Effectiveness of Fitness Programs over Antidepressants - Assignment Example

Health Psychology: Effectiveness of Fitness Programs over anti-depressants Name Institution Date of submission Abstract This paper discusses Health Psychology as an intervention approach to alleviate depression among individuals in their workplace. The paper begins by comparing the effectiveness of Fitness Programs over anti-depressants interventions before suggesting which of the interventions is the most appropriate to influence changes on the public policy. Besides, the paper explores circumstances under which each of the approaches is effective depending on the patient’s socio-economic groups, culture, age and gender. Finally, the paper identifies which of the two interventions requires advanced clinical expertise to implement. Keywords: Depression; psychological interventions, Health Psychology Introduction Psychologists and organizations have liaised to establish and develop various interventions to facilitate an individual’s wellbeing, positive emotions, fulfillment, creativity, growth, relationships and other outcomes related to positive psychology interventions. Depression is a major health problem that mostly affects adults in their working age (Henderson, and colleagues, 2008). It is a mood disorder associated with loss of interest and feeling of sadness at all times. Depression affects an individual’s way of thinking, feeling and behaviors, and leads to various physical and emotional difficulties. In addition to depression, mental health disorders affect many workers and incapacitate their productivity. However, most organizations only realize the effects of mental health disorders when the individuals are symptomatic or even on sick leaves because they have incorporated appropriate psychology interventions in their health programs (Mykletun and Harve, 2007 ). According to Henderson, and colleagues (2008), mental health and depression disorders are the main factors that cause sickness among workers and contribute to employee absenteeism and poor performance. However, most organizations have ignored depression and mental health of workers in their workplace health programs. Psychologists predict that by 2020, depression might be the major cause of poor job outcomes and work disability. This suggests that, it is essential for organizations to establish evidence-based workplace depression and mental health interventions to assist their employees cope with their daily challenges. Most evidence-based research proposes that, workplaces can prevent most of the mental health challenges and the onset of depression disorders. Conversely, most work-based interventions in use currently only respond when the employee exhibits symptoms of depression and when he/she is on a sick leave. Currently, the consensus on effectiveness of preventive programs and interventions is very regardless of the appeal for positive psychology interventions at the workplace. Effectiveness of Fitness Programs over anti-depressants in Health Psychology Clinical expertise The National Institute for Health and Care Excellence (Nice) has specialized in the provision of depression prevention programs. The institute provides the guidelines of evidence-based psychological treatment to NHS. The Nice recommends that, clinical psychologists should advice their clients to continue using for at least two years to prevent instances of depression relapse. The institute however remarks that psychologists should immediately discontinue anti-depressants and implement cognitive behavioral therapy (CBT) and fitness programs if the client fails to adhere to anti-depressants for more than two years. Besides, the institute advices clinicians to take into account clients’ preferences before deciding the appropriate intervention programs (Cuijpers and Beekman, 2012). Zindel Segal, John Teasdale and Mark Williams are famous psychologists who developed the mindfulness-based cognitive therapy (MBCT) interventions that combine the CBT programs and mindfulness meditation. Clinicians with long-term expertise in health psychology propose that fitness programs, which involve regular physical activities is the optimum way to manage or prevent the onset of depression. The clinicians suggest that fitness programs keep one active and enable him to achieve happiness. Additionally, they are of the view that personal fitness triggers the release of sleep enhancement chemicals in the brain that improve sleeping patterns. Furthermore, frequent exercises reduce negative thoughts, increases personal wellbeing and minimize the feeling of loneliness when individuals exercise in a group of other people (Mykletun and Harve, 2007). Experienced health psychologists recommend that individuals at a greater risk of developing depression should undertake at least a 30 minutes moderate physical activity on each day of the week. The psychologists state that, the exercises will stimulate stress management hormones and improve the production of endorphins and serotonin chemicals in the brain that induce sleep and promote individuals’ wellbeing. However, the psychological benefits associated with fitness and exercise interventions depend on the amount and intense of the exercises. Clinicians therefore recommend the use aerobic exercise line walking and running for at least thirty minutes each day of the day for about eight weeks (Finos and Conti, 2004). Client’s values and Circumstances Different clients require different health psychology interventions depending on the nature and levels of the depression. Individuals still developing or about to develop depression may require different approaches from those with recurrent depression. The National Institute for Health and Care Excellence (NICE) remarks that, individuals with recurrent depression to continue using anti-depressants for at least two years. The recommendation is however exceptional to some patients who are unwilling to take pills for a longer time. Some patients have also raised concerns over recurrent of depression immediately they stopped using the anti-depressant pills. Willem Kuyken, a professor of health