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In recent years there has been an increase in people seeking
multiple methods of treatment for mental illness and,
subsequently, an increase in research on the role of lifestyle
choices and their impact on mental health. The message from
both clinical practice and a large and growing body of research
has been that, while it requires more responsibility to make
healthy choices, the positive outcomes for physical and mental
health are worthwhile. In this chapter we examine the roles that
diet, exercise, sleep, time in nature, and social support play in
improving mental health. First, we examine one of the key
factors in the success of lifestyle choices: self-efficacy and
motivation.
Reframing Lifestyle Choices as Empowering
Decisions
While certain components or factors of mental illness are
beyond our control, recent research has demonstrated that
many choices we can make on a daily basis improve our mental
health or at least minimize symptoms. However, numerous
factors tend to predict whether individuals will take full
multiple methods of treatment for mental illness and,
subsequently, an increase in research on the role of lifestyle
choices and their impact on mental health. The message from
both clinical practice and a large and growing body of research
has been that, while it requires more responsibility to make
healthy choices, the positive outcomes for physical and mental
health are worthwhile. In this chapter we examine the roles that
diet, exercise, sleep, time in nature, and social support play in
improving mental health. First, we examine one of the key
factors in the success of lifestyle choices: self-efficacy and
motivation.
Reframing Lifestyle Choices as Empowering
Decisions
While certain components or factors of mental illness are
beyond our control, recent research has demonstrated that
many choices we can make on a daily basis improve our mental
health or at least minimize symptoms. However, numerous
factors tend to predict whether individuals will take full
responsibility for their lifestyle and specifically mental health.
One important factor is self-efficacy, a concept introduced by
psychologist Albert Bandura (Bandura 1977) that indicates one’s
level of ability to accomplish a specific task. Two research
reports examined numerous studies looking at self-efficacy as a
predictor of health behavior and found not only strong
correlations between self-efficacy and promotive health
behaviors but also that self-efficacy could be enhanced with
proper guidance (O’Leary 1985) (Strecher 1986). One study that
investigated the relationship between depression, obesity, and
self-efficacy found gender differences. Self-efficacy has been
shown to have a negative relationship with depression (Gecas
1989) especially in the fact that self-efficacy seems to mediate
between some forms of stress and depression.
Motivational Interviewing
Regarding lifestyle choice, self-efficacy speaks to a person’s
given response to a situation. The other component that plays a
key role in this is motivation. Clients may state that they desire
to make the change but then they may fail to do so. One way to
address this issue is to assess the client’s readiness to change. A
scale is available (Prochaska 1986) to determine if the individual
is completely ready to make the changes or if he is only in the
initial and more ambivalent stages ranging from precontemplation
to action. Once motivation is assessed the
provider could implement motivational interviewing (Miller
2002). This is a fairly easily taught psychotherapeutic technique
where a series of questions and interactions lead a client to
greater awareness about her level of motivation for change and
assist in increasing that motivation. A provider would likely
refer the client to a professional trained in motivational
interviewing or to a psychotherapist either for motivational
interviewing or longer-term psychotherapy to address the selfdefeating
thoughts and beliefs.
One important factor is self-efficacy, a concept introduced by
psychologist Albert Bandura (Bandura 1977) that indicates one’s
level of ability to accomplish a specific task. Two research
reports examined numerous studies looking at self-efficacy as a
predictor of health behavior and found not only strong
correlations between self-efficacy and promotive health
behaviors but also that self-efficacy could be enhanced with
proper guidance (O’Leary 1985) (Strecher 1986). One study that
investigated the relationship between depression, obesity, and
self-efficacy found gender differences. Self-efficacy has been
shown to have a negative relationship with depression (Gecas
1989) especially in the fact that self-efficacy seems to mediate
between some forms of stress and depression.
Motivational Interviewing
Regarding lifestyle choice, self-efficacy speaks to a person’s
given response to a situation. The other component that plays a
key role in this is motivation. Clients may state that they desire
to make the change but then they may fail to do so. One way to
address this issue is to assess the client’s readiness to change. A
scale is available (Prochaska 1986) to determine if the individual
is completely ready to make the changes or if he is only in the
initial and more ambivalent stages ranging from precontemplation
to action. Once motivation is assessed the
provider could implement motivational interviewing (Miller
2002). This is a fairly easily taught psychotherapeutic technique
where a series of questions and interactions lead a client to
greater awareness about her level of motivation for change and
assist in increasing that motivation. A provider would likely
refer the client to a professional trained in motivational
interviewing or to a psychotherapist either for motivational
interviewing or longer-term psychotherapy to address the selfdefeating
thoughts and beliefs.
