A recent report in The American Journal of Public Health shows that social isolation is as dangerous for our health, as we age, as smoking or weight problems. Social isolation is a lifestyle issue. Some people turn away from others, and some turn towards others. Mike Lambert has argued in some of his research that therapists can and should change social isolation into connection habits. He further argues that it should be one of a therapist’s core skills. Do therapists actually know how to coach people toward better connection?
Another lifestyle issue that was just published in The Journal of Affective Disorders is the amount of light in the bedroom is related, at least in the aged, to the risk of developing depression. That is, people sleeping in bedrooms with more ambient light are almost twice as likely to develop a depression as people sleeping in bedrooms that are very dark.
Both of these studies focus on issues that I think of as lifestyle interventions. Why would I bring two such different articles together into this post? Simply because lifestyle interventions are an unknown country, and an exciting one at that. We don’t know how much difference a more comprehensive approach to lifestyle coaching would make. Would it be as good as or better than psychotherapy or medication? We don’t know but it would be important to find out.
Michael Frisch has a lifestyle approach to treating mental illness that has been shown as somewhat better than treatment as usual, or TAU. If changing the ambient light in a patient’s bedroom has a positive effect on mental health, what will happen if we change several lifestyle issues? These are studies on components of a mentally healthy lifestyle. A broader view would see lifestyle change interventions as a sea change in counseling and therapy.
Another example comes to mind. A recent Cochrane report (Cochrane reports are about evidence-based interventions in medicine) showed that exercise is not better than meds or psychotherapy for depression. Conversely, exercise is statistically as good as depression, and I found the authors’ emphasis on it being no better than TAU to be passing strange. If a single lifestyle change produces as much benefit as either therapy or medication, I find that rather extraordinary. This means that all of the emphasis on changing thinking patterns, cognitive restructuring, might be only one pathway to mental health.
Since Freud, the unquestioned assumption is that our thinking creates our world. It is an attractive understanding. If you are psychoanalytic or if you are cognitive-behavioral, the assumption is the same. Naturally, to change our thinking is assumed to be a royal road to better mental health. It is a premise that no one has systematically checked.
Now there is this developing area of lifestyle changes as pathways to mental health. Yet lifestyle changes are entirely focused on behavior, not on thought. So the question is whether our thinking patterns are as important as we have believed.
To be fair, the history of psychotherapy shows that changing our thinking does actually change our emotions. Again, Freud showed that clearly, and since then, changing how we talk about our problems does change how we experience them. In that way, there is absolutely nothing surprising about several recent studies comparing psychoanalytic and cognitive treatment of obsessive-compulsive disorder, depression, and other complaints, showing equal effectiveness. Why wouldn’t they? They both rest on that same foundation.
But lifestyle is another pathway, and it makes us wonder whether acting in healthier ways changes our self-talk and reactions to the world. My final editorial comment is simple. If you will use a consistent measurement, you will know what is working. Use the CES-D, a free, public-domain instrument. I recommend the OQ-45, a checklist of 45 items that is widely used, clinically and in research. Use Scott Miller’s four item checklists. Use Goal Attainment Scaling. But use something. Then you can do your own experiments. Flip a coin when a problem comes up. Heads, apply Lifestyle Interventions. Tails, change your thinking. See what works.
6 Responses
Helen West-Rodriguez
Dear Dr. Johnson,
I just attended your workshop in Dallas and found it a bottomless pit of information. Thanks so much. Regarding the part where you talked about Vagal Tone reminded me of a book you might enjoy: “The Heart-Mind Matrix: How the heart Can teach the Mind new ways to Think, ” by Joseph Chilton Pearce. He is the author of those old books like “The Crack in the Cosmic Egg,” and “The Magical Child.” He has written lots more since then, more in the vein of heart thinking. This may be his last book, he is quite old and not quite clear headed anymore, a friend tells me.
Sincerely, Helen West-Rodriguez
Dr.J
I hadn’t thought of Joseph Chilton Pearce for a while. Thanks!
Lynn
Zak Zaklad, PhD
Lynn, again, we’re on the same page. i’ve worked as therapist with clients who have serious physical limitations, low incomes, and often histories of abuse. i’ve found it very productive to work with people on things like: nutrition, exercise, financial management, enhancing social world, volunteering, getting more education – all areas that are outside the traditional “clinical” purview. Probably the most useful approach i use is to teach TaiChi to those who have the patience and determination to learn it. thanks for you work!
Dr.J
Zak, I have always admired your work, and using Tai Chi is a wonderful intervention. You exemplify a therapist who is open to a much wider range of helpful interventions.
Ann Kramer
Absolutely lifestyle is a major part of many depressions. Long ago–I had severe ‘monthly’ depression….but I was also a total junkfood junkie and did no exercise (I was in college at the time). I used to spend several days each month “depressed” so badly that I stayed in bed for those days. By a fluke a friend of mine said–I bet if you ate better and started exercising, you’d fee better. I thought she was nuts–but to humor a friend–I did just that, changed my diet and started a regular exercise program. Voila–depression gone. And I’m grateful I never went to a doctor for my symptoms–he would’ve given me drugs–when all I needed was a healthy lifestyle!
Dr.J
Beautiful example, thanks so much. You made a wonderful point, that there are more ways to health and happiness than just traditional psychotherapy and / or drugs.