psychology at the University of Oxford and colleagues conducted a study to investigate the effectiveness of anti-depressant drugs and fitness programs in alleviating depression. The study exposed participants to mindfulness interventions while the control group was given anti-depressant drugs. Results of the study revealed similar relapse rates of 45% and 47% for the mindfulness intervention group and the anti-depressants group respectively. Additionally, each group had various adverse events that included two deaths. These findings were against the study’s hypothesis that fitness and mindfulness therapy programs are effective to mitigate depression compared to using anti-depressant depressant drugs. Another pilot study done in 2008 suggests that, exercise and mindfulness intervention are superior over anti-depressant treatment depending on the patient’s values and prevailing circumstances (Mykletun, Harvey, 2012). Despite the fact that the study by Willem Kuyken and colleagues shows statistically insignificant difference between fitness and anti-depressant interventions, many psychologists still recommend the use of fitness programs. The fitness program is appropriate for the clients who may be unable to tolerate the side effects associated with the pills and may not continue with the medication. Therefore, the exercise and fitness therapy is effective compared to anti-depressant pills if the client has a higher risk of depression recurrent. According to Mykletun, Harvey, (2012), the use of mindfulness and fitness interventions enables the clients at risk of relapse to learn and avoid the circumstances causing their depression to recur. According to Prof Roger Mulder, exercise or fitness interventions are a group therapy and involve many individuals, which reduce the cost of treatment. On the other hand, anti-depressants aim at a single client who may incur higher costs in the treatment and management of their recurrent depression. Hence, fitness programs are cost effective depression interventions and may be appropriate for clients who may not afford to purchase anti-depressant pills. The intervention is also appropriate for those clients who may be reluctant to take medication daily for longer periods. Finally, fitness programs are effective in circumstances where the client has history of sexual and childhood abuse (National Institute for Health and Clinical Excellence, 2013). Information from the practice context The Lancet medical journal published a trial that involved 424 adults willing to try the fitness therapy or the anti-depressant pills. The trial allotted half of the participants to each intervention randomly. The participants allocated to mindfulness and fitness interventions had at least two-hour eight group sessions and a daily home-based practice. The study included behavior exercises, group discussion and fitness exercises. The control group assigned to anti-depressants continued with the pills for two years. The journal established that there was no statistical difference between the effectiveness of fitness-based interventions and the use of anti-depressant pills (Cuijpers and Beekman, 2012). Prof. Richard Byng from Plymouth University suggests that keeping the course of antidepressant medication is the best treatment that helps individuals to avoid relapse and recurrent of depression to about two-thirds. However, the use of drugs to treat depression results to a large medical burden to the patients. Mood and depression disorders remain to be prevalent irrespective of the widespread use of antidepressant drugs. This implies that the use of a fitness program as an alternative non-medication approach is the best intervention to alleviate recurrent depression among affected patients (Finos and Conti, 2004). Moreover, another study illustrating the effectiveness of exercise and fitness intervention on depression outcomes involved Karen Bedford, a 49-year-old mother of two children. Karen remarks that, regular exercises as directed by her instructor enabled her to recover gradually from her long depression illness. Karen had suffered depression due to mental health problems for almost a decade but the exercise program helped to steadily recover and gain stability of her mental state. According to the study, Karen presented to her GP after developing depression who prescribed to her antidepressants. She remained on the medication for almost a year during which she suffered adverse side effects including stomach upsets. She acknowledged that the antidepressants were not the right solution for her since they sometimes made her feel unwell. During the second year of medication, Karen’s condition improved after which she found employment and even began a relationship. However, her depression relapsed severely three years later following the demise of her boyfriend. Dr. Sandrine Thuret of the Psychiatry department at King's College London argues that, antidepressant drugs are associated with various side effects including excessive sweating and lack of sex drive. Hence, patients exhibiting these side effects should not use the drugs for more than two years. Karen therefore resorted to a fitness exercise class that involved high-energy exercises and music dance after which her condition improved drastically and she has not yet had a relapse of depression. The above studies provide enough evidence that fitness programs have a positive on individuals with mental health problems and demonstrate good outcomes for patients with recurrent depression. Fitness exercises divert negative feelings thoughts because the individuals concentrate on the exercises. Additionally, Dr. Thuret advises that group fitness exercises improves the individual’s social aspect and boosts his/her well-being. However, Lawton-Smith, the chair of policies at Mental Health Foundation advises that individuals on antidepressants must discuss with their doctors before discontinuing the use of the pills (Cuijpers and Beekman, 2012). Finally, Dr. Thuret is of the view that, clinical psychologists must first recommend fitness and exercise programs to their clients and should only prescribe antidepressants