Delilah Harounian, MA
Doctoral Student, Clinical Psychology (Health Emphasis)
Psychology of Obesity Lab
Ferkauf Graduate School of Psychology
Yeshiva University – Albert Einstein College of Medicine
Lifestyle Medicine and Health Psychology are two fields that are centered on health behavior change and chronic illness. As such, they share several overlapping principles. Lifestyle Medicine is a growing field guided by six pillars: nutrition, physical activity, sleep, social connection, stress management, and reduction of substance use. The discipline focuses on the role of these key health behaviors for the prevention, treatment, and/or reversal of many chronic health conditions and optimization of overall health (Morton et al., 2018). Unhealthy lifestyle behaviors are a driving force for chronic diseases, high healthcare costs and poor health outcomes (Merlo & Vela, 2021). Modifying these behaviors has promising implications for individual health and well-being. In Health Psychology, while the role that psychology plays in health behavior change has been emphasized (Fisher et al., 2011; Firth et al., 2020), collaborating with the field of Lifestyle Medicine has the potential to provide even more collaborative, comprehensive patient care.
Mounting evidence underscores the positive impact of lifestyle-based strategies on mental-health and emotional well-being (Walsh, 2011; Morton et al., 2018; Manger et al., 2019; Piotrowski et al., 2021). A 2020 systematic meta-review of “Lifestyle Psychiatry” – a field closely tied with Lifestyle Medicine that addresses psychiatric disorders using lifestyle-based interventions – highlights that physical activity helps prevent and treat a variety of mental disorders and that poor sleep is a risk factor for mental illness. The positive association between nutrition and mental health disorders, for instance, has been investigated for a decade in the context of psychiatry and anxiety and depression and supported with extensive evidence (Kris-Etherton et al., 2021). However, further research is required to elucidate a clear causal relationship between diet and mental health in order to inform evidence based treatments (Firth et al., 2020; Merlo & Vela, 2021).
More broadly, despite the vast evidence in favor of lifestyle-based mental health interventions, there is a history of complex barriers and resistance among health professionals and organizations toward their wide-spread implementation into the mental healthcare system (Walsh, 2011; Fisher et al., 2011; Richardson et al., 2024). Despite the extensive documentation of links between diet and psychological health, for example, there is a lack of acceptance and incorporation of this knowledge into comprehensive mental health treatment (Kris-Etherton et al., 2021). Organizations such as the American College of Lifestyle Medicine (ACLM) set out to advance care but may not always consider the role that psychologists can play. This likely stems from medical professionals’ adherence to the traditional biomedical model which typically separates mental and physical health, in contrast with the biopsychosocial model. Utilizing the biopsychosocial model to target health behaviors as a component of care is often underemphasized in medical school, and thus the approach is underutilized in the healthcare system delivery (Fallows, 2023). Resulting barriers include a lack of education and training in prescribing lifestyle interventions and a lack of programs dedicated to facilitation of lifestyle change (Richardson et al., 2024).
To help shift these perspectives, the Mental and Behavioral Health Member Interest Group (MIG) was formed within ACLM to address and advocate for the intersection between mental health and lifestyle (Abascal et al., 2022). Moreover, some recent Lifestyle Medicine publications have included mental and behavioral health considerations (Merlo & Vela, 2021), but additional publications are needed. These changes reflect the ongoing paradigm shift in the field of medicine, which increasingly acknowledges and adopts a holistic and biopsychosocial model of health (Suls et al., 2010; Abascal et al., 2022; Fallows, 2023). This profound shift has opened the door to discussions about ways in which Lifestyle Medicine and Health Psychology interventions overlap and can be integrated to deliver robust mental health treatment, alongside pharmacological approaches (Richardson et al., 2024).
As students and professionals interested in or working within the Health Psychology field, we understand the need for a biopsychosocial approach to mental healthcare. Health Psychologists already prioritize the role of health behaviors including sleep, stress management, physical activity, social connections, nutrition, and substance misuse in psychological health and well-being. Within the medical realm, in order to help patients implement behavior change and develop the skills necessary to address, modify, and promote health behaviors (e.g. restful sleep and improved diet), it is vital to address poor mental health or additional psychological concerns that present barriers to lasting change (Abascal et al., 2022). If integrated into Lifestyle Medicine clinical teams, Health Psychologists can provide the necessary service of identifying psychological barriers to health behavior and lifestyle changes that medical professionals may or cannot dedicate their entire focus to, whether due to lack of bandwidth or specific education and training (Richardson, et al., 2024). Such psychological barriers include low mood, reduced social support, amotivation, sedentary behavior, higher rates of sleep disturbance, and poor diet quality. (Richardson et al., 2024). Health psychologists can employ behavioral interventions that target high-risk behaviors to help prevent disease progression, as well as interventions that emphasize adherence, coping, and stress management to enhance disease management and quality of life (Fisher et al., 2011). In tandem, the integration of both disciplines can pave the way for improved treatment effectiveness, health outcomes, and healthcare costs.
Although there currently remains a lack of representation of psychologists in the Lifestyle Medicine space, health psychologists, in particular, can and must make significant steps toward facilitating this integration to advance collaborative, holistic, and comprehensive patient care (Manger et al., 2019; Merlo & Vela, 2021). This will not only be foundational for informing individualized interventions for treating physical and/or mental health issues, but also ideally be used as a preventative approach for modifying a patient’s health behaviors prior to the onset of health disorders (Morton et al., 2018).