Food as Medicine
Certain foods and categories of foods impact mental wellness
and this impact is becoming increasingly better understood and
its correction more urgent. Recent research is demonstrating
that the modern Western diet is sorely lacking in essential
vitamins, minerals and other healthful properties. With the rise
of fast and easy to prepare foods, the natural, healthful
components included in fresh fruits and vegetables are not
ingested, leading to an imbalance in multiple body systems such
as the digestive system and the nervous system. The best course
of action is to increase intake of fruits, vegetables, whole grains
and lean, organic meats free of added hormones. However, due
to issues of income level and access, this is a challenge, and the
use of supplements may help where this is not fully possible
(Weil, 2006).
Two topics of interest include foods that increase
inflammation and foods that are toxic to the mind-body system
(Hyman 2007). Physician Mark Hyman has written extensively
about the ill effects of ingesting toxins and other substances that
lead to inflammation. He found through his clinical experience
and a review of the research that over time, these problems
seem to contribute to depression, anxiety and mood swings.
Shifting one’s diet from processed and chemicalized foods to a
diet full of fruits, vegetables, whole grains and clean lean
proteins seems to have a dramatic impact on physical and
mental health. Integrative health physician Andrew Weil has
written extensively on foods that contain nutrients required by
the body for optimum health, and his experience emphasizes the
need to take in omega-3 fatty acids, whole grains, fish, and fresh
vegetables and fruits (Weil 2006).
Other research has shown that folate and vitamin B12 have a
positive impact on mental health (Alpert 2000), as well as omega-
3 fatty acids (Settle 2001). One study surveyed 4644 New Zealand
adults about their fish consumption (omega-3) and mental
health, and a significant association was found between higher
fish consumption and better mental health (Silvers 2002).
Many healthy, simple meals can be prepared that help buffer
against mental illness or as a supplementary treatment. They
take some basic cooking skills and the desire to prepare healthy
food. Andrew Weil’s Eating Well for Optimum Health (2000) or Mark
Hyman’s The UltraMind Solution (2010) and The UltraSimple Diet
(2009) are good resources for further education about these
foods and both include some simple recipes.
Exercise: Free Mental Health Care
In the past twenty years, the critical role that physical exercise
plays in mental wellness has been demonstrated scientifically,
but this has failed to make the clinical connection in the
mainstream treatment of mental illness (Callaghan, 2004). The
growing body of evidence indicates that it is a powerful way to
treat and prevent mental health problems. It is especially critical
that exercise be included in the pantheon of treatment
modalities because so many forms of exercise are fun, free, and
accessible for people of all classes, cultures and income levels
(Paluska 2000).
Hassmen et al conducted a large-scale (N=3403) study
examining exercise habits and anxiety and depression levels and
found that a level of 2-3 times per week regularly was the rate
that predicted significantly less anxiety and depression. They
also found that moderate exercise over a long period was more
effective than intense, acute, intermittent exercise (Hassmen
2000). Paluska and Schwenk looked at the impact of exercise on
anxiety and found that people did best exercising in 40-minute
sessions for at least 10 weeks (frequency per week not noted)
(Paluska 2000). Overall, it seems that a commitment to moderate
exercise is sustainable and demonstrates the most meaningful
effects.
Exercise reduces anxiety, depression, and negative mood and
improves self-esteem and assists cognitive skills (Callaghan
Certain foods and categories of foods impact mental wellness
and this impact is becoming increasingly better understood and
its correction more urgent. Recent research is demonstrating
that the modern Western diet is sorely lacking in essential
vitamins, minerals and other healthful properties. With the rise
of fast and easy to prepare foods, the natural, healthful
components included in fresh fruits and vegetables are not
ingested, leading to an imbalance in multiple body systems such
as the digestive system and the nervous system. The best course
of action is to increase intake of fruits, vegetables, whole grains
and lean, organic meats free of added hormones. However, due
to issues of income level and access, this is a challenge, and the
use of supplements may help where this is not fully possible
(Weil, 2006).
