Meta-analytic studies provide more fine-grained details about the cognitive benefits of exercise for the elderly and offer four kinds of good news. First, the effects can be large, reducing the risk of Alzheimer’s disease by 45% and increasing cognitive performance by 0.5 SD . Second, though women may gain more than men, everyone seems to benefit, including both clinical and nonclinical populations. Third, improvements extend over several kinds of psychological functions, ranging from processing speed to executive functions. Fourth, executive functions, such as coordination and planning, appear to benefit most, a welcome finding given that executive functions are so important, and that both they and the brain areas that underlie them are particularly age sensitive . Finally, meta-analyses reveal the specific elements of exercise that benefit cognition. Relatively short programs of one to three months in length offer significant benefits, though programs of six months or longer are more beneficial. There seems to be a threshold effect for session duration,vertical greenhouse because sessions shorter than 30 minutes—while valuable for physical health—yield minimal cognitive gains. Cognitive benefits are enhanced by more strenuous activity and by combining strength training with aerobics .
In short, research validates the words of the second U.S. president, John Adams, who wrote, “Old minds are like old horses; you must exercise them if you wish to keep them in working order” . Fortunately, even brief counseling can motivate many patients to exercise , and the risks are minimal, although an initial medical exam may be warranted. Yet despite the many mental and medical benefits of exercise, only some 10% of mental health professionals recommend it. And who are these 10%? Not surprisingly, they are likely to exercise themselves .Growing evidence suggests that food supplements offer valuable prophylactic and therapeutic benefits for mental health. Research is particularly being directed to Vitamin D, folic acid, SAME , and—most of all—fish oil . Fish and fish oil are especially important for mental health. They supply essential omega-3 fatty acids, especially EPA and DHA , which are essential to neural function. Systemically, omega-3s are anti-inflammatory, counteract the pro-inflamatory effects of omega-6 fatty acids, and are protective of multiple body systems. Unfortunately, modern diets are often high in omega-6s and deficient in omega-3s . Is this dietary deficiency associated with psychopathology? Both epidemiological and clinical evidence suggest that it is. Affective disorders have been the ones most closely studied, and epidemiological studies, both within and between countries, suggest that lower fish consumption is associated with significantly, sometimes dramatically, higher prevalence rates of these disorders .
Likewise, lower omega-3 levels in tissue are correlated with greater symptom severity in both affective and schizophrenic disorders, a finding consistent with emerging evidence that inflammation may play a role in these disorders . However, epidemiological studies of dementia and omega-3 fatty acid intake are as yet inconclusive . Epidemiological, cross-sectional, and clinical studies suggest that omega-3 fatty acid supplementation may be therapeutic for several disorders. Again, depression has been the disorder most closely studied . Several meta-analyses suggest that supplementation may be effective for unipolar, bipolar, and perinatal depressive disorders as an adjunctive, and perhaps even as a stand-alone, treatment , although at this stage, supplementation is probably best used adjunctively. Questions remain about optimal DHA and EPA doses and ratios, although one meta-analysis found a significant correlation between dose and treatment effect, and a dose of 1,000 mg of EPA daily is often mentioned, which requires several fish oil capsules . There are also cognitive benefits of supplementation. In infants, both maternal intake and feeding formula supplementation enhance children’s subsequent cognitive performance . In older adults, fish and fish oil supplements appear to reduce cognitive decline but do not seem effective in treating Alzheimer’s disease . The evidence on omega-3s for the treatment of other disorders is promising but less conclusive. Supplementation may benefit those with schizophrenia and Huntington’s disease as well as those exhibiting aggression in both normal and prison populations. In children, omega-3s may reduce aggression and symptoms of attention-deficit/hyperactivity disorder .
A particularly important finding is that fish oils may prevent progression to first episode psychosis in high-risk youth. A randomized, double-blind, placebo-controlled study was conducted of 81 youths between 13 and 25 years of age who had subthreshold psychosis. Administering fish oil with 1.2 g of omega-3s once per day for 12 weeks reduced both positive and negative symptoms as well as the risk of progression to full psychosis. This risk was 27.5% in controls but fell to only 4.9% in treated subjects. Particularly important was the finding that benefits persisted during the nine months of follow-up after treatment cessa-tion . Such persistence has not occurred with antipsychotic medications, which also have significantly more side effects. Although coming from only a single study, these findings suggest another important prophylactic benefit of fish oils. With one exception, risks of fish oil supplementation at recommended doses are minimal and usually limited to mild gastrointestinal symptoms. The exception occurs in patients on anticoagulants or with bleeding disorders, because fish oils can slow blood clotting. Such patients should therefore be monitored by a physician. Omega-3s modify genetic expression and as such are early exemplars of a possible new field of “psychonutrigenomics.” Because genetic expression is proving more modifiable, and nutrients more psychologically important than previously thought, psychonutrigenomics could become an important field. Space limitations allow only brief mention of another significant supplement, Vitamin D. Vitamin D is a multipurpose hormone with multiple neural functions, including neurotrophic, antioxidant, and anti-inflammatory effects . Vitamin D deficiency is widespread throughout the population, especially in the elderly, and exacts a significant medical toll; several studies suggest associations with cognitive impairment, depression, bipolar disorder, and schizophrenia.