Introducing the Health Psychology in Lifestyle Medicine (HPLM) Interest Group
To organize and establish a voice for psychologists within the Lifestyle Medicine space, myself and fellow SfHP Division 38 members have come together to form the new SfHP interest group: Health Psychology in Lifestyle Medicine (HPLM). This group seeks to promote awareness and collaboration between Health Psychology and Lifestyle Medicine disciplines. The group aims to promote career development opportunities such as obtaining board certification in Lifestyle Medicine through the American Board of Lifestyle Medicine (ABLM) and/or certification in Nutritional Psychology through the Center for Nutritional Psychology (CNP). Additionally, we aim to develop strategies to integrate Lifestyle Medicine knowledge into clinical practice, and promote training within sub-interest groups including Nutrition, Physical Activity, Sleep, Social Connection, Stress Management, and Substance Use.
As our understanding of the intersection between psychological health and health behaviors deepens, it becomes increasingly clear that a robust, integrated approach to mental and physical healthcare is crucial for improving patient care and health outcomes. We invite you to join us in navigating these very exciting developments in Clinical Health Psychology. For more information on the Health Psychology in Lifestyle Medicine Interest Group, please visit the interest group website here. SfHP members may join the HPLM listserv by filling out the contact form on the website, and selecting “Join a listserv” > “Div38IG-LifestyleMedicine – Lifestyle Medicine Interest Group Forum”.
Delilah Harounian is a Clinical Health Psychology doctoral student specializing in eating disorders and obesity at Ferkauf Graduate School of Psychology.
References
Abascal, L., Vela, A., Sugden, S., Kohlenberg, S., Hirschberg, A., Young, A., Lane, K., & Merlo, G. (2022). Incorporating mental health into lifestyle medicine. American Journal of Lifestyle Medicine, 16(5), 570-576. https://doi.org/10.1177/15598276221084250
Fallows, E.S. (2023). Lifestyle medicine: A cultural shift in medicine that can drive integration of care. Future Healthcare Journal, 10(3), 226-231. https://doi.org/10.7861/fhj.2023-0094
Firth, J., Solmi, M., Wootton, R. E., Vancampfort, D., Schuch, F. B., Hoare, E., Gilbody, S., Torous, J., Teasdale, S. B., Jackson, S. E., Smith, L., Eaton, M., Jacka, F. N., Veronese, N., Marx, W., Ashdown-Franks, G., Siskind, D., Sarris, J., Rosenbaum, S., Carvalho, A. F., … Stubbs, B. (2020). A meta-review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry: Official Journal of the World Psychiatric Association (WPA), 19(3), 360–380. https://doi.org/10.1002/wps.20773
Fisher, E. B., Fitzgibbon M. L., Glasgow R. E., Haire-Joshu, D., Hayman, L. L., Kaplan, R. M., Nanney, M. S., & Ockene, J. K. (2011). Behavior matters. American Journal of Preventive Medicine. 40(5), e15-e30. https://doi-org.elibrary.einsteinmed.edu/10.1016/j.amepre.2010.12.031
Kris-Etherton, P. M., Petersen, K. S., Hibbeln, J. R., Hurley, D., Kolick, V., Peoples, S., Rodriguez, N., & Woodward-Lopez, G. (2021). Nutrition and behavioral health disorders: Depression and anxiety. Nutrition Reviews, 79(3), 247–260. https://doi.org/10.1093/nutrit/nuaa025
Manger S. (2019). Lifestyle interventions for mental health. Australian Journal of General Practice, 48(10), 670–673. https://doi-org.elibrary.einsteinmed.edu/10.31128/AJGP-06-19-4964
Merlo, G., & Vela, A. (2021). Mental health in Lifestyle Medicine: A call to action. American Journal of Lifestyle Medicine, 16(1), 7–20. https://doi-org.elibrary.einsteinmed.edu/10.1177/15598276211013313
Morton, D. P. (2018). Combining lifestyle medicine and positive psychology to improve mental health and emotional well-being. American Journal of Lifestyle Medicine, 12(5), 370-374. https://doi.org/10.1177/1559827618766482
Piotrowski, M. C., Lunsford, J., & Gaynes, B. N. (2021). Lifestyle psychiatry for depression and anxiety: Beyond diet and exercise. Lifestyle Medicine, 2(1), 1-12. https://doi.org/10.1002/lim2.21
Richardson, K., Petukhova, R., Hughes, S., & Jacobson, N. C. (2024). The acceptability of lifestyle medicine for the treatment of mental illness: Perspectives of people with and without lived experience of mental illness. BMC Public Health, 24, 171. https://doi.org/10.1186/s12889-024-17683-y
Suls, J. M., Davidson, K.W., & Kaplan, R. M. (Eds.) (2010). Handbook of Health Psychology and Behavioral Medicine (xv: 608). The Guilford Press.
The Center for Nutritional Psychology. (2024). The Center for Nutritional Psychology. Retrieved from https://www.nutritional-psychology.org/
Walsh, R. (2011). Lifestyle and mental health. American Psychologist, 66(7), 579-592. https://doi.org/10.1037/a0021769