How can psychobiotic therapy be used in clinical psychology to help mental health?

Psychobiotics are probiotic microorganisms you can add to your diet to improve your mental health by targeting your digestive system. There is nothing new or unusual about taking probiotics. They are a simple way of introducing good bacteria to your gut to improve your digestive system. This article is about the possibility of taking probiotics as a conscious way to create a better environment for your mental health.

As Clinical Psychologist’s, we pride ourselves on only providing therapy and advice based on rigorous scientific data. Psychobiotic therapy is such a new area that there’s very little concrete evidence yet.

But over the past two decades the research has been stacking up about how the bacteria in our gut is essential to good health. Not a day goes by without some mention of gut bacteria being related to health conditions such as Alzheimer’s, Parkinson’s Disease, and Crohn’s Disease. And it’s becoming increasingly clear that mental health issues such as anxiety, depression and schizophrenia along with other stress-related behaviors, start in the gut.

So, is this something we should be starting to consider in our therapy sessions? Should we encourage our clients to introduce live bacteria into their gut to influence their mood?

How does the microbiome influence brain and behavior?

In order to understand how psychobiotics work, it’s useful to look at the gut microbiome.

You already have trillions of bacteria in your digestive tract, and every time you eat, their job is to breakdown food. This breakdown process releases many different types of molecules called metabolites, such as short-chain fatty acids, which is a form your body can use. These metabolites interact with almost every cell in your body. Every. Little. Cell.

These metabolites help activate your genes, influence your immune system, guide your metabolism, insulin and bodyweight. And they influence brain health and behavior as well. Metabolites are involved in almost every process in your brain, behavior and mood. Every. Little. Process.

Gut-brain communication

Your gut and your brain communicate to each other. It’s a constant back and forth. Your gut and brain are like texting teenagers: they communicate their feelings often, quickly and don’t need face-to-face contact.  An important link to that communication chain comes from the vagus nerve, a long, wandering nerve reaching from the gut to the brain.

Studies have shown that if the vagus nerve is cut in mice, all the good effects of taking a probiotic are gone. Even if a healthy gut has been carefully created, there are certain microbes that will no longer transmit messages to the brain. It’s like the 5G network has gone down and the teenagers can still text but the messages can’t get through.  The vagus nerve is essential to passing on the messages quickly through the nervous system.

But the communication is not all about the vagus nerve. Your body transmits information from the gut to the brain in other ways, some we probably don’t even know about yet. Two other interactions are through messages in the bloodstream and via immune pathways. All of this communication goes between the smooth muscle of the gut and the fibers of the central nervous system.

Evidence for the gut-brain link

So far, the majority of the studies on brain health and gut have come from animal studies. And specifically, from germ-free mice that have been bred in a clinical vacuum, so they do not come into contact with bacteria. And these mice are very different to normally bred mice. Germ-free mice have a higher susceptibility to physical health conditions and mental health issues including anxiety and depression (yes, animals can become anxious or depressed). This gives rise to scientists believing it is the lack of contact with bacteria that causes the multitude of health conditions.

Further evidence comes from studies of fecal transplants. When poop is transplanted from a depressed person to a germ-free mouse, the mouse starts to display depressive-like characteristics. And the changes in that animal are most likely associated with the bacteria in that poop.

If you stress animals early In life it has an impact on their gut microbiome development. Bacteria is responsible for how we stressed and stress changes the bacteria. There can be major changes in brain health and behaviours if the microbiome is disturbed at key developmental stages.

Can psychobiotic therapy alter the gut microbiome to improve mental health?

To use psychobiotics, it is not necessary to have any medical training, though you must be willing to entertain the idea that thoughts, behavior and mood may be shaped by the gut and not the mind. Gut bacteria has a wide-reaching influence on health and brain function and are very important in your capacity to deal with stress.

Scientists are learning more and more about the individual types of bacteria that are related to each function in the body. But it’s still a relatively early, emerging field of study and there is still so much to learn. Nevertheless, it’s an exciting prospect for people who work within the mental health professions.

Your body is an ecosystem of various microbiomes. Each microbiome is a community of bacteria. But the bacteria in your gut can easily become off-balance (gut dysbiosis) due to eating an unhealthy diet or after taking a round of antibiotics.

Psychobiotics is a way to feed your microbiome to help improve mental illness.

What to eat for good gut health

It’s universally acknowledged by dietitian’s, doctors, and researchers alike, that diversity is the key to a healthy gut. People who have diverse microbiota due to eating a diverse diet, have better health.

The process of change from gut dysbiosis to a healthy gut occurs very simply:

“Eat whole foods, not too much, mostly plants.” – Michael Pollan

When you eat, you’re not only nourishing your cells, but you’re also feeding the trillions of bacteria inside your gut. Plant-based food is their favorite.

