These everyday practices could boost mentees’ mental health

Kazdin, A. (2023). Interventions in Everyday Life to Improve Mental Health and Reduce Symptoms of Psychiatric Disorders. American Psychologist, Vol. 79, No. 2, 185–209. ISSN: 0003-066X https://doi.org/10.1037/amp0001158

by Jean Rhodes

In a recent study, Yale psychology professor Alan Kazdin (2023) highlighted the global mental health crisis and the fact that most people do not receive interventions. Indeed despite advances in evidence-based treatments, barriers such as cost, stigma, and lack of access impede treatment their use. To address this gap, he proposed integrating interventions from everyday life as an addition to traditional mental health services to improve accessibility, scalability, and reach.

His review criteria for identifying suitable everyday interventions, including:

  • evidence-based
  • available in everyday life
  • scalable
  • reaching marginalized groups
  • free from system and attitudinal barriers
  • offering variations
  • being acceptable to consumers.

Three key examples were discussed: physical activity, contact with nature, and yoga, drawing from research evidence and meta-analyses.

Physical activity has been shown to reduce symptoms of various mental disorders, including anxiety, depression, and cognitive impairment, across age groups (Chen et al., 2022; Fernández-Abascal et al., 2021; Morres et al., 2019; Pearce et al., 2022).Of the everyday interventions showing promise for youth mental health, physical exercise has perhaps the most extensive evidence base. Scores of studies have demonstrated exercise’s efficacy in reducing symptoms of anxiety, depression, ADHD, trauma, eating disorders and more across the lifespan. A recent meta-analysis published in JAMA Psychiatry found that among adults with clinical depression, engaging in physical activity could reduce prevalence of the disorder by an estimated 11.5%. And these benefits kicked in at levels of exercise well below public health recommendations, suggesting that even small “doses” of activity can be psychologically protective.

Contact with nature has been associated with improved mood, well-being, and reduced rumination, depression, and anxiety (Bratman et al., 2019; Engemann et al., 2019; Pouso et al., 2021).

Yoga has demonstrated benefits for depressive symptoms, subjective well-being, cognitive functioning, and stress reduction in individuals with mental disorders (Brinsley et al., 2021; Cramer et al., 2016; National Library of Medicine, 2022).

He points out that these are just some examples, and there are many others (e.g., sleep)

Overcoming Barriers to Implementation

While the research supporting everyday activities like yoga, nature exposure, and exercise is compelling, significant barriers exist to implementing these practices with youth facing mental health challenges.

“For kids dealing with poverty, community violence, unstable home environments or other chronic stressors, getting outside to exercise or visit a park may not be a priority or even feel safe,” notes Tara Mehta, a community psychologist who studies nature’s impact on adolescent well-being.

Mehta and other experts emphasize the need for systemic changes to make these interventions truly accessible. Investing in green spaces and recreational facilities in under-resourced neighborhoods, subsidizing fitness and outdoor education programs, and increasing training for mentors are key first steps.

There are also concerns about the generalizability of existing research. “Most of the studies on yoga, nature exposure and exercise have been done with relatively privileged populations,” says Kazdin. “We need more work looking at whether and how the benefits translate across diverse racial, ethnic and socioeconomic backgrounds.”

Implications for mentoring programs

Despite the caveats, the potential upside of prioritizing these everyday activities is tremendous. In the context of scarce mental health resources and skyrocketing demand, simple, low-cost interventions that can be easily implemented by mentors and community leaders could be game-changing.

“We’re facing a crisis that will require rethinking how we approach youth mental health promotion and treatment,” reflects Kazdin. “The beauty of these everyday practices is that they’re available to anyone, they’re affordable, and they can be tailored to the unique needs and cultures of different communities.”

This work highlights the potential of integrating everyday interventions into mentoring relationships to improve accessibility and reach, particularly for marginalized groups. Mentors and other paraprofessionals working with youth experiencing distress could incorporate these interventions into their bonds, engaging in physical activity, taking walks, and even engaging in yoga practices. They could even use technology-enabled mentoring platforms, such as MentorPRO to set goals, track young adults’ challenges and engagement in these activities and provide “supportive accountability” between meetings. However, these interventions should fit the needs, desires, and circumstances of the mentees, and should not replace evidence-based treatments for severe mental disorders. Collaboration with supervisors is essential.

