Dieticians make the best psychotherapists

Dieticians make the best psychotherapists. Maybe so or maybe not. I was hoping the headline would grab attention.

You can file this post under the complaining, groaning, bitching and moaning category. I suspect that all professionals feel that their own profession gets badly treated by the media. I have thought about this in terms of psychotherapy in movies and TV shows and plan to write some things about this in the future. Do you have any suggestions about either good or bad portrayals of psychotherapy?

Today, the case to be examined is an article from March in the Pittsburgh Business Times. It is a little article, just three paragraphs, reporting, I believe, from a press release about some research being done here in Pittsburgh.

Study: Diet discussion as good as talk therapy

The opening sentence of this little three paragraph ditty goes as follows:

Discussions about healthy eating with a dietary professional were as effective as meeting with a counselor in preventing major depression among adults with mild symptoms of the mood disorder, Pitt researchers found.

This sounds rather bad for “counselors”, doesn’t it? In fact, there are some interesting findings in the psychotherapy outcome research that seem counter intuitive. For example, years of experience does not correlate with better outcomes. So maybe this fits into that somehow, no experience being as good as any experience?

There is a problem however. I only discovered this problem by tracking down the press release.

The press release headline reads:

Lifestyle interventions can prevent major depression in adults with mild symptoms

Okay, the headline is not as sensational as the one in the Pittsburgh Business Times. What does it actually say?

The team assessed whether problem-solving therapy for primary care (PST-PC), a scientifically proven seven-step approach delivered by non-mental-health professionals to help patients resolve difficulties and thus improve coping skills and confidence, could prevent elderly adults who have mild symptoms of depression from developing full-blown disease. Instead of comparing the PST-PC participants to those who received “usual care,” which would most likely mean receiving no intervention, the team took the novel approach of comparing the PST-PC group to participants who underwent a program of dietary coaching at a similar visit interval for the same number of hours.

I added the bold above, of course.

Reading the excerpt from the Pittsburgh Business Times, I assumed the “counselor” was a mental health professional, didn’t you? We don’t know what the researchers would have found if the comparison had been with a psychotherapist. As is, this little blurb just is one small way in which psychotherapy is degraded in our culture.

The other bummer about this is that this was a great study. My favorite parts of the study were not reported in the Pittsburgh Business Times. The researchers actively sought out lower income and African American subjects. They involved community leaders in doing this and the services were delivered in non-traditional settings such as homes and community settings, and medication was not prescribed.

The press release quotes co-investigators, Sandra Quinn and Stephen Thomas:

Because racial minorities are at greater risk for depression, in part due to socioeconomic disadvantages, lower educational attainment and a greater likelihood of other medical problems, we established a foundation of trust working through churches and community-based organizations in black communities,” said Dr. Quinn. Of the 244 participants, 90, or more than a third, were African-American.

“This project tells us that interventions in which people actively engage in managing their own life problems, such as financial or health issues, tend to have a positive effect on well-being and a protective effect against the onset of depression.”
“We suspect we had a higher than usual proportion of black participants because community leaders championed the project, no medication was prescribed, and treatment could be delivered at home or at other non-clinical settings,” said Dr. Thomas. “Lifestyle interventions, such as dietary coaching, may be more culturally appropriate and acceptable in racial-ethnic minority communities.”

In a new project, the researchers will examine whether PST-PC can be effectively administered by lay health counselors in low- and middle-income countries such as India.

As someone who has worked with disenfranchised people and in unconventional settings for much of my career, the findings of this study are not surprising. What would be a pleasant surprise would be to see this study used to develop properly funded programs to reach these folks. It would certainly be cost effective and well worth the efforts. I am not holding my breath.

In the meantime, why couldn’t the headline have been and the article reported:

Lifestyle interventions and problem solving prevents depression in the elderly without use of medications.

I remain a hopeful dreamer.

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