when programs fail to work (Finos and Conti, 2004). Research Evidence Evidence-based practice is the main concern in the provision of effective health care in both Australia and other countries. The optimum nursing practice is based on the detailed assessment of evidence from quality research studies. The research studies used must identify clinical interventions minimize the risks of recurrent of depression, maximize the benefits of the proposed treatment and provide the treatment at an affordable cost (Bryant, Smart, and King, 2005). Physicians usually base their treatment recommendation on the grades provided by the NHMRC. The grades depend on the quality, criteria of level, strength and relevance of the evidence. The following tables provide the research evidence from different sources with relevant information health psychology and prevention of recurrent psychology. Table 1: interpersonal Psychotherapy for adults Title Six-Year Outcome of Cognitive Behavior Therapy for The Prevention of Recurrent Depression Authors and journal Finos, L., Conti, S., Fava, G. A., Ruini, C., Rafanelli, C., and Grandi, S. (2004). American Journal of Psychiatry, 161, 1872 –1876. Design RCT of with a 6-year follow up Participants Forty adults with a relapse of major depression who had been treated with antidepressants successfully. interventions Pharmacotherapy and CBT Comparison groups Pharmacotherapy and Clinical management Procedure Researchers allocated to participants ten CBT sessions each lasting 30 minutes. They supplemented each session with well-being and lifestyle modification therapy. They gradually reduced Antidepressant treatment every week and finally withdrew it. The participants then underwent a 6-year period follow up. Findings CBT was more effective than clinical management in alleviating recurrent of depression over during the 6-year period of follow up. Table 2: mindfulness-Based cognitive therapy (MCPT) Title of Study Mindfulness-based cognitive therapy (MCBT): Evaluating current evidence and informing future research Authors and journal Canter, P. H., Coelho, H. F., and Ernst, E. (2007). Journal of Consulting and Clinical Psychology, 75, 1000-1005. Design Systematic review involving 4 studies Participants 2134 adults suffering from depression Intervention MBCT Comparison groups AU Procedure Four of the research studies Four studies met the inclusion criteria ; two studies involved RCTs, one featured a non-randomized trial and the other focused on 1 study based on a subsection of one of the RCTs. Findings There were limited MBCT trials for analysis. two trials showed that MBCT may have an additive advantage to when used to prevent recurrent of depression in patients with a history of depression relapse. Table 3: CBT-based depression treatment for adults Title of Study A randomized controlled trial of cognitive behavior therapy vs. treatment as usual in the treatment of mild to moderate late life depression Authors and journal Jackson, G., Clark, S., Laidlaw, K., Davidson, K., Toner, H., Law, J., et al. (2008). International Journal of Geriatric Psychiatry, 23, 843-850. Design RCT of two groups with a three and six month follow up Participants Forty older adults with a major depressive disorder Interventions CBT comparison groups TAU (general physician controlled physical treatment for depression, including physical review, pharmacotherapy or no treatment. Procedure Participants randomly received either TAU or CBT for late life depression. Each of the participants received at least 8 sessions of the CBT. Findings Both participants experienced a decrease in the in the levels of their depression at the end of six-months follow up. Table 4: Pilot study on effectiveness of MCBT interventions Title of Paper Mindfulness-based cognitive therapy for treatment resistant depression: A pilot study Authors and journal Bitner, R., Fenimore, P., Smit, M., Eisendrath, S. J., Delucchi, K., and McLane, M. (2008). Psychotherapy and Psychosomatics, 77, 319-320. Design Case series ParticiPants 51 adult outpatients with at least two episodes of depression recurrent after successful antidepressant medication treatments Interventions MBCT Comparison groups None Procedure The study implemented 6 MBCT groups with 7-12 participants each. Researchers modified the Standard MBCT to include actively depressed individuals and involved eight sessions with each lasting at least two hours weekly. Findings Participants who participated in MBCT interventions exhibited a considerable decrease in the levels of rumination, depression and anxiety. However, there was no statistically significant difference between the group exposed to CBT and that offered the pharmacotherapy intervention. References National Institute for Health and Clinical Excellence: Workplace health promotion: how to encourage employees to be physically active. In NICE Public Health Guidance 13. London, UK: National Institute for Health and Clinical Excellence; 2008. Harvey SB, Henderson M, Lelliott P, Hotopf M: Mental health and employment: much work still to be done.Br J Psychiatry 2009, 194:201-203. PubMed Abstract | Publisher Full Text Henderson M, Harvey SB, Overland S, Mykletun A, Hotopf M: Work and common psychiatric disorders. Cuijpers P, Beekman AT, Reynolds CF 3rd: Preventing depression: a global priority. JAMA 2012, 307:1033-1034. PubMed. Mykletun A, Harvey SB: Prevention of mental disorders: a new era for workplace mental health. Bernardo, A. B. J. (2010). Extending hope theory: Internal and external locus of trait hope.Personality and Individual Differences, 49, 944-949. Bryant, F. B. (1989). A four-factor model of perceived control: Avoiding, coping, obtaining, and savoring.Journal of Personality, 57, 773-797. Bryant, F. B., Smart, C. M., & King, S. P. (2005). Using the past to enhance the present: Boosting happiness through positive reminiscence. Journal of Happiness Studies, 6, 227- 260 Finos, L., Conti, S., Fava, G. A., Ruini, C., Rafanelli, C., and Grandi, S. (2004). Six-Year Outcome of Cognitive Behavior Therapy for The Prevention of Recurrent Depression American Journal of Psychiatry, 161, 1872 –1876. Read More

