How Health Psychologists Treat Depression

Health psychology is a branch of psychology (section 38, specifically, of the American Psychological Association) that “seeks to advance the contributions of psychology to understanding health and disease through basic and clinical research, education activities, and services.”

Practically speaking, health psychologists are involved in patient care, research, and system-wide activities to enhance the treatment and management of major medical conditions. Health psychologists are increasingly specializing these days in fields such as pain psychology, obesity and weight management psychology, oncology psychology, diabetes psychology, cardiac psychology, and smoking cessation, among many others.

Few people know that health psychologists also treat common mental health conditions such as depression. Furthermore, the way health psychologists help people with depression is fundamentally different from the traditional psychotherapy and psychotropic offerings available in most mental health treatment settings. As you will learn here, the health psychology of depression intervention model is no less evidence-based than conventional treatments and has at least three unique advantages in the form of a) carrying less treatment stigma; b) the ability to carry out treatment more independently; c) confer health benefits beyond improving symptoms of depression.

Persons who have either: 1) have not benefited from psychotherapy or psychotropic substances. 2) have physical or financial barriers to participation in conventional depression treatments; or 3) a career experience or personal concerns related to receiving mental health treatment may consider a health psychology approach as an alternative option to explore.

In the paragraphs below, I outline some of the recent science that supports the specific approaches that health psychologists use to treat depression. However, in a simple checklist form, here is the evidence-based formula I use with my patients (of course tailored to individual circumstances):

1. ______ 7-8 hours of sleep, exercised according to a regular schedule

2. ______ exercise at least 3-5 days/week (including both aerobic and resistance training)

3. ______ 1.75-2.5 grams of omega-3 fatty acids/day through diet or high-quality supplements

4. ______ reduce added sugar (maximum 6/9 grams/day for women/men)

5. ______ reduce processed foods (replace whole foods)

6. ______ 2+ servings of fermented foods / day

7. ______ 25+ grams of dietary fiber/day

8. ______ at least 15 minutes of morning sunlight

In practice, I ask people to rate each of these factors themselves—sometimes supplemented with a week or two of self-report notes for more accurate information—to create an individual ranking order. Trying to change multiple health behaviors at once is often counterproductive. Instead, it is more practical to start with the area(s) furthest from the recommended parameters. This is also usually the behavior most likely to produce mood benefits for a person.

As noted above, none of these health interventions require psychotherapy or prescription medications. This allows, for example, some of my treatments to consist of just one or two meetings with a person to describe the approach and discuss the logistics of implementation in their individual circumstances. Then many can implement the program independently or with periodic follow-up visits. This does not mean that there is no point in working regularly with a health psychologist; As with most other depression treatments, people usually get better results with the help of a professional.

With my students and colleagues, I enjoy discussing the rapid advances in science that support health psychology treatments for depression. Although this body of research is too large to be summed up in a short publication, here are the highlights and some recent clinical trial evidence:

sleeping. A healthy sleep schedule is essential to emotional well-being (1). Multiple clinical trials and systematic reviews have shown that CBT-I improves symptoms of depression (including symptoms ranging from fatigue to suicidal ideation).

Playing sports Most people are known to enhance muscle and cardiovascular function. However, few realize that the benefits of regular exercise on cognitive function are equal if not more profound. The good news is that both aerobic and resistance training provide these benefits (2).

omega-3 fatty acids, EPA, in particular, may have been shown repeatedly in clinical trials to improve symptoms of depression. Some can get adequate amounts of EPA and other omega-3 fatty acids from the diet; Others will benefit from supplementation (3).

Read the essentials of depression

reduce sugar It improves both metabolic health and cognitive function, often in surprisingly short time frames. Lower mood and anxiety are among the recent cognitive benefits (4).

processed food. Food has medicinal effects, including for our physical and emotional health. As Western societies increasingly drift toward diets that consist primarily of ultra-processed foods, the adverse consequences increasingly appear to include higher rates of depression (5).

Fermented foods. The gut microbiome – made up of trillions of bacteria that live in the stomach, small intestine, and colon – is the subject of intense research interest recently and is showing increasingly strong evidence for an impact on mental health (6).

Dietary fiber. Through mechanisms such as improving the intestinal flora and reducing systemic inflammation, high fiber intake is another dietary route to improving physical and mental health (7).

daily sunlight. Lack of sunlight has long been associated with seasonal affective disorder. However, recent evidence suggests that the emotional benefits of regular exposure to sunlight extend to all forms of depression (8).

Finally, for those who may still not be convinced by the evolving evidence to support behavioral health treatments for depression, keep in mind that these recommendations are already part of national guidelines for treating depression in some countries. For example, the 2020 edition of the Royal Australian and New Zealand College of Psychiatry includes many of the health interventions summarized here among the first tier of recommended treatments for depression (9).

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