• Whole grains
• Nuts & seeds
• Beans
• Fruit
• Vegetables
• Fermented foods
• Herbs and spices

Making dietary changes can change your gut microbiota in less than a month.  And in order to do so, eating a wider range of food is necessary. If you only eat the same five types of vegetables each week you’re only feeding a small portion of the gut microbes.  Eating thirty different types of fruits, vegetables and legumes, however, introduces a wider range of bacteria and has better health consequences.

The Mediterranean Diet and Gut Health

The Mediterranean diet rose to popularity after the Blue Zones research showed that in areas of the world where people regularly live to be 100 years old, their diet was fairly similar.  The food consists of olive oil, an abundance of vegetables, some fish, nuts and poultry.

Eating a Mediterranean Diet has been shown to prevent depression as well as a wide-range of health conditions such as heart health and diabetes.  And it’s possible that the health related benefits come from the increase in the lactobacillus bacteria in the gut.

One possible reason the Mediterranean Diet works is because it increases the diversity of gut bacteria.

What is a psychobiotic diet?

Probiotics are a live bacteria that you introduce to your body. And prebiotics nourish them. Dietary fiber, a prebiotic, introduces the right nutrients needed for the bacteria to feed on. Eating fiber is important because you can’t digest it, so it moves into your small intestine where the microbes eat it. Note: One of the waste products is gas so you may experience some bloating and pass wind when increasing your fiber intake. But this is normal.

A psychobiotic diet includes both probiotic and prebiotic food.

Dr Michael Moseley, a doctor who has created popular shows on the BBC for improving the health of the general public, joined forces with Professors Ted Dinan and John Cryan from University College Cork, to investigate the effect of a psychobiotic diet on mood.

Together, they created a diet plan with the purpose of diversifying participants gut microbiome to influence better mental health and resistance to stress. One group continued eating their regular diet which included takeaways and sugary foods. The second group followed a ‘psychobiotic diet’.

In addition to the foods suggested above in the previous section, such as whole grains, fruits and vegetable, they asked participants to eat foods which contain naturally occurring probiotics, including fermented food.

For example:

• Plain yogurt with probiotic bacteria
• Sauerkraut
• Miso soup
• Fermented soft cheeses (like Gorgonzola)
• Fermented vegetables
• Kombucha
• Kefir

For four weeks, they also avoided highly processed or take-out food.  The results showed that the probiotic group had far more beneficial gut bacteria and a reduction in the bad bacteria. And their mood had improved, with stress reduced by up to 31%.

This small study adds to the evidence that diet can affect gut bacteria and, in turn, mood.

Psychobiotic therapy considerations for clinical psychologist’s

Therapy does not occur in a vacuum. We cannot ignore the diets of our clients.  The benefits of eating a diverse diet and introducing psychobiotics could greatly influence the course of therapy.

The most important step in making therapy effective is not the clinical work itself but the therapeutic relationship. Having the feeling of being connected to each other in a safe, boundaried way allows you to be able to broach the personal subject of food. Here are some areas to consider.

Mental health

Mental health can affect food choices (and now we know food choice affect mental health).

Working in mental health services, you’ll know that someone who is clinically depressed has a reduced appetite and little motivation to cook. There are other clients with ARFID (avoidant/ restrictive food intake disorder) or who are on the Autism Spectrum that eat very little or eat the same, safe foods every single day. A person with anxiety may eat less because the anxiety messes with their digestion.

These are barriers to improving mental health through the gut. In these instances, food becomes even more important to discuss. This is where motivational interviewing and CBT can be useful tools.  Because telling someone what to do won’t help. But being a collaborative partner in figuring out a motivation can slowly change dietary habits.

Use your clinical judgement with each client, and especially with people who have eating disorders. Keeping in mind that it’s better to suggest adding to a diet rather than taking away foods.

Mindful eating

Understanding the gut-brain axis can be a helpful area of clinical work.  Remember how the communication through the vagus nerve is bi-directional? Well, this means stress and fear can lead to tummy troubles.

It’s no coincidence that the parasympathetic system (the opposite of the fight or flight) is also known as the ‘rest and digest’ response. So having stress-reducing practices in your life can help your gut. And helping your gut helps your brain health.

It’s not just what you eat, but how you eat it.

What this means for your client work is to introduce the idea of mindful eating.  Being intentional about food, making time to sit down and eating slowly is very effective in calming down a normally nervous belly. By introducing the idea of rest and digest you may be able to make far more effective changes in their life than you would by dealing only with the issues at hand. But mindfulness and meditation is not for everyone, having any quiet relaxing ritual can help your gut bacteria. For example, taking a bath, going for a walk, reading a book.

