Lifestyle Therapy Is as Effective as Psychotherapy for Mental Health Outcomes and Costs

• Lifestyle therapy for depression is gaining attention as an effective alternative to psychotherapy. An experimental study published in the LANCET Regional Health Western Pacific compared the effectiveness of psychotherapy and online videoconferencing lifestyle therapy (focused on diet and exercise)
• Results showed that participants’ depression symptoms were reduced to a similar extent in both types of therapy
• Lifestyle therapy was cheaper per participant, but there were no differences in the total costs of the two types of therapy

Depression is one of the most common mental health disorders worldwide. It is among the top 25 causes of global disease burden, along with conditions such as cancer, cardiovascular diseases, and others (O’Neil et al., 2024).

 

What is depression?

Depression is characterized by persistent feelings of sadness, hopelessness, and a loss of interest or pleasure in daily activities. It can affect how a person thinks, feels, and behaves, often leading to physical and emotional problems that interfere with daily functioning. Untreated depression can also lead to suicidal ideas. Individuals with depression are at a more than 20-fold higher risk of suicide compared to the general population (Briley & Lépine, 2011).

Mainstream treatments for depression include psychotherapy and antidepressant drugs. However, in many individuals, these treatments do not result in improvement, leading to a condition called treatment-resistant depression. Estimates state that at least 30% of cases of depression represent treatment-resistant depression (De Carlo et al., 2016; McIntyre et al., 2023). Additionally, up to 15% of patients show only partial improvement (Fava, 2003).

 

Lifestyle Therapy and new treatments for depression

Because mainstream treatments are limited in effectiveness, scientists are constantly seeking new approaches. Studies have demonstrated certain effects produced by therapies organized around physical exercise, hiking, and sports activities (Kvam et al., 2016; Noetel et al., 2024; Sturm et al., 2012). Researchers have also examined the effectiveness of art therapy, particularly in suicidal patients (Abdulah & Abdulla, 2020).

Novel studies are examining the effectiveness of psychedelic drugs such as MDMA and psilocybin in treating treatment-resistant depression and report very promising results (Barone et al., 2019; Goldberg et al., 2020). Ketamine, a traditionally used general anesthetic substance, also shows promise (Zavaliangos-Petropulu et al., 2023).

One more novel approach to treatment is lifestyle changes. Studies have suggested that certain lifestyle changes might also be beneficial for individuals with depression. This includes the previously mentioned exercises and dietary changes (Araste et al., 2024; Fatahi et al., 2021; Lu et al., 2024). Working with patients to implement these practices in their lives became known as lifestyle therapy.

 

How Lifestyle Therapy for Depression Compares to Psychotherapy

Study author Adrienne O’Neil and her colleagues wanted to compare the effectiveness of lifestyle therapy delivered via Zoom to cognitive-behavioral therapy for depression (O’Neil et al., 2024). Cognitive-behavioral therapy is currently considered the gold-standard psychotherapy approach for treating depression. These researchers aimed to explore whether lifestyle therapy is less effective than cognitive-behavioral therapy for treating depression or not.

The study participants were 182 adults with depression recruited from a tertiary mental health service in Victoria, Australia. The study authors randomly divided them into two groups. One group underwent lifestyle psychotherapy, while the other completed a set of cognitive behavioral psychotherapy sessions, both delivered via Zoom.

The lifestyle psychotherapy treatment consisted of six 90-minute sessions delivered over eight weeks. A dietitian and an exercise physiologist conducted sessions. They targeted nutrition and physical activity but could integrate alcohol, smoking, substance use, and/or sleep hygiene. Two psychologists delivered the cognitive-behavioral psychotherapy program, which consisted of six group sessions delivered over eight weeks.

The study authors tracked changes in depression symptoms using the Patient Health Questionnaire-9, a tool for assessing depressive symptoms over the preceding two weeks. Participants also completed short clinical interviews and other questionnaires (see Figure 1).

 

Figure 1. Study Procedure (O’Neil et al., 2024)

 

Lifestyle therapy was not less effective than cognitive-behavioral psychotherapy

80% of participants who started the treatments completed 3 or more of the 6 sessions. The two groups did not differ in how many participants attended the sessions. Engagement checks showed that participants were “mostly engaged” or “very engaged” around 80% of the time.

Analyses showed that both groups of participants displayed reductions in depressive symptoms after their respective treatments. These reductions were of similar magnitude, indicating that lifestyle therapy was not worse than cognitive-behavioral psychotherapy. Participants who had more severe depression symptoms at baseline tended to report a stronger decrease in symptoms after treatment in both therapy types.

Additionally, lifestyle therapy participants reported improved diet quality and greater self-reported stool consistency. However, they reported fewer improvements in social support compared to psychotherapy participants (see Figure 2).

 

Figure 2. Lifestyle and cognitive-behavioral psychotherapy findings

 

Looking at the economic aspect of these two types of treatment, study authors found that the cost of delivering lifestyle therapy was marginally lower for lifestyle therapy (482 AUD ≈ 304 USD) per participant compared to psychotherapy (503 AUD ≈ 317 USD). However, the cost difference disappeared when additional costs of delivering and receiving these therapies were considered.

 

Conclusion

Overall, the study found that group lifestyle therapy delivered via Zoom is not less effective than cognitive-behavioral therapy of the same length delivered in the same way. When all relevant costs were considered, it was also not more expensive.

Given the increasing burden of depression and that a substantial percentage of individuals with depression remain untreated or without access to psychotherapy, these findings suggest that trained dietitians and exercise physiologists may be well-placed to provide remote mental health care and help alleviate the current burden on mental health services.

The paper “Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression: results from the CALM non-inferiority, randomised trial” was authored by Adrienne O’Neil, Joahna Perez, Lauren M. Young, Tayla John, Megan Turner, Dean Saunders, Sophie Mahoney, Marita Bryan, Deborah N. Ashtree, Felice N. Jacka, Courtney Bruscella, Megan Pilon, Mohammadreza Mohebbi, Megan Teychenne, Simon Rosenbaum, Rachelle Opie, Meghan Hockey, Lucija Peric, Samantha De Araugo, Khyati Banker, India Davids, Monica Tembo, Jessica A. Davis, Jerry Lai, Tetyana Rocks, Melissa O’Shea, Niamh L. Mundell, Grace McKeon, Murat Yucel, Pilvikki Absetz, Vincent Versace, Sam Manger, Mark Morgan, Anna Chapman, Craig Bennett, Jane Speight, Michael Berk, Steve Moylan, Lara Radovic, and Mary Lou Chatterton.

 

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