Netflix documentary by Jonah Hill, stutz, is an insightful journey into the mind of her therapist, famed psychiatrist Phil Stutz. Hill delves into Stutz’s model of care, creatively using visual representations of key concepts and “toolsdrawn by Stutz himself.
This model is based on his relationship with his physical body. When discussing 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 “lifestyle” factors. Surprised, Hill says in the film:
When I was a kid, exercise and diet were introduced to me as “there’s something wrong with the way you look”. But I was never offered any exercise or diet in terms of mental health. I just wish it was presented to people differently. Because for me it caused a lot of problems.
So, is Stutz right?
What does the latest evidence tell us?
Although the 85% figure is debatable, there is now good evidence that therapies targeting lifestyle factors can be an essential part of the treatment of psychiatric conditions such as depression. A recent meta-analysis (which brings together the results of different research studies) shows that exercise can be as powerful as antidepressant drugs for depression.
Our own to research shows that a modified Mediterranean diet can significantly improve symptoms and functioning in people with moderate to severe depression.
The mental health benefits of these interventions are evident independent of weight losscan be used in combination with medications (such as antidepressants or antipsychotics) and are profitable due to societal gains such as increased productivity at work.
And the benefits of these approaches can be felt relatively quickly, with effects evident in as little as three weeks.
Lifestyle changes can reduce the risk of common diseases such as heart disease and diabetes, which contribute to 20 years 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, advocacy and clinical practice guidelines Europe and the UK.
The main organization representing the medical specialty of psychiatry, the Royal Australian and New Zealand College of Psychiatrists, today recommended lifestyle modification should be considered the first step in treating depression.
Despite all this, this approach has not been fully embraced by mainstream mental health providers in Australia or as part of the Stutz documentary in the United States.
Support clinicians
The use of lifestyle therapies is a relatively new area in psychiatry compared to other treatments such as antidepressants or talk therapy with psychologists. Our randomized controlled trial showing that diet can be a previously mentioned depression treatment strategy was the first of its kind and was only completed in 2017.
There are various barriers to its translation into mental health care: training, funding, access, and variability in quality given the historical lack of guidelines.
In October, we released the first international guidelines which can be used in any clinical setting – from general practitioners 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:
More to understand
While these guidelines and resources are an important first step, there are still key questions in this area that remain unanswered.
These include how best to personalize treatments using a person’s physiology, genetics, demographics, background, and individual preferences.
We need to consider how this approach compares to gold standard care such as psychotherapy, especially for more severe depressions. We are currently testing this issue and recruitment participants in a national trial.
It is important to note that medications and other therapies can play an important role in the treatment of mental health. Medications should not be discontinued or changed without consulting a healthcare professional. We have also created a Classes for healthcare professionals who want additional support.
For now, our guidelines offer a way for medical professionals to start addressing Jonah Hill’s point – that lifestyle factors should be presented to people as central to their mental health.
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