Episode 100 | Oct 3, 2024

Can Health Coaching Help With Depression?

Can lifestyle changes really be as effective as therapy for depression? In Episode 100 of Health Coach Talk, Dr. Sandi celebrates the milestone with a solo episode focused on the clinical and cost-effectiveness of lifestyle therapy in comparison to psychotherapy for reducing depression. She highlights an Australian study published in The Lancet that found lifestyle therapy, including nutrition and physical activity guidance, to be as effective as cognitive behavioral therapy (CBT) in reducing depression. Dr. Sandi discusses how health coaches, through group support and lifestyle modifications, could play a crucial role in improving mental health outcomes, offering an accessible, cost-effective alternative to traditional therapy.

Dr. Sandi explains the importance of using cognitive behavioral principles in conjunction with lifestyle changes like better eating and regular exercise. She encourages health coaches to lead lifestyle therapy groups, working alongside dietitians and exercise professionals, to help individuals reduce depression through holistic health interventions. The power of group support and making small shifts in self-talk can lead to significant improvements in mental health, allowing individuals to feel empowered, hopeful, and more connected to themselves and others.

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Episode Transcript

Welcome to Episode 100 of “Health Coach Talk.” I am so excited that we made it to 100 episodes, and I cannot wait, as we continue on, we have great guests that are coming up so stay tuned. But in honor of our 100th episode, I thought I would do a solo episode. And one of the things that I really enjoy doing is finding research studies that I think are useful for the health coaching profession. They are good for you to know about wherever you are, if you are a practitioner, if you’re a health coach, if you’re thinking about becoming a health coach, or if you just want general information. I want to talk about a study that came out of Australia. So, let me pull it up and I’m going to share the details.

So, this was published in The Lancet in July of 2024, and the title is “Clinical and cost-effectiveness of remote-delivered, online lifestyle therapy versus psychotherapy for reducing depression.” This is the results from the CALM, that’s C-A-L-M, non-inferiority, randomized trial. So, they’re using the word non-inferior because they want to determine whether lifestyle therapy is not inferior to psychotherapy. Let me share the details. The authors claim that they conducted the first non-inferiority randomized controlled trial to determine whether lifestyle therapy is not inferior, in other words, just as good, not worse than psychotherapy with regards to mental health outcomes and costs, and they delivered it virtually.

So, this is what they did. It was randomized. They were offering group treatment design, and the participants were given a questionnaire. It was called specifically the Distress Questionnaire. This is a measure to indicate depression. So, those folks who were depressed were then recruited, and they were assigned to six 90-minute sessions over eight weeks using group format, and it was remote. So, one group of participants got lifestyle therapy. What does that mean? Well, they were targeting specifically nutrition and physical activity. Now this is the crucial part, and I’m going to discuss this later. Who was conducting these lifestyle therapy sessions? A dietitian and an exercise physiologist. The second group got psychotherapy and very specifically, they got cognitive behavior therapy with psychologists. Now, I worked for many years, over 35, as a licensed clinical psychologist, and my specialty happened to be cognitive behavior therapy. In fact, I trained with one of the so-called fathers of CBT, that was Albert Ellis. So, this is something that I am very familiar with, and I’m going to comment on this.

But let me first share the outcome. So, the outcome, so after those sessions, they were given another questionnaire and both groups improved. In other words, their ratings that would indicate whether they were depressed, how depressed, they got better with both groups. So, the conclusion then was that the lifestyle was not inferior. Who were in these groups? Let me talk about that. So, these were 80% women. They had a mean age of 45, and they completed an average of a little over four sessions. I don’t know how they got that, 4.2 of the 6 sessions were completed over those 8 weeks period. So, again, depression reduced in both groups. And what did they conclude? I’m just going to read this from the study. And Adrienne O’Neil was the lead investigator in this Australian study. They concluded, “Remote delivered lifestyle therapy was non-inferior to psychotherapy with respect to clinical and cost outcomes.” In other words, it didn’t cost more to do the lifestyle therapy, and they’re suggesting it should be replicated. So, they go on and I quote, “If replicated in a fully powered RCT, that’s randomized controlled trial, this approach could increase access to allied health professionals who with adequate training and guidelines can deliver mental healthcare at a comparable cost to psychologists.

Wow. So, this really resonated with me because we have a crisis, growing rates of depression. This study didn’t look at anxiety, but anxiety levels are also just through the roof. The same time we are facing a severe shortage of mental health professionals, psychologists in particular. Many of the older psychologists, my generation, for example, are retiring in droves, and newer psychologists are not taking their place. To get training to become a psychologist, it is rigorous. It takes a lot of schooling. It’s expensive and it tends to be not as high-paying unless you are, for example, an industrial organizational psychologist, but clinical psychologists are facing a severe shortage. The waiting list for getting intervention is very long.