Most evidence-based research proposes that workplaces can prevent most of the mental health challenges and the onset of depressive disorders. Conversely, most work-based interventions in use currently only respond when the employee exhibits symptoms of depression and when he/she is on sick leave. Currently, the consensus on the effectiveness of preventive programs and interventions is very regardless of the appeal for positive psychology interventions at the workplace. 

Effectiveness of Fitness Programs over anti-depressants in Health Psychology    

Clinical expertise

The National Institute for Health and Care Excellence (Nice) has specialized in the provision of depression prevention programs. The institute provides the guidelines of evidence-based psychological treatment to the NHS. The Nice recommends that clinical psychologists should advise their clients to continue using for at least two years to prevent instances of depression relapse. The institute however remarks that psychologists should immediately discontinue anti-depressants and implement cognitive behavioral therapy (CBT) and fitness programs if the client fails to adhere to anti-depressants for more than two years. Besides, the institute advises clinicians to take into account clients’ preferences before deciding the appropriate intervention programs (Cuijpers and Beekman, 2012).

Zindel Segal, John Teasdale, and Mark Williams are famous psychologists who developed mindfulness-based cognitive therapy (MBCT) interventions that combine CBT programs and mindfulness meditation.  Clinicians with long-term expertise in health psychology propose that fitness programs, which involve regular physical activities are the optimum way to manage or prevent the onset of depression. The clinicians suggest that fitness programs keep one active and enable him to achieve happiness. Additionally, they are of the view that personal fitness triggers the release of sleep enhancement chemicals in the brain that improve sleeping patterns.  Furthermore, frequent exercises reduce negative thoughts, increases personal wellbeing, and minimize the feeling of loneliness when individuals exercise in a group of other people (Mykletun and Harve, 2007).

Experienced health psychologists recommend that individuals at a greater risk of developing depression should undertake at least 30 minutes of moderate physical activity on each day of the week. The psychologists state that the exercises will stimulate stress management hormones and improve the production of endorphins and serotonin chemicals in the brain that induces sleep and promote individuals’ wellbeing. However, the psychological benefits associated with fitness and exercise interventions depend on the amount and intensity of the exercises. Clinicians, therefore, recommend the use of aerobic exercise like walking and running for at least thirty minutes each day of the day for about eight weeks (Finos and Conti, 2004).

Client’s values and Circumstances

Different clients require different health psychology interventions depending on the nature and levels of the depression.  Individuals still developing or about to develop depression may require different approaches from those with recurrent depression. The National Institute for Health and Care Excellence (NICE) remarks that individuals with recurrent depression to continue using anti-depressants for at least two years. The recommendation is however exceptional to some patients who are unwilling to take pills for a longer time. Some patients have also raised concerns over recurrent depression immediately after they stopped using the anti-depressant pills. 

Willem Kuyken, a professor of health psychology at the University of Oxford, and colleagues conducted a study to investigate the effectiveness of anti-depressant drugs and fitness programs in alleviating depression. The study exposed participants to mindfulness interventions while the control group was given anti-depressant drugs. Results of the study revealed similar relapse rates of 45% and 47% for the mindfulness intervention group and the anti-depressants group respectively.  Additionally, each group had various adverse events that included two deaths.

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