Jonah Hill’s Netflix documentary Stutz is a journey deep into the mind of his therapist, renowned psychiatrist Phil Stutz. Hill delves into Stutz’s model of care, creatively using visual representations of key concepts and “tools” drawn by Stutz himself.
This model is based on one’s relationship with their physical body. When talking about the importance of health behaviors like exercise, diet, and sleep, Stutz estimates that 85% of the initial gains for someone with mental health issues starting therapy can come from focusing on these factors of ” Lifestyle”. Surprised, Hill says in the film:
As a kid, exercise and diet were framed for me as, ‘there’s something wrong with your appearance.’ But they never proposed to me exercise or diet in terms of mental health. I just wish it would be presented to people differently. Because for me, that caused a lot of problems.
So is Stutz right?
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What does the latest evidence tell us?
While the 85% figure is debatable, there is now good evidence that therapies that target lifestyle factors can be a critical part of treating psychiatric conditions such as depression. A recent meta-analysis (bringing together results from different research studies) shows that exercise may be just as powerful as antidepressant medications for depression.
Our own research shows that a modified Mediterranean diet can substantially improve symptoms and functioning for people living with moderate to severe depression.
The mental health benefits of these interventions occur independently of weight loss, can be used in combination with medications (such as antidepressants or antipsychotics), and are cost-effective due to social gains, such as increased productivity in the workplace.
And the benefits of these approaches can be experienced relatively quickly, with effects seen in as little as three weeks.
Lifestyle changes can reduce the risk of common conditions, such as heart disease and diabetes, that contribute to the 20-year gap in life expectancy for people with mental illness.
The strength of the evidence means that it has now been cited in key policy documents, recommendations and clinical practice guidelines in Europe and the UK.
The leading organization representing the medical specialty of psychiatry, the Royal Australian and New Zealand College of Psychiatrists, now recommends that lifestyle modification be considered the first step in the treatment of depression.
Despite all this, this approach has not been fully taken up by mainstream mental health care providers in Australia or on the set of Stutz’s documentary in the United States.
“You have to give someone the feeling that they can change right now.”
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supporting doctors
The use of lifestyle therapies is a reasonably new area for psychiatry compared to other treatments such as antidepressant medication or talk therapy with psychologists. Our randomized control trial showing that diet may be a treatment strategy for the aforementioned depression was the first of its kind and was only completed in 2017.
There are several barriers to its translation into mental health care: training, financing, access, and variability in quality given the historical absence of guidelines.
In October, we published the first international guidelines that can be used in any clinical setting, from general practice to specialist mental health care and by dietitians, in any country. They cover nine established and emerging lifestyle “pillars” to support whole person care. These are:
1. physical activity and exercise: improve aerobic and resistance training, yoga, reduce sedentary behaviors
two. relaxation techniques, such as guided breathing exercises
3. commit (or re-commit) to employment or volunteering
Four. get enough sleep
5. mindfulness-based therapies and stress management (including coping skills)
6. healthy diet that includes eating a wide variety of whole, plant-based foods and minimizing highly processed foods
7. give up smoking
8. improve social connections
9. interaction with nature: in green spaces like forests and parks, and blue spaces like the ocean or streams and rivers.
Exercise and participation in natural spaces can generate improvements in mental health.
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Clinicians can shape their approach in four key ways:
increase lifestyle and social evaluations. Our guidelines contain a list of recommended tools to capture changes in a patient’s health behaviors throughout therapy, as well as social assessment tools to help understand their socioeconomic background (such as stable housing, access to resources).
Obtain information from allied health professionals (such as dietitians or exercise physiologists), patient support networks, including other health professionals, the community, family, caregivers, and peers. It is important to know, for example, how a person’s home or neighborhood can influence their ability to quit smoking.
Identify behavior change strategies. Each individual will have a different mindset in terms of his openness to changing her behaviors. Clinicians can use the guidelines to identify the best strategies for different individuals.
help reduce stigma and/or assumptions that lifestyle is a choice. Instead, understand and explain to patients how individual, social, and business factors can play a role and make it difficult for them to make changes. This can make it feel less like a personal responsibility or fault and help navigate realistic changes.
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even more to understand
While these guidelines and resources are an important first step, there are key questions in this field that remain unanswered.
These include how to best customize treatments using a person’s physiology, genetics, demographics, history, and individual preferences.
We need to examine how this approach compares with standard care such as psychotherapy, especially for more severe depression. We are currently testing this question and recruiting participants for a national trial.
It is important to note that medications and other therapies can play an important role in mental health treatment. Medications should not be stopped or changed without consulting a medical professional. We have also created a course for healthcare professionals who want additional support.
For now, our guidelines provide a way for healthcare professionals to begin to address Jonah Hill’s point: that lifestyle factors should be presented to people as critical to their mental health.
If this article has caused you problems, or if you are worried about someone you know, please call Lifeline on 13 11 14.
Source: news.google.com