S4 E12: Dr. Cassandra Vieten on Using Exercise to Improve Mental Health

Released December 15, 2021

There are many benefits to exercising. It can help with weight control, strengthen your bones and muscles, and improve your quality of sleep. But did you know it can also improve your mental health? Today, we speak with Dr. Cassandra Vieten about a new report from the John W. Brick Mental Health Foundation and her insights on the connection between the two.

Podcast Transcript

So, for anxiety, it’s best if you do the exercise, but you also monitor whether or not it’s causing more anxiety. And if so, can you find types of exercise that are not anxiety-provoking? For example, adding tai chi, qigong, some of these down-regulating types of exercise, and then also maybe finding the types, being outdoors might be more helpful for someone who’s anxious. 

Welcome to Beyond Theory, a podcast powered by Meadows Behavioral Healthcare that brings you in-depth conversations with firsthand insights from the front lines of mental health and addiction recovery. I’m Dominic Lawson.

There are many benefits to exercising. It can help with weight control, strengthen your bones and muscles, and improve your quality of sleep. But did you know it can also improve your mental health? Today, we speak with Dr. Cassandra Vieten about a new report from the John W. Brick Mental Health Foundation that shares her insights on the connection between the two. 

Let’s get out of the abstract and see how this applies in the real world. It’s time to go Beyond Theory. 

Cassandra Vieten: My name is Cassandra Vieten and I am the executive director of the John W. Brick Mental Health Foundation.

Dominic Lawson: Thank you so much, Dr. Vieten, for coming on the Beyond Theory podcast. We really appreciate your time.

Cassandra Vieten: You are welcome.

Dominic Lawson: Awesome. If you would, can we just start with your background?

Cassandra Vieten: Sure. I’m a clinical psychologist by training, so that means I was trained to become a psychotherapist with a PhD. I had a very interesting training because early on in my undergraduate life I became interested in Buddhism and meditation and how that might be influential in people’s mental and emotional wellness. So, my training program was the California Institute of Integral Studies in San Francisco and that was the place that integrated eastern philosophy and western psychology. It was very interesting

And then after that I actually ended up becoming a mind-body medicine researcher more than a psychotherapist, going to UC San Francisco for my pre- and post-doctoral training where I studied the genetic behavior of alcoholism as it runs in families. And then I moved to California Pacific Medical Center and the Institute of Noetic Sciences where I continued to do research in mindfulness and spiritual engagement, holistic approaches to mental health and well-being, and how to help people to transform their lives.

Now I’m very happy to be leading the efforts of the John W. Brick Mental Health Foundation where we are expanding the way people are approaching mental health, looking to exercise, nutrition, and mind-body practices and how they might influence the way people think about mental health and the way they prevent and treat mental illness.

Dominic Lawson: Absolutely. If you would, just kind of talk about the inspiration for the John W. Brick Foundation, if you would, Dr. Vieten?

Cassandra Vieten: Victor Brick and Lynn Brick are the largest franchise holders of the Planet Fitness gym that you probably seen ads for, which really is a great organization, great company that was founded on democratizing access to fitness and gym membership making it affordable and accessible for folks. They own about over 90 Planet Fitness gyms

And unfortunately, Victor’s brother John was diagnosed with schizophrenia early in life. And he struggled with it throughout his life, in and out of institutions, and really had access to the best mental healthcare institutions, but even with that, he ended up dying from complications from schizophrenia. And he also was never offered a fully, like, a well-rounded, holistic plan that would address his mental health issue. So, it’s mainly medication, psychoanalysis, institutionalization, but never really body movement exercise, nutrition, any kind of mind-body practices that he might be able to feel empowered to use on his own.

The Bricks really want to change the way the world treats mental health. So, the Brick Foundation was founded in 2015, and today, in 2021, we are funding research on exercise nutrition and mind and body approaches and how they impact people’s mental health. We are supporting model programs that integrate these approaches to see if we can show that they really work in the real world, it’s not just idealistic. And then we collaborate with over 50 different mental health organizations to advance our road map for expanding the way people look at mental health and treatment approaches.