Two topics of interest include foods that increase
inflammation and foods that are toxic to the mind-body system
(Hyman 2007). Physician Mark Hyman has written extensively
about the ill effects of ingesting toxins and other substances that
lead to inflammation. He found through his clinical experience
and a review of the research that over time, these problems
seem to contribute to depression, anxiety and mood swings.
Shifting one’s diet from processed and chemicalized foods to a
diet full of fruits, vegetables, whole grains and clean lean
proteins seems to have a dramatic impact on physical and
mental health. Integrative health physician Andrew Weil has
written extensively on foods that contain nutrients required by
the body for optimum health, and his experience emphasizes the
need to take in omega-3 fatty acids, whole grains, fish, and fresh
vegetables and fruits (Weil 2006).
Other research has shown that folate and vitamin B12 have a
positive impact on mental health (Alpert 2000), as well as omega-
3 fatty acids (Settle 2001). One study surveyed 4644 New Zealand
adults about their fish consumption (omega-3) and mental
health, and a significant association was found between higher
fish consumption and better mental health (Silvers 2002).
Many healthy, simple meals can be prepared that help buffer
against mental illness or as a supplementary treatment. They
take some basic cooking skills and the desire to prepare healthy
food. Andrew Weil’s Eating Well for Optimum Health (2000) or Mark
Hyman’s The UltraMind Solution (2010) and The UltraSimple Diet
(2009) are good resources for further education about these
foods and both include some simple recipes.
Exercise: Free Mental Health Care
In the past twenty years, the critical role that physical exercise
plays in mental wellness has been demonstrated scientifically,
but this has failed to make the clinical connection in the
mainstream treatment of mental illness (Callaghan, 2004). The
growing body of evidence indicates that it is a powerful way to
treat and prevent mental health problems. It is especially critical
that exercise be included in the pantheon of treatment
modalities because so many forms of exercise are fun, free, and
accessible for people of all classes, cultures and income levels
(Paluska 2000).
Hassmen et al conducted a large-scale (N=3403) study
examining exercise habits and anxiety and depression levels and
found that a level of 2-3 times per week regularly was the rate
that predicted significantly less anxiety and depression. They
also found that moderate exercise over a long period was more
effective than intense, acute, intermittent exercise (Hassmen
2000). Paluska and Schwenk looked at the impact of exercise on
anxiety and found that people did best exercising in 40-minute
sessions for at least 10 weeks (frequency per week not noted)
(Paluska 2000). Overall, it seems that a commitment to moderate
exercise is sustainable and demonstrates the most meaningful
effects.
Exercise reduces anxiety, depression, and negative mood and
improves self-esteem and assists cognitive skills (Callaghan
2004). It appears that various types of exercise may help specific
disorders: hiking for spiritual connection, martial arts for
depression and spirituality, boxing or ultimate fighting to work
out anger, and team sports to improve confidence and build
social skills (D’Silva 2002). One study found that panic was
reduced equally as well by both anti-anxiety medication and
exercise from individual self-report, although the medications
worked more quickly (Broocks 1998). Higher levels of coherence,
mastery, self-efficacy, and better social support were reported
by those engaged in physical exercise (Hassman 2000).
Paluska and Schwenk published a detailed review of the state of
the research on exercise and mental health and concluded that
exercise appears to have the most impact on people with mild to
moderate anxiety and depression. The authors found that
exercise has the same impact as psychotherapy for people with
mild to moderate symptoms in clinically depressed populations
but the correlation between exercise and mood is less clear in
non-clinical populations (Paluska 2000).
Regarding neurotransmitters, exercise has been shown to
increase serotonin (Fox 1999), acetylcholine and norepinephrine
(Deslandes 2009). Recent data revealed that exercise may
function more as an analgesic, sedative, and anxiolytic than as a
producer of endorphin highs (Deslandes 2009).
An interesting finding in the literature reveals that all types of
exercise seem to have a positive effect on depression and other
mental illness: aerobic, anaerobic and flexibility (Paluska 2000).
Atlantis et al found that multimodal exercise (as opposed to one
form of exercise) resulted in significantly less depression and
stress and better levels of mental health and vitality after 24
weeks (Atlantis 2004).