Mental health professionals are therefore beginning to join physicians in recommending routine supplementation and, where indicated, testing patients’ Vitamin D blood levels and modifying supplement levels accordingly . There are further benefits to supplementation and pescovegetarian diets. First, they have multiple general health benefits and low side effects. Second, they may ameliorate certain comorbid disorders—such as obesity, diabetes,vertical grow towers and cardiovascular complications—that can accompany some mental illnesses and medications. A diet that is good for the brain is good for the body. As such, dietary assessment and recommendations are appropriate and important elements of mental health care.We have barely begun to research the many implications of artificial environments, new media, hyperreality, and our divorce from nature. However, the problems they may pose can be viewed in multiple ways. Biologically, we may be adapted to natural living systems and to seek them out. This is the biophilia hypothesis, and multiple new fields—such as diverse schools of ecology, as well as evolutionary, environmental, and eco- psychologies—argue for an intimate and inescapable link between mental health and the natural environment . In existential terms, the concern is that “modern man— by cutting himself off from nature has cut himself off from the roots of his own Being” , thereby producing an existential and clinical condition generically described as nature-deficit disorder . Clinicians harbor multiple concerns. Evolutionary and developmental perspectives suggest that children in environments far different from the natural settings in which we evolved, and to which we adapted, may suffer developmental disorders, with ADHD being one possible example . Likewise, evolutionary theory and cross-cultural research suggest that for adults, artificial environments and lifestyles may impair mental well-being and also foster or exacerbate psychopathologies such as depression .Fortunately, natural settings can enhance both physical and mental health. In normal populations, these enhancements include greater cognitive, attentional, emotional, spiritual, and subjective well-being . Benefits also occur in special populations such as office workers, immigrants, hospital patients, and prisoners . Nature also offers the gift of silence.
Modern cities abound in strident sounds and noise pollution, and the days when Henry Thoreau could write of silence as a “universal refuge . . . a balm to our every chagrin” are long gone. Unfortunately, urban noise can exact significant cognitive, emotional, and psychosomatic tolls. These range, for example, from mere annoyance to attentional difficulties, sleep disturbances, and cardiovascular disease in adults and impaired language acquisition in children . By contrast, natural settings offer silence as well as natural sounds and stimuli that attention restoration theory and research suggest are restorative . As yet, studies of specific psychotherapeutic benefits are limited, and the benefits are sometimes conflated with those of other therapeutic lifestyle factors. Though further research is clearly needed, immersion in nature does appear to reduce symptoms of stress, depression, and ADHD and to foster community benefits . In hospital rooms that offer views of natural settings, patients experience less pain and stress, have better mood and post surgical outcomes, and are able to leave the hospital sooner . Consequently, nature may be “one of our most vital health resources” . Given the global rush of urbanization and technology, the need for mental health professionals to advocate for time in, and preservation of, natural settings will likely become increasingly important.Not surprisingly, good relationships are crucial to psychotherapy. Multiple meta-analyses show that they account for approximately one third of outcome variance, significantly more than does the specific type of therapy , and that “the therapeutic relationship is the cornerstone” of effective therapy . As Irvin Yalom put it, the “paramount task is to build a relationship together that will itself become the agent of change.” Ideally, therapeutic relationships then serve as bridges that enable patients to enhance life relationships with family, friends, and community. The need may be greater than ever, because social isolation may be increasing and exacting significant individual and social costs. For example, considerable evidence suggests that, compared with Americans in previous decades, Americans today are spending less time with family and friends, have fewer intimate friends and confidants, and are less socially involved in civic groups and communities . However, there is debate over, for example, whether Internet social networking exacerbates or compensates for reduced direct interpersonal contact and over the methodology of some social surveys . Yet there is also widespread agreement that “the health risk of social isolation is comparable to the risks of smoking, high blood pressure and obesity…. [while] participation in group life can be like an inoculation against threats to mental and physical health” . Beyond the individual physical and mental health costs of greater social isolation are public health costs. In “perhaps the most discussed social science article of the twentieth century” , and in a subsequent widely read book, Bowling Alone: The Collapse and Revival of American Community, the political scientist Robert Putnam focused on the importance of social capital. Social capital is the sum benefit of the community connections and networks that link people and foster, for example, beneficial social engagement, support, trust, and reciprocity . Social capital seems positively and partly causally related to a wide range of social health measures—such as reduced poverty, crime, and drug abuse—as well as increased physical and mental health in individuals. Yet considerable evidence suggests that social capital in the United States and other societies may have declined significantly in recent decades . In short, relationships are of paramount importance to individual and collective well-being, yet the number and intimacy of relationships seem to be declining. Moreover, “the great majority of individuals seeking therapy have fundamental problems in their relationships” . Clients’ relationships are a major focus of, for example, interpersonal and some psychodynamic psychotherapies . Yet clients’ interpersonal relationships often receive insufficient attention in clinical and training settings compared with intrapersonal and pharmacological factors . Focusing on enhancing the number and quality of clients’ relationships clearly warrants a central place in mental health care.Involvement in enjoyable activities is central to healthy lifestyles, and the word recreation summarizes some of the many benefits . In behavioral terms, many people in psychological distress suffer from low reinforcement rates, and recreation increases reinforcement. Recreation may overlap with, and therefore confer the benefits of, other TLCs such as exercise, time in nature, and social interaction. Recreation can involve play and playfulness, which appear to reduce defensiveness, enhance well-being, and foster social skills and maturation in children and perhaps also in adults . Recreation can also involve humor, which appears to mitigate stress, enhance mood, support immune function and healing, and serve as a mature defense mechanism .