Therapeutic Lifestyle Changes: Impact on Weight, Quality of Life, and Psychiatric Symptoms in Veterans With Mental Illness.

INTRODUCTION: Veterans with mental illness tend to have shorter life spans and suboptimal physical health because of a variety of factors. These factors include poor nutrition, being overweight, and smoking cigarettes. Nonphysical contributors that may affect quality of life are the stigma associated with mental illness, social difficulties, and spiritual crises. Current mental health treatment focuses primarily on the delivery of medication and evidence-based psychotherapies, which may not affect all the above areas of a Veteran's life as they focus primarily on improving psychological symptoms. Clinicians may find greater success using integrative, comprehensive, multifaceted programs to treat these problems spanning the biological, psychological, social, and spiritual domains. These pilot studies test an adjunctive, holistic, behavioral approach to treat mental illness. This pilot work explores the hypotheses that engagement in a greater number of therapeutic lifestyle changes (TLCs) leads to improvement in quality of life, reduction of psychiatric symptoms, and weight loss. MATERIALS AND METHODS: Institutional Review Boards for human subjects at the Veterans Affairs (VA) Greater Los Angeles and Long Beach Healthcare Systems approved pilot study activities at their sites. Pilot Study 1 was a prospective survey study of Veterans with mental illness, who gained weight on an atypical antipsychotic medication regimen, participating in a weight management study. At each session of the 1-year study, researchers asked a convenience sample of 55 Veterans in the treatment arm whether they engaged in each of the eight TLCs: exercise, nutrition/diet, stress management and relaxation, time in nature, relationships, service to others, religious or spiritual involvement, and recreation. Pilot Study 2 applied the TLC behavioral intervention and examined 19 Veterans with mental illness, who attended four classes about TLCs, received individual counseling over 9 weeks, and maintained journals to track TLC practice. Besides weekly journals, researchers also collected prospective data on quality of life, psychiatric symptoms, vitals, and anthropometric measurements. In both studies, investigators tested for main effects of the total number of TLCs practiced and study week using mixed-effects linear models with independent intercepts by participant. RESULTS: In Study 1, engagement in more TLC behaviors was significantly associated with higher ratings of quality of life, as well as greater weight loss for each additional type of TLC practiced. In Study 2, TLC practice increased significantly over 9 weeks, and was significantly associated with improvements in quality of life and diastolic blood pressure. CONCLUSION: Counseling Veterans to practice TLCs provides a holistic adjunct to current treatments for mental illness. TLCs may confer multiple benefits upon Veterans with mental illness, enhancing quality of life and well-being along with weight management efforts. As these were pilot studies, the samples sizes were relatively small and a control group was lacking. Our findings may have broader implications supporting a holistic approach in both primary and mental health care settings. Future research will expand this work to address its weaknesses and examine the cost differential between this holistic approach and traditional mental health treatment.

Yoga-Based Classes for Veterans With Severe Mental Illness: Development, Dissemination, and Assessment.

Throughout 8 weeks of yoga-based wellness classes, veterans were assessed for perceived benefits, pain, stress, and biological, psychological, social, and spiritual wellness.

Yoga as an ancillary treatment for neurological and psychiatric disorders: a review.

Yoga is gaining acceptance as an ancillary medical treatment, but there have been few studies evaluating its therapeutic benefits in neurological and major psychiatric conditions. The authors reviewed the literature in English on the efficacy of yoga for these disorders. Only randomized, controlled trials were included, with the exception of the only study of yoga for bipolar disorder, which was observational. Trials were excluded if yoga was not the central component of the intervention. Of seven randomized, controlled trials of yoga in patients with neurological disorders, six found significant, positive effects. Of 13 randomized, controlled trials of yoga in patients with psychiatric disorders, 10 found significant, positive effects. These results, although encouraging, indicate that additional randomized, controlled studies are needed to critically define the benefits of yoga for both neurological and psychiatric disorders.

Effectiveness of yoga therapy as a complementary treatment for major psychiatric disorders: a meta-analysis.

OBJECTIVE: To examine the efficacy of yoga therapy as a complementary treatment for psychiatric disorders such as schizophrenia, depression, anxiety, and posttraumatic stress disorder (PTSD). DATA SOURCES: Eligible trials were identified by a literature search of PubMed/MEDLINE, Cochrane Control Trials Register, Google Scholar, and EBSCO on the basis of criteria of acceptable quality and relevance. The search was performed using the following terms: yoga for schizophrenia, yoga for depression, yoga for anxiety, yoga for PTSD, yoga therapy, yoga for psychiatric disorders, complementary treatment, and efficacy of yoga therapy. Trials both unpublished and published with no limitation placed on year of publication were included; however, the oldest article included in the final meta-analysis was published in 2000. STUDY SELECTION: All available randomized, controlled trials of yoga for the treatment of mental illness were reviewed, and 10 studies were eligible for inclusion. As very few randomized, controlled studies have examined yoga for mental illness, this meta-analysis includes studies with participants who were diagnosed with mental illness, as well as studies with participants who were not diagnosed with mental illness but reported symptoms of mental illness. Trials were excluded due to the following: (1) insufficient information, (2) inadequate statistical analysis, (3) yoga was not the central component of the intervention, (4) subjects were not diagnosed with or did not report experiencing symptoms of one of the psychiatric disorders of interest (ie, schizophrenia, depression, anxiety, and PTSD), (5) study was not reported in English, and (6) study did not include a control group. DATA EXTRACTION: Data were extracted on participant diagnosis, inclusion criteria, treatment and control groups, duration of intervention, and results (pre-post mean and standard deviations, t values, and f values). Number, age, and sex ratio of participants were also obtained when available. DATA SYNTHESIS: The combined analysis of all 10 studies provided a pooled effect size of -3.25 (95% CI, -5.36 to -1.14; P = .002), indicating that yoga-based interventions have a statistically significant effect as an adjunct treatment for major psychiatric disorders. Findings in support of alternative and complementary interventions may especially be an aid in the treatment of disorders for which current treatments are found to be inadequate or to carry severe liabilities. CONCLUSIONS: As current psychopharmacologic interventions for severe mental illness are associated with increased risk of weight gain as well as other metabolic side effects that increase patients' risk for cardiovascular disease, yoga may be an effective, far less toxic adjunct treatment option for severe mental illness.