Dominic Lawson: Absolutely. I love the way you say it’s a “real world” scenario and not being idealistic. That’s what we like to hear on Beyond Theory. What are the main ways that your research tells you that mental health needs to change? I know you talk about this often.

Cassandra Vieten: Yes. So, one of the things we just completed is the review of the scientific literature on exercise, physical activity, movement, and mental health outcomes. So, we synthesized 30 years of research from 1990 to 2020, looking for every publish article we could find on exercise, physical activity, various types of movement like tai chi, qigong, yoga, walking, sports, cycling, on mental health outcomes. And we sorted through the data, and we’ve been able to create a report that examine patterns across the different kinds of exercises.

What kind of mechanism might be, what are some of the clear outcomes of exercise on mental health? And we’ve come to the conclusion through the synthesis that, particularly for depression and anxiety, the evidence is very clear that people who are presenting with depression should be prescribed exercise in addition to any kind of psychotherapy medication or, even if they have to be institutionalized, there should be some sort of body movement.

We also recommend that this movement be supervised by somebody, like sort of like when you get an injury and you get physical therapy. We’re not sure that this kind of exercise would require the level of knowledge that physical therapy has, but we do believe a fitness professional who would receive a little bit of training in mental health might be able to help with supervising this experience. That’s because, number one, motivation of course is a huge issue with people who are experiencing anxiety and depression. And number two, we want to look at exactly what is the optimal form of exercise, what is the optimal intensity, what is the optimal frequency, and give people a hand for maybe 12 weeks in this so they can begin to create these patterns in their own lives.

Dominic Lawson: Before we move forward, and that kind of leads us to the report that we are going to talk about today, you named a lot of different exercise. What is your favorite, Dr. Vieten?

Cassandra Vieten: For myself, it’s absolutely soccer. I was a soccer fanatic. I played since I was five years old — team club leagues and then women’s leagues later — and I was really interested to find in our research that the top two kinds of exercise, that we reduce the number of poor mental health days. I know that is a double negative. What they do is they count how many poor mental health days do you have in a month, and what type of exercise reduces that amount the most. And what they found was cycling and outdoor sports were the highest. We think that could be the highest because it not only is brining you some physical activity, but it is also bringing you sunshine, being outdoors, fresh air, and for team sports it’s bringing you social support. So, all of those things together have a positive influence, but I’m into the soccer. How about you?

Dominic Lawson: Basketball. I’m starting to get into soccer, been learning a lot about the game. But basketball is my favorite sport, for sure. I appreciate that, Dr. Vieten, for sure. Let’s kind of dive into the report. You have a report from the John W. Brick Foundation, kind of talk to us about that?

Cassandra Vieten: Sure, first of all, you can see it by going to Johnwbrickfoundation.org — it’s completely free — and go to the resource section to the “Move Your Mental Health” report. What we have is an 80- page report, if you are really into this stuff and you want to get deeply into every single type of exercise and how it’s impacted the forms of mental health outcomes we were able to look at. But there is also an executive summary that is about 12 pages.

And I think I’m most excited about data visualization on the webpage that is interactive where you can search for either a type of exercise and or a type of mental outcome. For example, you can put in cycling and depression, all the published article that have been published in peer-reviewed scientific journals on cycling and depression will show up, and you can even click through and go straight to the article to read it on your own. So, it gives you an idea, a landscape of what we know about exercise and mental health.

We really hope that it’s useful for not only mental health professionals but also for individuals and families and people in the fitness industry to help guide them in making some choices about what kinds of physical activity might be helpful to their mental health.

Dominic Lawson: Absolutely. I’m curious about the different type of study that supports the role of exercise. I know you talked about it. Can we dive into that a little bit more?