Given the evidence that exercise makes a profound impact on
mental health, it is wise to assess exercise habits with clients.
Along with assessing motivation for fitness, it would be helpful
to present the evidence that exercise has a direct effect on
mental illness and to engage a discussion on the “fun factor.”
Exercise encompasses so many activities that it is entirely
disorders: hiking for spiritual connection, martial arts for
depression and spirituality, boxing or ultimate fighting to work
out anger, and team sports to improve confidence and build
social skills (D’Silva 2002). One study found that panic was
reduced equally as well by both anti-anxiety medication and
exercise from individual self-report, although the medications
worked more quickly (Broocks 1998). Higher levels of coherence,
mastery, self-efficacy, and better social support were reported
by those engaged in physical exercise (Hassman 2000).
Paluska and Schwenk published a detailed review of the state of
the research on exercise and mental health and concluded that
exercise appears to have the most impact on people with mild to
moderate anxiety and depression. The authors found that
exercise has the same impact as psychotherapy for people with
mild to moderate symptoms in clinically depressed populations
but the correlation between exercise and mood is less clear in
non-clinical populations (Paluska 2000).
Regarding neurotransmitters, exercise has been shown to
increase serotonin (Fox 1999), acetylcholine and norepinephrine
(Deslandes 2009). Recent data revealed that exercise may
function more as an analgesic, sedative, and anxiolytic than as a
producer of endorphin highs (Deslandes 2009).
An interesting finding in the literature reveals that all types of
exercise seem to have a positive effect on depression and other
mental illness: aerobic, anaerobic and flexibility (Paluska 2000).
Atlantis et al found that multimodal exercise (as opposed to one
form of exercise) resulted in significantly less depression and
stress and better levels of mental health and vitality after 24
weeks (Atlantis 2004).
Given the evidence that exercise makes a profound impact on
mental health, it is wise to assess exercise habits with clients.
Along with assessing motivation for fitness, it would be helpful
to present the evidence that exercise has a direct effect on
mental illness and to engage a discussion on the “fun factor.”
Exercise encompasses so many activities that it is entirely
possible for individuals to find at least one exercise—aerobic,
anaerobic or flex-training—where they can truly enjoy
themselves and be empowered to treat their mental illness.
Sleep: Nature’s Mood Management System
Another factor in lifestyle effects on mental health is sleep.
Along with the negative consequences of fast food, loss of sleep
causes more problems than simply lack of concentration, energy,
and creativity (Kemper 2010). Typically in the field of mental
health sleep was considered a symptom and not a causal agent in
mental disorders, but recent studies have found that sleep issues
seem to contribute to anxiety, depression, ADHD and bipolar
disorder (Harvard 2009). Essential sleep restores all of the major
mind-body systems, including the ability to relax, release stress,
and regulate emotions. Lack of sleep plays a role in the growing
obesity rates, which are also linked to growing rates of
depression. Exercise increases sleep time, which leads to
improved overall mental health (Landers 1997).
Connecting back to the introduction, achieving proper sleep
begins with a decision to do so and to adjust one’s schedule and
lifestyle in a way that prioritizes the mental health care role of
sleep. Although many elements of sleep continue to elude
scientific understanding, we do know that limiting alcohol and
nicotine before bed improves sleep. Aerobic exercise during the
day and meditation before sleep can improve sleep, and thus
mood (Harvard 2009) (Kemper 2010).
Being in Nature
As technology has progressed, people have become more
sedentary, spending more hours indoors. This has taken a toll on
mental health. Recent research has investigated the impact of
greenery and green outdoor spaces on various mental disorders
and negative states. For example, Sugiyama et al examined the
relationship between perceived neighborhood “greenness” and
mental health and found a stronger correlation between
anaerobic or flex-training—where they can truly enjoy
themselves and be empowered to treat their mental illness.
Sleep: Nature’s Mood Management System
Another factor in lifestyle effects on mental health is sleep.
Along with the negative consequences of fast food, loss of sleep
causes more problems than simply lack of concentration, energy,
and creativity (Kemper 2010). Typically in the field of mental
health sleep was considered a symptom and not a causal agent in
mental disorders, but recent studies have found that sleep issues
seem to contribute to anxiety, depression, ADHD and bipolar
disorder (Harvard 2009). Essential sleep restores all of the major
mind-body systems, including the ability to relax, release stress,
and regulate emotions. Lack of sleep plays a role in the growing
obesity rates, which are also linked to growing rates of
depression. Exercise increases sleep time, which leads to
improved overall mental health (Landers 1997).