So, what do I think was most significant about this study? Well, first of all, lifestyle. So, as people were getting education with the dietitians and the exercise professionals, they were eating better. They were moving. They were exercising. And we know there’s been many studies to show, for example, that exercise you go out and take a walk, that’s going to significantly alter your mood. You’re going to feel better. And studies have shown that when compared with antidepressants for those who are… We’re not talking about people who are severely depressed to the point where they may be suicidal, but physical activity has been shown to be as effective as antidepressants for mild to moderate depression.

So, how would I have designed this study differently? And what do I want you to take away? Well, rather than the dietitians and the exercise professionals, have health coaches lead those groups, have the nutrition professional, the exercise professional design a program, help in terms of perhaps an assessment of somebody’s nutritional status, their physical fitness, and suggest possible dietary plans, for example, and exercise plans, but have health coaches run those groups. If you are a primary care doctor and you have a lot of patients who are complaining of depression, and you’re quick to put them on antidepressants, well, how wonderful would it be if you had a group going in your office led by a health coach, and they could focus on those two lifestyle factors, which are nutrition and exercise. And yes, health coaches are not the ones prescribing the diet plan or the exercise plan, but they’re doing that crucial work in that group where everybody is committed together, and they’re helping them to meet their goals.

And there’s another crucial piece that I would add, because cognitive behavior therapy, that is not gated. That is not something that only psychologists can do. So, health coaches do not do psychotherapy. So, you drop the psychotherapy part of it. In other words, it’s not cognitive behavioral therapy. It is cognitive behavioral principles. And you may hear this all the time, not realizing that this is cognitive behavioral principles, but many influencers who just listened to podcasts, I listened to one the other day, and someone was talking about the benefit of changing your self-talk. Well, that is cognitive behavioral principles. That’s cognitive behavioral therapy, if you are applying that. And so when I was working as a psychologist, I was using cognitive behavioral principles, and I was integrating that with helping people change aspects of how they were living their life, like what they were eating, have them eating better, working out. Sleep is not included in this study as well, but that could be something stress levels, doing some mind-bodies and relaxation techniques. But first and foremost, it is those principles of cognitive behavioral therapy that are very effective. And that is where you analyze, you stop, “What are you thinking? And what are those words that you’re saying to yourself?” And if you’re saying, “It’s awful, my life is terrible. My past was awful, it’ll never get better.” And then you dispute those thoughts, and you come around to something that is more logical, like, “Yeah, I’ve had many disappointments, but I’m strong, I’m resilient,” or you lower the intensity of that language. Instead of something being awful, horrible, terrible, it’s inconvenient, it’s disappointing, I can get through it, my life will go on. There are many ways that a coach can help somebody who is depressed to start to feel that they can use their strengths, they can experience hope and gratitude, they can support others, and the beauty of being in a group. And I’ve seen this because I’ve led many groups in my life, and that is where the people in the group, the participants start to help one another. And that is the power of the group.

And so both of these groups in the study, another thing that I would say is, well, the power of they were coming together, even online, it’s very possible that the power of the group was one of the reasons that both groups got better as well. And health coaches can reinforce that, where people are supporting one another. And when you are of service to someone else, that is very healing. You are personally transformed, your depression, you can feel better, you feel more optimistic. You feel like you have value and worth.

So, what are we going to conclude from this study? I think this is one that you, if you are a health coach, have this in your back pocket, because it does show that if you are looking at the need for psychotherapy and there’s a long waiting list, maybe a lot of therapists, a lot of psychologists are now cash pay, it might be out of reach, might be not on your insurance plan, but you can get into a group led by a health coach. It’s going to be clinically effective, in other words, you’ll feel better, and cost-effective. So, it won’t be more than psychotherapy, and chances are that it might be even less costly than therapy.

And the other thing that’s great about health coaching, these were time-limited groups, and look what changes were made. They felt better in just this finite period of time. Many people get stuck in psychotherapy, I’ve seen this over and over again, where it might be 10 years on, and they’re still in therapy, and they’re still thinking that they need the therapy. And many times short-term work is very effective with a health coach. Now I just want to say that I am not suggesting that for people who are severely depressed, where they might be suicidal, for example, where they can’t get out of bed, they can’t get to work, that would be different. They would need a different type of intervention with a mental health professional, a psychiatric intervention. There’s actually a lot of great work being done in nutritional psychology, and we’re going to have an episode about that on the podcast as well.

So, I hope that you found this interesting, that this study again shows the power of lifestyle change. And if we put that lifestyle change with thought change, in other words, catching what you’re thinking about and the conclusions that you are saying about the world, about yourself, if you modify those, that has a direct impact. Your thoughts are actually very powerful. And what is real in the mind, it becomes real in the body. So, thanks for listening to this solo episode, our 100th episode of “Health Coach Talk.”