References

Bratman, G. N., Anderson, C. B., Berman, M. G., Cochran, B., de Vries, S., Flanders, J., Folke, C., Frumkin, H., Gross, J. J., Hartig, T., Kahn, P. H., Jr., Kuo, M., Lawler, J. J., Levin, P. S., Lindahl, T., Meyer-Lindenberg, A., Mitchell, R., Ouyang, Z., Roe, J., & Daily, G. C. (2019). Nature and mental health: An ecosystem service perspective. Science Advances, 5(7), Article aax0903. https://doi.org/10.1126/sciadv.aax0903

Brinsley, J., Schuch, F., Lederman, O., Girard, D., Smits, J., Wigal, T. L., Berry, R. B., Rosenfield, D., Wagner, J., Aiken, C., Dunlop, B. W., Goldin, P., Hauser, J., Zamora, D., Corey-Bloom, J., Dindo, L., & Neylan, T. C. (2021). Mindfulness-based cognitive therapy for mental health professionals treating veterans with PTSD: A non-randomized study of acceptability, health benefits, and mechanisms. Complementary Therapies in Medicine, 56, Article 102622. https://doi.org/10.1016/j.ctim.2020.102622

Chen, P. J., Chen, K. M., Hsu, H. F., & Belcastro, F. (2022). Types of exercise and training duration on depressive symptoms among older adults in long-term care facilities. Ageing Research Reviews, 77, Article 101613. https://doi.org/10.1016/j.arr.2022.101613

Cramer, H., Lauche, R., Langhorst, J., & Dobos, G. (2016). Is one yoga style better than another? A systematic review of associations of yoga style and conclusions in randomized yoga trials. Complementary Therapies in Medicine, 25, 178–187. https://doi.org/10.1016/j.ctim.2016.02.015

Engemann, K., Pedersen, C. B., Arge, L., Tsirogiannis, C., Mortensen, P. B., & Svenning, J. C. (2019). Residential green space in childhood is associated with lower risk of psychiatric disorders from adolescence into adulthood. Proceedings of the National Academy of Sciences of the United States of America, 116(11), 5188–5193. https://doi.org/10.1073/pnas.1807504116

Fernández-Abascal, B., Suárez-Pinilla, P., Cobo-Corrales, C., Crespo-Facorro, B., & Suárez-Pinilla, M. (2021). In- and outpatient lifestyle interventions on diet and exercise and their effect on physical and psychological health: A systematic review and meta-analysis of randomised controlled trials in patients with schizophrenia spectrum disorders and first episode of psychosis. Neuroscience and Biobehavioral Reviews, 125, 535–568. https://doi.org/10.1016/j.neubiorev.2021.01.005

Kazdin, A. E. (2023). Interventions in everyday life to improve mental health and reduce symptoms of psychiatric disorders. Advance online publication. https://doi.org/10.1037/amp0001119

Morres, I. D., Hatzigeorgiadis, A., Stathi, A., Comoutos, N., Arpin-Cribbie, C., Krommidas, C., & Theodorakis, Y. (2019). Aerobic exercise for adult patients with major depressive disorder in mental health services: A systematic review and meta-analysis. Depression and Anxiety, 36(1), 39–53. https://doi.org/10.1002/da.22842

National Library of Medicine, National Center for Biotechnology Information. (2022). Meta-analysis, review, systematic review, in the last 5 years. National Institute of Health, U.S. Department of Health and Human Services.

Pearce, M., Garcia, L., Abbas, A., Strain, T., Schuch, F. B., Golubic, R., Kelly, P., Khan, S., Utukuri, M., Laird, Y., Mok, A., Smith, A., Tainio, M., Brage, S., & Woodcock, J. (2022). Association between physical activity and risk of depression: A systematic review and meta-analysis. JAMA Psychiatry, 79(6), 550–559. https://doi.org/10.1001/jamapsychiatry.2022.0609

Pouso, S., Borja, Á., Fleming, L. E., Gómez-Baggethun, E., White, M. P., & Uyarra, M. C. (2021). Contact with blue-green spaces during the COVID-19 pandemic lockdown beneficial for mental health. Science of the Total Environment, 756, Article 143984. https://doi.org/10.1016/j.scitotenv.2020.143984

The Power of Physical Activity
Of the everyday interventions showing promise for youth mental health, physical exercise has perhaps the most extensive evidence base. Scores of studies have demonstrated exercise’s efficacy in reducing symptoms of anxiety, depression, ADHD, trauma, eating disorders and more across the lifespan.

