psychiatrists can have detrimental effects on health. ***Diet intervention should be optimally addressed in treatment planning in mental health care.
EXERCISE
Physical activity has profound positive functional effects on the brain and body (Bellicha et al., 2021). An active lifestyle promotes psychological health and larger total brain volume, correspondingly, it is those with the most serious psychological difficulties that lead the most sedentary lifestyles (Bort-Roig et al., 2020; Liegro et al., 2019). From this, it is clear to see that physical activity is a modifiable factor that can be targeted to improve psychological health in which current evidence corroborates.
Clinicians/academics state that physical activity interventions should be placed above or on par with pharmacotherapy/meds (Recchia et al., 2022).
However, gaps in literature remain, whereby, professionals need to know how to implement, measure and monitor physical activity interventions for optimal results. Currently, many physical interventions are generalised, the focus being on activities that individuals find enjoyable and accessible, however, individuals with depression and anxiety may experience low adherence and struggle with this flexible approach (Collado-Mateo et al., 2021). A structured approach that incorporates accountability, milestones, goals and the opportunity to experience success is a more effective approach for those with anxiety and/or depression.
SLEEP
Sleep difficulties and the disruption of the circadian rhythm is associated bi-directionally with depression and anxiety (Hertenstein et al., 2019; Lyall et al., 2018). Depression and anxiety are prevalent conditions that frequently co-occur, this comorbidity exacerbates sleep difficulties, highlighting the importance of sleep intervention for such cohorts (Oh et al., 2019). The relationship between sleep and depression and anxiety appears to be bi-directional and complex.
Chellapa & Aeschbach (2022) highlight potential mechanisms between depression and anxiety and sleep quality, inclusive of the overlap of brain networks underlying sleep and emotional regulation. Despite this, sleep intervention is rarely implemented into treatment strategies for those with depression and anxiety (Gee et al., 2019).
Simply put, the areas of the brain that are active during sleep are also responsible for emotional regulation. Emerging research has found non-pharmacological sleep interventions, such as sleep hygiene education can be an effective adjunctive treatment in psychotherapy.
Recent studies have postulated that multi-component lifestyle interventions such as those that target multiple lifestyle factors are more effective than single-component interventions (Simjanoski, 2023).
At WEXEN lifestyle components are assessed and lifestyle intervention is planned accordingly in conjunction with therapy. Physical wellbeing is an essential and inextricable aspect of psychological health.