Cassandra Vieten: Sure. There is a range of evidence. One thing the report did not do is evaluate the strength of evidence for every article we were doing, what is called the “scoping review,” where you try to get your arms around an entire field of data. And then the next step, people might do meta-analysis or systematic review where they look at the strength of the evidence for each article. But in the absence of that, we really were trying to show the whole landscape.

So, you’ve got everything from a case study where its people observed and one individual that something changed in their mental health when they engaged in the activity or the intervention. You might have qualitative research where you interview people about their subjective experience with when they exercise, when they move, when they do some type of movement doesn’t help them, and if so, how. That help you generate a hypothesis.

And then sometimes people do surveys where they ask hundreds or thousands of people, “Do you do this, and does it help you?” Which is still based on self-report, so it’s a little bit, people can be biased, people can create stories about what helped and what didn’t help that may or may not be true. So, then we move into actually creating interventions and seeing if it works in real time before and after. We might measure people before and after they do moderate to intense exercise or before and after they engage in yoga and see if their mood changes.

And then finally, the gold standard is the randomized control trial where you do head-to-head analysis of “does it help over and above a placebo, over and about just time and attention or people who are just sitting on a waiting list or getting a standard of care?” The last type of studies would be what I mentioned before, a mental analysis and systematic reviews that try to look at patterns across this study and come up with some definitive answers.

Dominic Lawson: Dr. Vieten, I’m curious about something. I’m curious about what key conclusion that you were able to draw. Were there any surprises to you?

Cassandra Vieten: Yes. So, what I mentioned for depression, and particularly to just a slightly less extent for anxiety, engaging in three to four times a week moderate to intense cardiovascular exercise is definitely, it appears to be helpful for depression at levels that are equal to and even superior to anti-depressants. That I think the number one finding is, like, right now we have enough evidence to indicate that this should be integrated into treatment right away.

Anxiety was only slightly less strong because for some people who are experiencing anxiety disorders, number one, the expectation to exercise, the commitment to exercise can cause more anxiety, the tracking of exercise can cause more anxiety and even the actual act of exercising at a high-intensity level can increase people anxiety. That is obviously not what we want. So, for anxiety, its best if you do the exercise but you also monitor whether or not it’s causing more anxiety. And if so, can you find types of exercise that are not anxiety provoking? For example, adding tai chi, qigong, some of these, yoga, some of these down-regulating types of exercise. And then also maybe finding the types, being outdoors might be helpful for someone who is anxious.

One thing that was surprising to me is how little research there was on exercise with serious mental illness. So, we really can’t say much yet about exercise being effective or not effective for bipolar disorder, schizophrenia. It’s not that it’s not, there is not enough evidence out there. I’d love to see more studies that look at those, what are feasible types of exercise for this population? Another exciting part of it was some of the trends that are coming out now. So, exergaming for example, making exercise into a game. So, you think about those type of cycling, indoor cycling that are really pumped up, or Peleton, or the mirrors now that people have that people will interact with the mirror to do the exercise, or the good old fashion Nintendo Wii.

Those kind of gamifications of exercise, some people are now using virtual reality, are really new and exciting developments, especially for young people and teens who might find that more engaging than a treadmill or indoor bike or long hike outside.

Dominic Lawson: It’s funny you mentioned that. You are right, we are absolutely seeing a lot of gamifications in exercise and stuff like that. I imagine that it probably even boosts mental health, like you can get a new high score or something like that. Does that make sense, Dr. Vieten?

Cassandra Vieten: Yes. You get a double dose of increasing the good hormones in your body but also getting a little dopamine hit every time you get a badge or a star or something like that.

Dominic Lawson: Absolutely. I appreciate you indulging me there. I wanted to ask you this because one of the reasons we want to reach out to you and have you on Beyond Theory is because we saw you at the Never Alone Summit collaborating with the Chopra Foundation with Deepak Chopra. Can we talk about that experience and what you were hoping to accomplish?