A recent meta-analysis published in JAMA Psychiatry found that among adults with clinical depression, engaging in physical activity could reduce prevalence of the disorder by an estimated 11.5%. And these benefits kicked in at levels of exercise well below public health recommendations, suggesting that even small “doses” of activity can be psychologically protective.

“For kids dealing with stress, anxiety, or depressive symptoms, exercise can be incredibly therapeutic,” says Jacqueline Gollan, a professor of psychiatry at Northwestern University. “It increases neuroplasticity, releases mood-boosting neurotransmitters, and provides a healthy outlet for difficult emotions and energy.”

Gollan stresses that the type of exercise doesn’t seem to matter as much as finding an enjoyable movement practice that can be sustained. “The key is making it a habit and lifestyle change rather than just a short-term intervention,” she says. “That’s when you see the biggest mental health payoffs.”

For mentors, the options for engaging youth in physical activity are virtually limitless – from dance classes, to hiking clubs, to simple games of basketball or frisbee in the park. Structured “exergaming” programs that blend exercise with video games have also shown promise in motivating sedentary youth. The most important factor is creating an environment where physical activity is normalized, celebrated, and made accessible regardless of income level or ability.

Overcoming Barriers to Implementation
While the research supporting everyday activities like yoga, nature exposure, and exercise is compelling, significant barriers exist to implementing these practices with youth facing mental health challenges.

“For kids dealing with poverty, community violence, unstable home environments or other chronic stressors, getting outside to exercise or visit a park may not be a priority or even feel safe,” notes Tara Mehta, a community psychologist who studies nature’s impact on adolescent well-being.

Mehta and other experts emphasize the need for systemic changes to make these interventions truly accessible. Investing in green spaces and recreational facilities in under-resourced neighborhoods, subsidizing fitness and outdoor education programs, and increasing training for mentors are key first steps.

There are also concerns about the generalizability of existing research. “Most of the studies on yoga, nature exposure and exercise have been done with relatively privileged populations,” says Kazdin. “We need more work looking at whether and how the benefits translate across diverse racial, ethnic and socioeconomic backgrounds.”

Despite the caveats, the potential upside of prioritizing these everyday activities is tremendous. In an era of scarce mental health resources and skyrocketing demand, simple, low-cost interventions that can be easily implemented by mentors and community leaders could be game-changing.

“We’re facing a crisis that will require rethinking how we approach youth mental health promotion and treatment,” reflects Kazdin. “The beauty of these everyday practices is that they’re available to anyone, they’re affordable, and they can be tailored to the unique needs and cultures of different communities.”

As the youth mental health epidemic rages on, it’s time we looked to solutions that have been hiding in plain sight all along – in the parks, yoga studios, and playgrounds that surround us every day. The path forward may be surprisingly simple.

Citations:
[1] https://ppl-ai-file-upload.s3.amazonaws.com/web/direct-files/9592508/5120003d-00b2-4a7a-8540-9e3e6f8be85f/Kazdin.pdf
[2] https://www.frontiersin.org/articles/10.3389/fnhum.2023.1239411/full
[3] https://www.cambridge.org/core/journals/bjpsych-advances/article/yoga-and-mental-health-what-every-psychiatrist-needs-to-know/D1B28ED8D55B6B01385A7416B34DE6F1
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[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9902068/
[9] https://www.psychiatry.org/news-room/apa-blogs/yoga-as-a-mental-health-treatment
[10] https://www.mcleanhospital.org/essential/nature
[11] https://www.betterhealth.vic.gov.au/health/healthyliving/exercise-and-mental-health
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[13] https://mhanational.org/surroundings/outdoors-nature
[14] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9819335/
[15] https://www.mentalhealth.org.uk/explore-mental-health/publications/how-look-after-your-mental-health-using-exercise
[16] https://www.apa.org/monitor/2020/04/nurtured-nature
[17] https://www.nrpa.org/globalassets/research/mentoring-in-parks-and-recreation-strategies-to-engage-families-and-caregivers.pdf
[18] https://health.gov/news/202112/physical-activity-good-mind-and-body
[19] https://www.health.harvard.edu/staying-healthy/yoga-for-better-mental-health
[20] https://www.mind.org.uk/information-support/tips-for-everyday-living/nature-and-mental-health/how-nature-benefits-mental-health/