LIFESTYLE INTERVENTIONS2014-07-14T09:24:11+00:00

You are likely on this page because of the interview I presented with Dr. Kelly Brogan on July 8, 2014. She sees herself as a “psychoneuroimmunologist” but I think of her as a “lifestyle-focused psychiatrist.”

What are the lifestyle interventions? Think of healthy eating, exercise, social connection and service to others. Changing lifestyles change emotional and physical health.They are, in my opinion, the Next Big Thing. You see, many of the chronic illnesses that we struggle with are not really going to improve with medication. People will have to change their lifestyles. Mental illnesses have been increasing dramatically for at least the last 60 or 70 years, and this is almost certainly the result of negative lifestyle changes. So in both medicine and mental health, lifestyle changes are going to be where the action is. 

A core reading for this is Roger Walsh’s 2011 American Psychologist article, Lifestyle and Mental Health. Here is a link to download that article. https://s3-us-west-2.amazonaws.com/lifestyle-interventions/Walsh+Lifestyle+Interventions.pdf  

I suggest you read Dr. Walsh’s article before you listen to Dr. Brogan. Her link is below, but if you do your homework, you’ll have a much better background. Dr. Walsh is both a psychiatrist and a psychologist, and I found it interesting that he chose to publish this significant paper in The American Psychologist, when he just as well may have published it, say, Archives of General Psychiatry. Why didn’t he?  

Because it is precisely that we, the non-medical therapists, who are most open to prescribing lifestyle interventions.  

Dr Kelly Brogan is a practicing psychiatrist in New York City who has virtually abandoned psychotropics and practices a lifestyle focused treatment approach. You may download an interview I did with her on July 8, 2014 below.

She gives a simple answer to the (unasked!) question of why Walsh doesn’t talk more to psychiatrists. In the interview, she points out that without the prescription pad, the vast majority of psychiatrists would have nothing of value to contribute to patient care.   Here is the download link so you can listen to the interview: https://s3-us-west-2.amazonaws.com/lifestyle-interventions/Dr+Kelly+Brogan7-8-2014.mp3  

You can listen to the interview with any mp3 player. Please do not ask me for technical support. I am giving away this information, and I don’t want to be punished unnecessarily for being generous.  

Lifestyle? Psychiatrists are mostly ignoring that issue. Of course, that is a remarkable change within my almost 40 years of practice. When I got started in private practice in 1977, there were many psychiatrists in town who were very competent therapists.

That has changed. Now they – the new generation – are only prescribing drugs, and changing how people view and do the problem has disappeared, at least for them.

But not for us! It is our special area of skill and expertise.   Brogan’s work gives psychiatrists a way to walk that back, and even go further. Instead of thinking as emotional disorders as primarily the result of dysfunctional thinking as cognitive therapists do, or simply as “chemical imbalances” as the drug houses want us to think, Brogan and others argue that the biology of our organisms might be a stressor that provokes the brain to think in certain patterns.  

(Look up, read up on “stress-diathesis” in the medical literature. That is, there may be a weakness, or proneness, to a certain disease, a vulnerability, perhaps genetic, more likely epigenetic, but it doesn’t emerge until the stressor is present. That is a diathesis. For example, my dear friend Ben Dean talks about his father who survived the Bataan Death March, but was an alcoholic for much of his life. My own father, a flight engineer / bombardier / waist gunner on a B-17 during World War II suffered terribly from the war, creating a diathesis for PTSD and drug abuse. But his religious commitment prevented him from using alcohol. His brother had relatively less stress in WWII, but rose above our prejudice about alcohol, and died early after a lifetime of alcohol abuse. Stress-diathesis. Ironically, the stress in such cases is also the preferred intervention for the victim. The victim thought the alcohol was a good treatment, and it was actually a stressor!)  

Last year I interviewed Dr. Charles Raison, a psychiatrist at University of Arizona. Listen to his emphasis on lifestyles and mental health. His interview shares some pretty jaw dropping research findings, including his position that depression is not a brain disorder! This is really worth listening to, if you are going to understand lifestyle interventions.   https://s3-us-west-2.amazonaws.com/lifestyle-interventions/Dr-Charles-Raison-Inflammation.mp3  

Chuck kindly shared some of his articles, which you can download below:

https://s3-us-west-2.amazonaws.com/lifestyle-interventions/Can_we_vaccinate_against_depression_Rook_and_Raison.pdf  

https://s3-us-west-2.amazonaws.com/lifestyle-interventions/Is+Depression+an+Inflammatory+Disorder+Raison.pdf  

There is a rather fascinating book I am now digging into, Missing Microbes, by Marvin J. Blaser, MD. I recommend it also!  

Fornier et al 2010 article in JAMA showed some of the glaring weaknesses in the actual antidepressant research. As we move toward lifestyle interventions, it is important to review that article, which is here: http://jama.jamanetwork.com/article.aspx?articleid=185157  

Is depression a chemical imbalance? Dr Brogan suggests we read the following article:

https://s3-us-west-2.amazonaws.com/lifestyle-interventions/_chemical+imbalance_.pdf 

Psychiatry, as I said, has virtually abandoned psychotherapy, and along with that, isn’t really focused on such things as lifestyle interventions. Psychiatry has succumbed to the siren song of 15 minute med check sessions, billing at the hour rate, so as to make more money like the surgeons. But that doesn’t allow time to go over lifestyle interventions like eating, exercise, time in nature, social connection (or, compassionate service to others), and other lifestyle changes. 

We therapists and coaches still offer people a 50 minute hour, most of us, and we have time to engage the patient and pursue a commitment to a healthier lifestyle. In that way we have a great advantage over our brothers and sisters in psychiatry.  

We need to know some things.  

Walsh recommends eight separate lifestyle interventions.  

Which ones are appropriate for which clients? Should everyone start with an eating style change? Or, is there a way we can decide which intervention to offer which client?  We don’t know yet, or at least I don’t. 

(There is a long history of trying to match treatment with client in the clinical psychology academic community, and I am unaware of any real successes in that area. So while it sounds like something that should work, I haven’t seen it work, practically speaking.)  

What are the best strategies for improving adherence / compliance? These are lifestyle changes, and many times clients don’t follow their homework as we’d hope.   How big are the changes we can expect? Brogan considers a two month trial sufficient to see results. What if there is no change in two months? What is the next step?  

Raison and his colleagues have found that not all depressed individuals are high in inflammation, although a majority are. How do lifestyle interventions impact people like those low in inflammation?  Would they do particularly well with Positive Psychology interventions?

How do non-medical therapists track inflammation? C-rp, C-reactive protein, is often recommended to assess inflammation; what is our strategy for that? Are their better inflammatory markers? How do we bill?  

We stand at the cusp of some significant changes in the range of interventions we can – and likely, should – offer our clients. They will have to come from post-grad education, since no grad program that I am aware of is teaching them. This is perfectly reasonable. Our graduate degree, you will likely agree, is simply stepping through a door, but once on the other side of the door, we have a lifetime of learning, discovery, and adventure ahead. There is so much we do not know. What an exciting time to be alive!