Working with other disciplines

Should you work with your clients to help them make better choices when it comes to food, even when their motivation to change is low? You may feel it’s not your business, that you should stick to psychology only, and leave this area to the nurses, occupational therapists and dietitians.

Remember, this change in gut can help change their mood and behavior for the better. It is your business if it helps with therapy.

When you feel too out of your comfort zone, get together with another health professional who is more knowledgeable about nutrition.  Be open and curious to this new area of mental wellness. You’ll be surprised at how receptive your clients will be.

Institutional food standards

Another barrier to this work is the food served in hospitals, schools, care homes and prisons. If you work in these institutions, can you get together with the policy makers to influence changes at a higher level?

Low income factors

Most psychologists are in a privileged position, no longer having to worry about being able to afford food.  But we must remember that lack of money can impact our clients, making it difficult to afford even basic foods.  It’s often cheaper to eat packaged meals rather than real fruits and vegetables.  And some people, particularly vulnerable adults or children, have no choice in what they eat.

This is challenging, as it’s a sensitive area and many people are fearful of revealing their financial or social situation. But they won’t divulge the information unless you ask.

Specific probiotics

In learning to use probiotics for better mental wellness you may come across companies who are selling direct to customers (your clients).  It’s imperative that we check the claims and research that is being put out there by their marketing teams.  Psychobiotics are not yet ready to make the claims that some food and drug companies are betting on.

It is best to follow the scientists themselves who will be more conservative in their claims.  People like Professors John Cryan and Ted Dinan at the University College Cork in Ireland. Clinical neuroscientist Laura Steenbergen from the Leiden University, Netherlands and Nutritional Psychiatrist, Prof. Felice Jacka at Deakin University, Australia.

The studies so far, mostly animal studies, have not shown a single species of bacteria that influences mental health but it’s the diversity that matters. With the gut microbiomes of depressed and anxious people showing less overall diversity than individuals without mental health problems.

But there are certain strains of microbiota that have been shown to be good for health such as Bifidobacterium, lactobacillus and Akkermansia. So should we encourage clients to take these over the counter probiotics? This is a personal choice, but there is no harm in telling clients who want to be proactive about their mental health the valid information that is out there. Helping them find that information from reliable sources, rather than wellness influencers, is a valuable use of time.

I personally buy Bio-Kult for our family (I have no affiliation with Bio-Kult, I genuinely buy their products) but do your own research to find the best for you.

Exercise and the gut

Food has a direct effect on the gut bacteria.  And regular, physical exercise has an indirect effect of increasing gut bacteria.

Faecalibacterium prasnitzii is the main gut bacterial species responsible for producing butyrate. And exercise increases the level of this bacteria. And higher levels of butyrate, a short-chain fatty acid that aids the gut cells, provides fuel for the gut cells, reduces inflammation and controls the gut barrier.  So exercise promotes good gut health. People with low levels of F. prausnitzii appear to be more at risk of inflammatory bowel disease, obesity and depression.

Athletes tend to have a more diverse gut microbiome compared to sedentary people. But prolonged, excessive exercise has a detrimental effect on intestinal function, including increased permeability of the gut barrier.  So balance is key.

Just as a diet change makes changes in the gut fairly quickly, exercise does the same thing. But if you stop exercising regularly the gut microbes return to their original numbers.  So sticking with the exercise routine is important if you want the changes to be more permanent.

Conclusion

Did you notice what makes a gut more healthy? Yes, the basic health requirements that have been encouraged for years; eat well, exercise and manage stress. The cool term ‘psychobiotics’ makes it sound more attractive and new.

Professors John Cryan and Ted Dinan coined the term psychobiotics to describe live microorganisms which have a mental health benefit. So far, most of the real research has been on mice.

Even if we find out that gut health is central to mental wellness in humans, bacteria alone is unlikely to overcome the effects of anxiety and depression. There are many other factors that come together to create mental health issues. But taking psychobiotics may make the brain more receptive to treatment.

Good mental health starts by what we put in our gut. Whether you see a client for one, ten or one hundred sessions, if you don’t mention food, it’s like fighting fire without water.  Encouraging the use of a food and mood diary can be a helpful start.

Every person’s microbiome is as unique as a fingerprint, having been developed over a lifetime. So until we can measure the best type of bacteria for each individual person, the best course of action is to encourage a diverse meal plan.

Reflecting on the idea of psychobiotics, I feel a surge of hope for this new intervention for mental health.  Plus a little concerned that it will turn into a new version of taking benzo’s to reduce anxiety.  And instead of ‘doing the work’ of therapy, the reliance will be on popping a probiotic.

Diet shapes the gut bacteria. And what we know for sure right now, is that a psychobiotic diet that improves the gut microbiome can influence the mental health of your clients.

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