By Dr Felix Naughton, Senior Lecturer
Our physical health behaviours, such as what we eat, how much alcohol we drink or how active we are, can both affect and be affected by our wellbeing and mental health.
Most people would recognise that when they are feeling particularly anxious, down or stressed, their eating and drinking habits can change, or they may feel less motivated to keep on top of their physical health.
But people may be less aware that, vice-versa, their health behaviours can have quite a big impact on their self-esteem in the first place, and that developing healthy habits can improve wellbeing and mental health. Not only that, it can be more effective than some traditional mental illness treatments, like antidepressants.
In this article, Thrive’s Behaviour Change Consultant, Dr Felix Naughton, explores how developing good habits can help to improve your emotional health, and to reduce common mental health problems such as anxiety and depression.
Healthy diet equals healthy mind
We’ve learnt a lot over the last decade about how diet and nutrition can affect mental health. Much of the new research focuses on the ‘brain-gut microbiota axis’ – how the bacteria in the gut interacts with brain health and vice versa.
Studies have found a long list of bacteria (or ‘flora’) that are less common among people with symptoms of depression. These microbes are believed to affect neurotransmitters (chemicals which help different parts of the brain and nervous system to communicate) and the brain and body’s inflammatory response, both of which are linked to depression.
But rather than going straight in to adapt the gut flora, even though there is increasing evidence that some probiotics may be effective, a balanced diet is a better solution for improving mood and your general health. For example, sticking to a Mediterranean diet was found in one review to reduce the risk of depression by 33%.
How regular exercise leads to better mental health
Being physically active, whether that’s taking more steps, gardening, doing more cardio or strength training, all seem to contribute to your psychological wellbeing too. There are many pathways for how being active helps to improve brain function. As with some gut flora, physical activity can reduce inflammation in the body, which is associated with poor mental health states.
There are also endorphins, a naturally produced morphine in the body that blocks pain and produces feelings of pleasure, which is usually released in response to vigorous activity. Many people also report a pleasant experience when exercising – which is most consistent at moderate levels of activity.
Incorporating exercise into your daily habits can also help you to sleep well, which in turn is associated with improved mood and wellbeing (getting enough sleep can also strengthen your immune system and reduce inflammation). The effectiveness of exercise for improving depression is so well established that it is a recommended treatment and is effective even for people with severe depression.
Evidence shows that for people with depression, exercise has a similar effect to antidepressants. Even a single bout of exercise increases hormones that are associated with the antidepressant effect of exercise. One study found that the equivalent of 15 minutes running every day instead of sitting (or one hour of brisk walking if running isn’t your thing), was associated with a 26% reduction in depression risk.
For those who can’t avoid sedentary time, research in Sweden found that mentally active sedentary time, like desk-based office work and surfing the internet, was associated with a lower risk of depression compared to passive sedentary time, like watching the TV. Swapping 30 mins per day of passive for mentally active sedentary time reduced the risk of getting depression by 5%.
Quitting cigarettes can be better than antidepressants for improving mood
Ask any smoker and they will probably report that smoking helps them alleviate mental health issues such as anxiety, stress and feelings of depression. However, experts believe smokers mistake this for relief from the anxiety, stress and low mood caused by tobacco withdrawal.
The net result is that smokers spend more of their life experiencing negative feelings while being left with the belief that smoking is actually associated with good mental health. A review of 26 studies found that quitting smoking is associated with later improvements in depression, anxiety, stress and wellbeing, compared to people who continue to smoke.
The improvements in mood due to quitting smoking were higher than for a common class of antidepressants (SSRIs) and quitting relieved anxiety as well as antidepressants did.
Exactly why quitting smoking improves mental health is not fully understood. Probably the most plausible explanation is that smoking changes the pathways in the brain which are affected by nicotine and tobacco.
Evidence shows that these changes are associated with the feelings of low mood, anxiety and levels of stress observed among smokers during withdrawal. The improvement in mental health happens several weeks after quitting, similar to the time frame of withdrawal.
Other plausible explanations are that nicotine, and potentially other chemicals in tobacco smoke, interact with serotonin, a chemical in the brain associated with mood, and regular smoking may lead to a disruption of how serotonin operates.
The drink-depression link
Unlike with smoking, most people are probably aware that excessive alcohol consumption can lead to depression. Though they may not be familiar with how this happens.
Evidence from a large UK study finds it is drinking intensity, rather than frequency, that explains the effect of drinking on subsequent depression. However, for women, drinking was found often to be a consequence of depression, but for men, drinking was more likely to lead to depression.
As to why drinking might lead to poorer mental health, there are a number of potential factors. One is a social factor, where excessive drinking can damage family, friend and work relationships. From a biological perspective, drinking excessively over time is associated with lower levels of serotonin and other neurotransmitters and can influence hormone levels, which are all involved in mood regulation.
And there are also much shorter-term effects, such as the effect of alcohol on sleep hygiene and quality, which effects mood and mental state.
Behaviour change can address health habits and improve wellbeing
Fortunately, these health behaviours can be changed, and in turn improve mental wellbeing. While some people are able to establish new habits themselves, many struggle to do this without external support. Studies have shown that providing behavioural support and advice through digital media, such as text messages or smartphone apps, can help people to change their behaviour. For example:
- Diet: Evidence shows positive effects of mobile phone based support, although it is weaker than other areas currently
- Physical activity: A review of 21 studies shows mobile interventions can help people reduce sedentary time and very likely increase physical activity, although the impact is modest. Technology-based approaches seem to be as effective as face-to-face or written approaches.
- Alcohol: A recent review of 41 studies found mobile phone based approaches can help people reduce drinking by about 3 units per week on average and seems as effective as face-to-face approaches.
- Smoking: A review of 26 studies provides good evidence that text message-based support can increase quitting, but no evidence yet that smartphone apps are effective.
Health and public services rely more than ever on digital approaches since Covid-19 has reduced face-to-face engagement and routine services have shifted. But this can have a positive side. We can expect to see more effective digital support being developed and made available as services change, and hopefully many will benefit as a result – mentally as well as physically.
If you are searching for mental health support, please refer to the NHS’s online mental health services resource or contact your local GP.
Felix is Senior Lecturer in Health Psychology in the School of Health Sciences at UEA, and Behaviour Change Consultant at Thrive. He has a primary research interest in investigating how technology, particularly mobile phones, can support behaviour change.
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