Researchers at Kansas University are studying the effects of a six-part Therapeutic Lifestyle Change program, specifically for people with symptoms of depressive illness.

But the techniques could benefit a wide range of people, said Steve Ilardi, professor of clinical psychology.

All six elements have been shown in previous studies to help ward off depression, he said. That means they likely would be beneficial for anyone at risk of depression or with a family history of depression.

And many of the elements including exercise, bright light, enhanced sleep and improved social interaction have been shown to be mood-boosters for most people, not only those with depressive symptoms, Ilardi said.

Here are the six elements. Clients in the Therapeutic Lifestyle Change study are under the guidance of therapists and doctors. Always consult with a doctor before starting an exercise program or using dietary supplements.

Omega-3 fatty acids

The brain needs essential fatty acids, omega-6 and omega-3, for healthy function. The typical American diet provides a 16-to-1 ratio of omega-6 to omega-3 fats. The healthiest ratio is 1-to-1.

Omega-3 intake has dropped precipitously in the past 100 years, due in part to farm-raised meat and fish, Ilardi said. Studies have associated omega-3 deficiency with an increased vulnerability to depression.

Treatment: Daily supplement of 1,000 milligrams of omega-3, known as EPA (eicosopentaenoic acid), a concentrated form of fish oil, and a multivitamin. Ilardi said this is a high, therapeutic dose based on the best information available now, but that "nobody knows for sure what the optimal omega-3 dose is." The multivitamin is intended to lessen the oxidative effects of the supplement. Clients are specifically reporting better sleep with the supplement, he said, a result he plans to study further.

Exercise

While people in hunter-gatherer societies spend hours a day in physical activity, walking as much as 10 miles a day, a majority of American adults get no regular physical exercise.

Clinical trials have identified exercise as an effective treatment for depression. One study found just 90 minutes of aerobic exercise a week to be effective.

Treatment: Thirty minutes of aerobic exercise three times a week. Some clients use a walking program. Lawrence Athletic Club offers some free services to study participants.

Light exposure

Hunter-gatherers spend the day outside, exposed to sunlight. The light on a sunny day is at least 10 to 20 times brighter than light indoors, where most Americans spend much of the day.

A lack of light exposure has been found to disrupt sleep and alter hormones, contributing to fatigue. Sunlight deprivation, acute in winter, is known to lead to symptoms of depression. "All of us get a mood boost from bright sunlight," Ilardi said.

Treatment: Thirty minutes of daily exposure to sunlight. The program provides clients with a 10,000-lux light box. (Lux is a measure of illumination.) They can sit next to or under the light box to simulate light exposure on a sunny day.

Sleep

Americans on average get 6.8 hours of sleep a night. Just 100 years ago, they slept nine hours. Hunter-gatherers spend more than 10 hours in darkness, and some members of modern-day hunter-gatherer societies complain about getting too much sleep.

Lack of sleep is a well-established health risk on many fronts, including an increased risk of depression.

Treatment: The goal is eight hours of sleep a night. Therapists suggest ways to improve sleep, such as dimming lights and lowering the thermostat an hour before bedtime and retiring and rising at the same time each day, including on weekends.

Social connectedness

Hunter-gatherer societies live in groups of 50 to 100, chiefly with close relatives and friends. American adults for several generations have grown socially isolated from other family members and from friends. Social support is a known safeguard against the risk of depression. "We're designed to be interdependent," Ilardi said. "We're designed to have lots of face time with those closest to us."

Treatment: Therapists and clients discuss relationships that have waned or become shallow. Clients set specific goals for social activities, including scheduling meetings and phone conversations with friends and relatives. Ilardi noted that while spiritual practices are not a specific element of the program, many people find powerful social connections in church communities.

Anti-ruminative behavior

Rumination is the tendency to dwell on negative thoughts. Episodes of rumination occur most often when alone. Clients often don't realize the amount of time they spend engaged in such thoughts or the amount of distress it causes, Ilardi said.

Hunter-gatherers spend almost no time alone. With nearly constant social activity, they have little opportunity for rumination. Americans spend much more time alone, including sitting in traffic and staring at unengaging TV shows.

Treatment: Therapists don't try to explore clients' negative thoughts. Instead they explain the toxic effects of rumination. One strategy to combat rumination is to avoid long periods of time alone. Another is to interrupt periods of rumination with an activity or by contacting a loved one.

Take part in the study: The Therapeutic Lifestyle Change study at the University of Kansas is looking for participants. They must be 18 to 65 years old and meet the diagnosis criteria for clinical depression. Participants also must be available for 12 sessions over 15 weeks in Lawrence, Kan.