Connecting back to the introduction, achieving proper sleep
begins with a decision to do so and to adjust one’s schedule and
lifestyle in a way that prioritizes the mental health care role of
sleep. Although many elements of sleep continue to elude
scientific understanding, we do know that limiting alcohol and
nicotine before bed improves sleep. Aerobic exercise during the
day and meditation before sleep can improve sleep, and thus
mood (Harvard 2009) (Kemper 2010).
Being in Nature
As technology has progressed, people have become more
sedentary, spending more hours indoors. This has taken a toll on
mental health. Recent research has investigated the impact of
greenery and green outdoor spaces on various mental disorders
and negative states. For example, Sugiyama et al examined the
relationship between perceived neighborhood “greenness” and
mental health and found a stronger correlation between
greenness and mental health as compared to physical health,
while controlling for recreation and social coherence (Sugiyama
2008). Van den Berg et al conducted a study on the relationship
of green space to mental health and stress specifically. They
found that people who had a large amount of green space within
3 km of their house (not simply a backyard or a neighborhood
park) were less negatively impacted by stress than people with
less greenery. This followed for mental health in general (Van
den Berg 2010). Children with ADHD demonstrate improved
symptoms after spending time in nature (Faber 2011). This is a
critical issue because ADHD has increased in prevalence and
some components of it may correlate with an increase in indoor,
sedentary activity and less time outside.
These studies offer data that reveal the power of greenery and
nature on the mind-body-spirit system. With the exception of
impoverished urban areas, most individuals have access to some
sort of green space. Consciously engaging with it, whether it is a
park, mountain, or meadow, is a simple way to release stress and
anxiety and connect with something larger. Clinically, it seems
that engaging with green space connects us to something larger
than ourselves and our perceived problems.
Social Connections
Abundant evidence indicates that social support promotes
health on all levels, but especially mental health (Kemper 2010).
Most data indicate that there are two models that explain how
social support impacts mental health: the general/main-effect
model and the buffering model. The general model describes the
degree to which individuals are generally socially connected,
engaged and interactive at any given point in time. The
buffering model is more specific in that individuals are in
specific distress and know they have people who will support
them emotionally (Kawachi 2001).
Lifestyle choices are simple, accessible and typically affordable.
With some education and access to resources, nearly anyone can
while controlling for recreation and social coherence (Sugiyama
2008). Van den Berg et al conducted a study on the relationship
of green space to mental health and stress specifically. They
found that people who had a large amount of green space within
3 km of their house (not simply a backyard or a neighborhood
park) were less negatively impacted by stress than people with
less greenery. This followed for mental health in general (Van
den Berg 2010). Children with ADHD demonstrate improved
symptoms after spending time in nature (Faber 2011). This is a
critical issue because ADHD has increased in prevalence and
some components of it may correlate with an increase in indoor,
sedentary activity and less time outside.
These studies offer data that reveal the power of greenery and
nature on the mind-body-spirit system. With the exception of
impoverished urban areas, most individuals have access to some
sort of green space. Consciously engaging with it, whether it is a
park, mountain, or meadow, is a simple way to release stress and
anxiety and connect with something larger. Clinically, it seems
that engaging with green space connects us to something larger
than ourselves and our perceived problems.
Social Connections
Abundant evidence indicates that social support promotes
health on all levels, but especially mental health (Kemper 2010).
Most data indicate that there are two models that explain how
social support impacts mental health: the general/main-effect
model and the buffering model. The general model describes the
degree to which individuals are generally socially connected,
engaged and interactive at any given point in time. The
buffering model is more specific in that individuals are in
specific distress and know they have people who will support
them emotionally (Kawachi 2001).
Lifestyle choices are simple, accessible and typically affordable.
With some education and access to resources, nearly anyone can
utilize them as adjunctive or primary treatments for varying
degrees of mental health challenges. The key to success is
developing a strong belief in self-mastery, in achieving goals and
in coming to know what good health feels like.
degrees of mental health challenges. The key to success is
developing a strong belief in self-mastery, in achieving goals and
in coming to know what good health feels like.
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