Cassandra Vieten: The Never Alone Summit, and you can find it at NeverAloneSummit.live, is an event we put together at the very beginning of the COVID pandemic because both of our organizations — the John W. Brick Foundation and The Chopra Foundation had a number of live events that we had been planning. Of course, that was all shut down in the spring 2020. So, we got our head together and said, “What can we do for people who are at home who might be depressed, anxious, losing income, losing work, having their kids out of school?” Just ton of stress and a ton of uncertainty and fear about the actual virus during that time.

So, we put together a three-day Never Alone Summit in 2020, which is amazing and it’s still online and completely free to anyone who might want to access it. You can find it at NeverAloneSummit.live or the johnwbrickfoundation.org website. So that was fantastic. We had over 120,000 views from over 50 countries, over 100 speakers over three days.

So, this year, with people re-entering life and the workforce and not being home quite as much, we narrowed down to one day and more highly curated the content. So, we had that just a couple of weeks ago — the Never Alone Summit, you can find it at the same website — where we looked into specific topics like parenting and families in mental health. We had Senator Patrick Kennedy and singer Jewel. We looked at new/emerging stories of mental health, how we talk about it, with Russell Brand and sport figures like Russell Wilson and people who have been, Alex Smith.

These amazing, incredibly successfully athletes who you think have everything and how could they be facing mental health issues, but they are very vulnerable about sharing about their own mental issues. We have the former Archbishop of Canterbury and people talking about racial and social justice and mental health because that’s a big stressor, especially for communities of color. And technology and mental health, talking to the CEO of Verizon and multiple people, and of course having Deepak Chopra.

We hope that the content of the Never Alone Summit is very useful to people. We heard from colleagues, we heard from San Quentin prison, for example, that they are using the 2020 Never Alone Summit recordings in their wellness programs. So, we hope everybody will go and check it out.

Dominic Lawson: That just made me think of something. I want to ask you about the state of fostering mental health in the incarcerated population. Can you talk about that a little bit?

Cassandra Vieten: Yes, I have very strong opinions about this that, you know how there used to be asylums or sanitariums where they would have people who had mental health challenges be subjected to frankly barbaric treatment? Now, there has been a lot of elevation of mental healthcare based on evidence and science. I do think it needs to be expanded, as you know from what we talked about so far, but in some way, prison has become the newest asylum and people who are in prison and in jail have extremely high rates of addiction and mental illness.

If we truly believe that these are brain and body diseases — they are not moral and character failings — and as we know they are impacted by growing up with trauma and poverty. The idea that putting people in cages is the best solution to this is just, in my opinion, an incredibly outdated and cruel way of facing this issue. And I hope we as a society can very soon do better.

Dominic Lawson: Absolutely. Thank you for sharing that. I want to ask you this; I just want to go back just a little bit. You talk often about the difference between mental wellness and mental health. Can you explain that a little bit?

Cassandra Vieten: Sure. When we collaborated closely with the Global Wellness Institute and we recently funded, in part, a report that they did on the mental wellness economy where they look at all of the different sectors of the economy that have opportunity now to be instrumental in mental wellness, in addition to the traditional medical and psychotherapeutic healthcare systems. And so, when they wrote their report, they found this very interesting dynamic where there is a spectrum that we all kind of know about.

You might think about it as horizontal from mental health or an absence of symptoms to mental illness or the presence of symptoms and everything in between. So, on one end of the spectrum would be severe mental illness with hallucination, delusions, destructive behavior, and the other end of this spectrum might be really thriving, not experiencing much distress, and in the middle might be anxiety and depression, and everyone one can move up and down the scale.

Everyone could be susceptible at some point to drifting down the scale within enough stress and difficulty. And, of course, you’ve got genetic predispositions or extreme trauma throughout your lifetime. There is also another access, a vertical access of mental wellness at the top and languishing at the bottom, maybe languishing at the bottom, and flourishing at the top. It’s what we call orthogonal axis, meaning that you can have, actually, a large amount of mental health symptoms, but you can also be flourishing because the way you are dealing with those symptoms is through an ecosystem of mental health support which may include medication and psychotherapy. It may also include support group or peer support, self-help, 12-Step, exercise, nutrition, mind body practices, positive relationships, making a contribution, spending time in nature, spirituality. This is really what boosts mental health is an entire interlocking ecosystem of all of these elements and surrounded by a community of support.

