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.