• Movement and Nutrition

    Whether or not one embraces reliance on technological advancements, it is hard to argue against the power of technology to shape the human experience. In this digital age we are constantly bombarded with advancements purported to increase productivity and enhance interpersonal connections. Anyone who uses a smartphone can speak to the convenience and quality of life conferred by constant access to navigation systems, multiple communication interfaces, cameras, and interactive games. In theory, technology allows us to be more efficient, productive, and connected versions of ourselves. On the other hand, anyone seated across from a smartphone-wielding loved one knows that these advancements come at a cost. Tools that make us more efficient and improve our quality of life demand our attention. Unfortunately, attention is a limited well; focus on technology necessarily comes at a cost of attention to other things. Priorities must be examined to determine whether the benefits of the technology outweigh the costs. This is true at the level of the individual and, on a broader scale, at the level of organizations, communities, and society.

    Modern psychology and psychiatry are not immune to the push for technological advancements, or “quick fixes” to mental health concerns. This is evident in the National Institute of Mental Health’s overwhelming allocation of research funding to the exploration of brain functioning. The goal of this research is to find interventions that treat emotional problems by bypassing thoughts and feelings and targeting the brain directly. Such interventions include psychotropic medications, brain stimulation techniques, and electroconvulsive treatments. Empirical evidence suggests that each of these treatments can be effective at treating psychiatric disorders in certain populations. For example, electroconvulsive therapy has been found to be particularly effective for individuals suffering from treatment-resistant depression (Khalid et al., 2008). That said, effectiveness does not necessarily make these treatments the optimal first line of defense. Costs can be prohibitive. Furthermore, the more invasive the procedure, the greater the risk of side effects. Side effects can range from memory loss and confusion to strokes or seizures.

    More basic, less invasive treatments, such as psychotherapy, are given far less attention in recent outcome research, even though data exists to suggest they can be just as effective. In 2015, only 5.4 percent of NIMH funding was devoted to researching the effectiveness of psychotherapy (Freeman, 2015). This trend represents a prioritization of technologically-advanced interventions over more basic ones. Given this push for cutting-edge cures, do more basic health and wellness practices, such as nutrition and exercise, have a place in modern psychology or psychiatry?

    To answer this question it is necessary to explore the research that does exist on the effectiveness of more basic practices for the promotion of health and well-being. In doing so it becomes evident that, while the interventions themselves might be basic, the mechanisms by which they work have complex biological bases. Hippocampal neurogenesis is thought to be one of these mechanisms. The hippocampus is a brain structure implicated in learning and memory, as well as regulation of mood. It is one of the few structures in the brain for which generation of new neurons occurs into adulthood. Research suggests that adult hippocampal neurogenesis is impacted by nutrition, thereby implying a link between nutrition and mental health. The following practices have been shown to positively impact hippocampal neurogenesis: restriction of calories and fat and exposure to omega-3 fatty acids, flavonoids, folic acid, and vitamin E (Zainuddin & Thuret, 2012). Conversely, the following have been shown to negatively impact hippocampal neurogenesis: vitamin A deficiency, thiamin deficiency, zinc deficiency, a diet high in sugar, and ethanol (Zainuddin & Thuret, 2012). These results suggest that psychiatrists might want to start writing prescriptions for omega-3 fatty acids or vitamins in addition to (or instead of) psychotropic medications.

    Another hypothesized mechanism by which nutrition and intake influence health and well-being is through the gut. The gut plays host to numerous bacteria with the potential to impact physical and mental health. There is empirical evidence to suggest that bacteria can influence the development of neural pathways and brain chemistry, thereby impacting mood, cognition, and behavior. Bacteria generally has a negative connotation— rightly so in certain cases, given its association to conditions like irritable bowel syndrome and food poisoning. However, not all bacteria is associated with negative outcomes. Probiotics are live bacteria and yeasts found to be beneficial for digestive health. There is evidence to suggest that they can lead to improved mental health and wellness in mouse models. Mice exposed to probiotics exhibit lower levels of the stress hormone corticosterone (Carpenter, 2012). Additionally, behavioral markers suggest that exposure to probiotics is associated with improved coping skills. Measurement of mental health variables in mice poses a challenge, but the “forced swim test” is one of the more highly regarded behavioral experiments designed to provide a mouse analog to depressive behavior. Compared to a control group, mice exposed to probiotics were more likely to persevere in the forced swim test, showing less depressive behavior and greater coping skills (Carpenter, 2012). Perhaps there is room on the psychiatrist’s prescription pad for bacteria as well.

