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Evaluating telehealth lifestyle therapy versus telehealth psychotherapy for reducing depression in adults with COVID-19 related distress: the curbing anxiety and depression using lifestyle medicine (CALM) randomised non-inferiority trial protocol

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journal contribution
posted on 2022-01-01, 00:00 authored by Lauren Young, Steve MoylanSteve Moylan, Tayla John, Megan TurnerMegan Turner, Rachelle Opie, Meghan Hockey, Dean SaundersDean Saunders, Courtney Bruscella, Felice JackaFelice Jacka, Megan TeychenneMegan Teychenne, Simon Rosenbaum, Khyati Banker, Sophie MahoneySophie Mahoney, Monica TemboMonica Tembo, Jerry Lai, Niamh MundellNiamh Mundell, Grace McKeon, Murat Yucel, Jane SpeightJane Speight, Pilvikki Absetz, Vincent VersaceVincent Versace, Mary Lou Chatterton, Michael BerkMichael Berk, Sam Manger, Mohammadreza MohebbiMohammadreza Mohebbi, Mark Morgan, Anna Chapman, Craig Bennett, Melissa O’Shea, Tetyana RocksTetyana Rocks, Sarah Leach, Adrienne O’Neil
There is increasing recognition of the substantial burden of mental health disorders at an individual and population level, including consequent demand on mental health services. Lifestyle-based mental healthcare offers an additional approach to existing services with potential to help alleviate system burden. Despite the latest Royal Australian New Zealand College of Psychiatrists guidelines recommending that lifestyle is a ‘first-line’, ‘non-negotiable’ treatment for mood disorders, few such programs exist within clinical practice. Additionally, there are limited data to determine whether lifestyle approaches are equivalent to established treatments. Using an individually randomised group treatment design, we aim to address this gap by evaluating an integrated lifestyle program (CALM) compared to an established therapy (psychotherapy), both delivered via telehealth. It is hypothesised that the CALM program will not be inferior to psychotherapy with respect to depressive symptoms at 8 weeks.

The study is being conducted in partnership with Barwon Health’s Mental Health, Drugs & Alcohol Service (Geelong, Victoria), from which 184 participants from its service and surrounding regions are being recruited. Eligible participants with elevated psychological distress are being randomised to CALM or psychotherapy. Each takes a trans-diagnostic approach, and comprises four weekly (weeks 1-4) and two fortnightly (weeks 6 and 8) 90-min, group-based sessions delivered via Zoom (digital video conferencing platform). CALM focuses on enhancing knowledge, behavioural skills and support for improving dietary and physical activity behaviours, delivered by an Accredited Exercise Physiologist and Accredited Practising Dietitian. Psychotherapy uses cognitive behavioural therapy (CBT) delivered by a Psychologist or Clinical Psychologist, and Provisional Psychologist. Data collection occurs at baseline and 8 weeks. The primary outcome is depressive symptoms (assessed via the Patient Health Questionnaire-9) at 8 weeks. Societal and healthcare costs will be estimated to determine the cost-effectiveness of the CALM program. A process evaluation will determine its reach, adoption, implementation and maintenance.

If the CALM program is non-inferior to psychotherapy, this study will provide the first evidence to support lifestyle-based mental healthcare as an additional care model to support individuals experiencing psychological distress.

Trial registration
Australia and New Zealand Clinical Trials Register (ANZCTR): ACTRN12621000387820, Registered 8 April 2021.



BMC Psychiatry





Article number



1 - 13




Berlin, Germany







Publication classification

C1 Refereed article in a scholarly journal