Lifestyle changes -- such as getting more exercise, time in nature, or helping others -- can be as effective as drugs or counseling to treat an array of mental illnesses, according to a new paper published by the American Psychological Association.

Multiple mental health conditions, including depression and anxiety, can be treated with certain lifestyle changes as successfully as diseases such as diabetes and obesity, according to Roger Walsh, M.D., PhD. of the University of California, Irvine's College of Medicine. Walsh reviewed research on the effects of what he calls "therapeutic lifestyle changes," or TLCs, including exercise, nutrition and diet, relationships, recreation, relaxation and stress management, religious or spiritual involvement, spending time in nature, and service to others. His paper was published in American Psychologist, APA's flagship journal.

Walsh reviewed research on TLCs' effectiveness and advantages, as well as the psychological costs of spending too much time in front of the TV or computer screen, not getting outdoors enough, and becoming socially isolated. He concludes that "Lifestyle changes can offer significant therapeutic advantages for patients, therapists, and societies, yet are insufficiently appreciated, taught or utilized," The paper describes TLCs as effective, inexpensive and often enjoyable, with fewer side effects and complications than medications. "In the 21st century, therapeutic lifestyles may need to be a central focus of mental, medical and public health," Walsh said.

According to research reviewed in the paper, the many often unrecognized TLC benefits include:

• Exercise not only helps people feel better by reducing anxiety and depression. It can help children do better in school, improve cognitive performance in adults, reduce age-related memory loss in the elderly, and increase new neuron formation in the brain.
• Diets rich in vegetables, fruits and fish may help school performance in children, maintain cognitive functions in adults, as well as reduce symptoms in affective and schizophrenic disorders.
• Spending time in nature can promote cognitive functions and overall well-being.
• Good relationships can reduce health risks ranging from the common cold to strokes as well as multiple mental illnesses, and can enhance psychological well-being dramatically.
• Recreation and fun can reduce defensiveness and foster social skills.
• Relaxation and stress management can treat a variety of anxiety, insomnia, and panic disorders.
• Meditation has many benefits. It can improve empathy, sensitivity and emotional stability, reduce stress and burnout, and enhance cognitive function and even brain size.
• Religious and spiritual involvement that focuses on love and forgiveness can reduce anxiety, depression and substance abuse, and foster well-being.
• Contribution and service, or altruism, can enhance joy and generosity by producing a "helper's high." Altruism also benefits both physical and mental health, and perhaps even extends lifespan. A major exception the paper notes is "caretaker burnout experienced by overwhelmed family members caring for a demented spouse or parent."

Difficulties associated with using TLCs are the sustained effort they require, and "a passive expectation that healing comes from an outside authority or a pill," according to Walsh. He also noted that people today must contend with a daily barrage of psychologically sophisticated advertisements promoting unhealthy lifestyle behaviors such as smoking, drinking alcohol, and eating fast food. "You can never get enough of what you don't really want, but you can certainly ruin your life and health trying" lamented Walsh.

For therapists, the study recommends learning more about the benefits of TLCs, and devoting more time to foster patients' TLCs.

The paper recognizes that encouraging widespread adoption of therapeutic lifestyles by the public is likely to require wide-scale measures encompassing educational, mental, and public health systems, as well as political leadership.

For more information on the American Psychological Association, visit www.apa.org