Last week we gave an introduction to emotional health and the prevalence of emotional health issues in South Africa.  The pharmacological and psychotherapeutic management of these conditions is well established.  But there is increasing evidence to show that some simple lifestyle changes may be as effective at addressing some of these conditions as what medications have been, without many of the side effects.  We will give you references for this.  This does not in any way suggest that you must throw your medications down the toilet, but if you are starting on the journey of therapy for mental health issues, you may well consider lifestyle interventions, or incorporate them into your current therapeutic regimen, under the guidance of your health-care professional.

ALSO READ : Turning the Tide – Lifestyle Medicine and Emotional Health (part 1)

Here is a summary of lifestyle/non-pharmacological treatments found to be beneficial for depression (and probably for anxiety as well) recommended by the American College of Lifestyle Medicine.

• Physical activity
• Increased fruits and vegetables intake
• Sleep management
• Mindfulness, relaxation therapy
• Bibliotherapy – storytelling, writing, journaling and poetry
• Light therapy
• Positive relationships and social support

These are apart from cognitive behaviour therapy and psychotherapy provided by a professional therapist.

Physical activity

I just completed a 6 part series on this weekly blog on the role of exercise in health, including reduction of depression and anxiety.  We know from numerous studies that exercise can play an important role in the management of both depression as well as anxiety.  Here is a review for major depression disorder:  . It reports some studies that show exercise to be as effective as medication, and even as effective as cognitive behaviour therapy.

Here is another which shows robust evidence of the value of exercise in managing depression:

Increased fruits and vegetables intake

There is much evidence now to show a strong correlation with lowered incidence of depression and other mental health issues with increasing whole foods, particularly fruit and vegetables.  “Evidence suggests that both low rates of common mental disorders including depression, low mood, stress, and anxiety, and higher rates of positive mental health including life satisfaction, positive mood, and perceived life flourishing, co-occur with fruit and vegetable intake. Furthermore, research suggests that a dose-response relationship exists, whereby each serving increase in fruit and vegetables is associated with an improvement in mental health.” No doubt this also goes along with reduction in processed and refined foods,  and a high animal product intake.

Sleep management

Sleep disorders and depression and other psychiatric disorders are bi-directionally related.  In other words – insomnia (difficulty sleeping) is a common cause of emotional and mental health conditions, but emotional and mental health issues are also a common cause of insomnia. This is not surprising as during sleep the brain is able to clean up and organise itself, filing information away in accessible folders.

And a disorganised brain is enough reason to become dysfunctional. I’m sure we have all felt more irritable and short-tempered and stressed when we are forced to have reduced sleep. 

My family can certainly attest to that in my past obstetric life getting called out at all times of the night.

Mindfulness and relaxation therapy

There is much that is written about the importance of mindfulness in calming the stress of life and bringing inner harmony.  Much has been researched also about the value of meditation and yoga.  I and others from the Judaeo-Christian background can attest to the power of prayer and deep reflection on the Word.

There are many forms of mindfulness. It can be done eating food, when one concentrates upon the flavours and textures of each mouthful; living in the moment, excluding all the pressing worries that sap our emotional energy; it can be done walking in nature, or along the beach; it can be through listening to grand and inspired music;  it can be lying awake at night reflecting upon your life and all the blessings you have experienced; it can be writing letters to loved ones and friends, expressing appreciation for all they mean to you; it can be quietly washing dishes, or ironing clothes, reflecting on the privilege of having food and clothes.

It can also be through spiritual exercises – reading holy books, attending church and religious worship and participating in prayer – deeply meaningful, interactive communication with God.  Here is an article about this.

An important consideration though is that being religious does not mean you can’t suffer depression and anxiety.  Too often religious people feel guilt on top of depression which only aggravates their mental distress.  The brain is an organ like the heart or liver, and can also suffer dysfunction, needing therapy.

Bibliotherapy

One of the forms of bibliotherapy is journaling – writing down your feelings and experiences in journal or diary.  Often putting your thoughts to paper provides opportunity to formulate and express your thoughts, and examine them objectively.  It also provides a gauge of the healing journey, when you can read how far you have come.

Other forms of bibliotherapy are reading or telling stories, or reading and memorising poetry, or reading literature.  Words have the power to create pictures and to change our thought patterns.  Reading the experiences of others can provide inspiration and perspective.  Here is a more expansive discussion of the role of bibliotherapy in mental health:

Light therapy

Our bodies respond to diurnal rhythms which affect all sorts of functions – our hormone levels, body temperature, mental function, energy levels, etc.  Seasonal affective disorder is a form of depression often encountered in parts of the world characterised by short days and long nights in winter.  By exposing people to regular bright light, particularly in the morning, and even better when combined with exercise, mental health benefits are obtained.  It is even helpful in preventing dementia and Alzheimer’s disease.

Here is an article that expounds the value of light therapy in managing depression: . Note that evenings are not a good time to be exposed to bright light, as that can aggravate insomnia.

Positive relationships and social support

Here is a very readable article written by a psychiatrist on the benefits of loving relationships and their effect on mental health.

The rates of suicide and depression rise significantly during the Christmas holiday season as so many people feel isolated from family and former friends due to death or separation or physical incapacity.  It is easy to slip into self-pity and blame others for our isolation.  The good news is that we can initiate positive relationships as well.  It may be by joining service organisations involved in providing soup kitchens, or meals on wheels; it could be by making eye contact with the cashier at the supermarket and making a positive comment about her attitude or identifying with the stresses she is enduring.  Making someone else smile or feel special has a wonderful return upon one’s own sense of self-worth and happiness.

Ben Carson, famous brain surgeon is quoted as saying:  “Happiness doesn’t result from what we get, but from what we give.”   Brian Tracy said: “Love only grows by sharing. You can only have more for yourself by giving it away to others.”

This will be the last blog of this year, as I will be away in Norway for an extended “White Christmas” with family.   May you experience the gift of sharing love and friendship during this season, and find inner peace and joy in the greatest gift ever given – the One who created Love.

Dave Glass

Dr David Glass graduated from UCT in 1975.  He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital. 

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world.  He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work.  He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle – obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing.  He is active in community health outreach and deeply involved in church activities.  He enjoys teaching and sharing information.

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