Lifestyle Psychiatry as First-Line Treatment Highlighted at Psych Congress PA Institute

Key Clinical Summary

• Speakers emphasized lifestyle medicine as foundational, evidence-based interventions for chronic disease and mental health.
• Data demonstrated high relapse rates across depression and bipolar disorder despite optimized therapies, underscoring the need to address root causes.
• Practical strategies such as motivational interviewing, SMART goals, and shared decision-making can enhance adherence and improve clinical outcomes.

At the inaugural Psych Congress PA Institute in Orlando, Florida, faculty presented compelling evidence that lifestyle psychiatry should serve as a first-line treatment in mental health care.

The session, “Lifestyle Psychiatry: The Role of Sleep, Nutrition, and Behavior in Mental Health,” was presented by meeting Co-Chair James Somers, PA-C, DHSc, DFAAPA, and Sheila Hautbois, PA-C, MSPAS, MPH, CHES, DipACLM, FACLM, assistant professor, Shenandoah University.

Lifestyle psychiatry is the application of lifestyle medicine to mental health care. Lifestyle medicine itself is comprised of 6 pillars—nutrition, physical activity, restorative sleep, stress management, social connection, and avoidance of risky substances.

During the session, the speakers positioned lifestyle psychiatry as a clinically necessary intervention for both chronic disease and psychiatric conditions. “We’re talking about the common-sense pieces of lifestyle,” Hautbois emphasized while noting that 59.3 million U.S. adults experience mental illness annually. Only one-third of depression patients achieve remission after first-line pharmacological treatment, and 50% relapse within 2 years. Bipolar disorder relapse rates remain 50–55% within 2 years despite optimized therapies.

Somers emphasized this point, stating that “We are losing the battle in mental health.”

Amid rising chronic disease prevalence—affecting 6 in 10 U.S. adults—and worsening mental health burdens, Somers and Hautbois argued that integrating the pillars of lifestyle medicine into routine psychiatric practice may significantly improve patient outcomes. “If we don’t talk about the root causes with our patients, how can we expect medication or psychotherapy to improve them?” Hautbois asked the audience.

The session then focused on the pillars of nutrition, sleep, and physical activity, as many psychiatric PAs are comfortable addressing the other 3 pillars.

Together, the speakers highlighted evidence showing causal links between diet quality, physical activity, sleep, and depression risk. For example, one systematic review showed that exercise demonstrated large antidepressant effects (-0.946, 95% CI -1.18 to -0.71; NNT=2). Dietary interventions showed meaningful reductions in depressive symptoms, independent of weight change, with remission rates up to 32.3% vs 8% in controls in the SMILES trial and a 20.6-point reduction in Beck Depression scores compared to 12.6-point reduction in controls in the AMMEND trial. Improved sleep, particularly through cognitive behavioral therapy for insomnia (CBT-I), was associated with reductions in downstream depression and anxiety.

Hautbois and Somers also stressed the importance of following the patient’s lead when counseling these types of interventions. “We [as clinicians] don’t just tell patients what to do, we work with them to work on pillars of lifestyle medicine,” Hautbois said. “Once they work on one thing, it makes them want to move on to another element.” In practice, this might look like prescribing physical activity in general rather than exercise alone or simply reducing daily soda consumption from 2 beverages to 1.

These choices are made in collaboration with the patient through motivational interviewing and shared decision-making. “Motivational interviewing helps patients find their own reasons for change,” Somers said. He also recommended setting SMART goals together to enhance patient motivation and adherence to lifestyle changes.

Overall, the session underscored that lifestyle medicine is not alternative care but evidence-based, clinically actionable treatment that complements pharmacotherapy and psychotherapy. Targeting root causes of metabolic and behavioral dysregulation has the potential to reduce relapse, enhance medication response, and improve patient engagement. To accomplish this, PAs can easily incorporate brief assessments, SMART goals, and motivational interviewing into routine psychiatric visits.

For more updates from the Psych Congress PA Institute, visit the meeting newsroom.