If you have those things, even if you are living with a mental illness, you could be flourishing. Even if you don’t have many traditional symptoms of mental illness, you can also have low mental wellness in the sense of being lonely, having a lot of stress, having disruptive relationships, just having a very poor engagement with life, and so that is a different spectrum.

The mental and wellness spectrum versus the mental health and mental illness spectrum. Sometimes we think of the mental health and mental illness spectrum as pathogenic. In other words, disease- or symptom-focused, and the other one is salutogenic. In other words, wellness or salutogenic means what are the elements that produce positive emotions, positive state of being?

Dominic Lawson: I just want to say before I ask the last two questions. Thank you so much, Dr. Vieten, for coming on the Beyond Theory podcast. I know you are a big fan of space exploration and science fiction and stuff like that. You know we are on our way as a country to try to head to planet Mars. I’m just curious, from just, to get some commentary from you. Are there any mental health or mental wellness consideration for those astronauts who are going to make that trip?

Cassandra Vieten: Yeah, tons. It’s not my academic area of expertise, but absolutely. Like other forms of space exploration have created a ton of inventions for everyday life on earth such as things like Velcro and all these different inventions that were invented for space travel that permeated our lives. I think looking at mental health in the context of space travel, long periods of being alone or being with just a few people in a confined space. Having completely different perceptual day-to-day interactions where, when you are in space, for example, there is no horizon.

If you ever feel seasick when you couldn’t see the horizon in your car, in your boat, or carsick if you couldn’t see it in your car, imagine having no horizon for two or three years. These kinds of things are going to teach us a lot about how the mind works, what our vulnerabilities are and what are kind of things we can do to build resilience. And I think they are great testing grounds for these ecosystem-based approaches. When we have astronauts go to Mars, we are not going to want to have them only be addressed when they are in crisis with medication or psychotherapy or hospitalization, which they won’t be able to have. We want to have them have a full ecosystem of mental health support that they engage in on their own, they are empowered to engage, in and that a community of support helps them with. And I think that’s true for every single person on the planet also.

Dominic Lawson: So, you mentioned the report. If you could, just mention where we can get that report again and if there are any other resources that we should check out?

Cassandra Vieten: Yes, I very much encourage everyone to go check out Johnwbrickfoundation.org. Go to the resources section, you will see the Move Your Mental Health report, and you can download the full report, you can download the executive summary, and you can also play with the data right on that page with the interactive data visualization, being able to search for various types of physical activities and various type of mental health outcomes.

Let’s say you are somebody who struggles with anxiety, you can put in “anxiety” and explore what kind of exercise modalities have been connected to treating anxiety effectively. We also have a resource, this page on that section has a ton of different places that you can go in terms of crisis support and other forms or ways you can build this ecosystem of mental health. We have a section called Move Your Mental Health, which has 10 different 10-minute exercises and movement routines that are led by leaders in the field of fitness.

And so, you can do everything from low-key gymnastic session to a dance session to a dance-shadow boxing session — 10 of them are available for you there, just if you want to, right now, start to integrate some movement into your life. And we also recommend that you check out the Never Alone Summit for dozens of hours of content, people talking about the variety of mind-body approaches to mental health that people can access.

Dr. Cassandra Vieten is a licensed clinical psychologist and executive director of the John W. Brick Mental Health Foundation. You can find out more about her work and the report we discussed at www.johnwbrickfoundation.org.   

Beyond Theory is produced and hosted by me, Dominic Lawson. You can discover more, including videos of some of our conversations, at BeyondTheoryPodcast.com.

For more information on Meadows Behavioral Healthcare, go to Meadowsbh.com.

Finally, thank you for listening and I hope you join us next time for another episode of Beyond Theory.