    Nutrition is not the only “basic” practice to have implications for health and well-being. Exercise and movement also have associations to positive outcomes. These outcomes have been observed across a lifespan, from infancy to end of life. Starting with infancy, early exposure to movement has been associated with optimal brain development and positive attitudes toward exercise. Such attitudes can set the tone for lifelong adherence to health-promoting activity, thereby guarding against future mental and physical illness. For optimal development, researchers recommend a host of age-appropriate activities for infants and children, ranging from sensory-motor experiences to coordination of movements, postural control, and locomotion (Gabbard & Rodrigues, n.d.).

    The effects of exercise are not just preventative or life-enhancing; they can also be curative. Exercise has exhibited clear therapeutic benefits for individuals suffering from depression. A meta-analysis of the effects of exercise on reduction of depressive symptoms revealed a large and significant effect size (Josefsson, Lindwall, & Archer, 2012). For the studies included in the meta-analysis, the mean exercise session was 36.4 minutes with a median frequency of 3 times per week (Josefsson et al., 2012). A relatively low investment of 109 minutes per week yielded significant benefits for depressed subjects. Another study found an aerobic exercise program to produce effects comparable to that of the antidepressant sertraline, also known as Zoloft, for depressed patients, with both experimental groups showing a greater reduction in symptoms than control groups (Blumenthal et al., 2007). If you factor in the greater potential for negative side-effects with the anti-depressant, the simpler intervention may have the edge over the more advanced one.

    There is an even greater potential for exercise to have therapeutic benefits in older adults, in part because baseline activity tends to decrease with age. One study examined the effectiveness of a 12-week exercise program for adults over the age of 60. The program consisted of 1-hour sessions, 3 x week. Sessions included guided stretching and balancing exercises; aerobic exercises using treadmills, recumbent bikes, or elliptical machines; and strength training. At the end of the program the older adults enrolled in the exercise program, relative to controls, showed a statistically significant improvement in quality of life (Langlois et al., 2012). The experimental group also showed statistically significant improvement in cognitive performance on the domains of executive functioning, processing speed, and working memory (Langlois et al., 2012). These results have important implications because maintenance of cognitive skills can increase the amount of time that an individual is able to live independently.

    In addition to a decline in activity, age is also correlated to polypharmacy, or the prescription of multiple medications. Adding a psychotropic medication to an already long list of medications can increase the risk for dangerous interactions. Therefore, it is especially important to consider the relative effectiveness of exercise to pharmacological interventions for older adults. A study comparing the effectiveness of an anti-depressant to an exercise program for the treatment of depression in older adults found that, while medication resulted in a more immediate therapeutic response, the interventions were equally effective across the 16-week period of the study (Blumenthal et al., 1999). The type of physical exercise that an individual is able to engage in may vary widely over the course of a lifetime, but there is no question that movement is beneficial.

    While diet and exercise seem like simple fixes in theory, they are often neglected in practice. In the digital age, that which is considered simple is often dismissed. Some will argue that technology is responsible for our neglect of proper nutrition and exercise practices. We no longer eat nutritious meals because we have countless options for high-fat, high-calorie fast foods that can be ordered online and delivered to our doorsteps in less than half the time and effort it would take to cook. We no longer walk places because we have cars, segways, and conveyer belts to do the moving for us. The time we save on cooking and walking is spent sitting on the couch, watching TV, or looking at our computers. It is true that technology can make it more challenging to make decisions that promote health and wellness. However, we as individuals have to take ownership of our actions and consciously strive to make better, more-informed decisions. This is where modern psychology and psychiatry have the potential to make a difference. Including basic health and wellness practices in research and clinical recommendations could influence individuals to adopt them. More advanced treatments need not be displaced entirely, but perhaps the field could make room for simpler ones as well.

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