There have been several trials of multiple health behaviours and healthy lifestyles interventions among people with mental health disorders, all of which have included a smoking component. These interventions typically include strategies to address multiple health risk behaviours for CVD within the one intervention package, allowing for links between these behaviours to be drawn and addressed in context, and people to focus on one behaviour first (e.g., sleep), experience early success, and then apply that success to other health behaviours that they may be more reluctant to shift (e.g., smoking). Baker and colleagues [375] conducted a pilot trial to reduce CVD risk in 43 people with acute psychotic disorder, using MI with CBT, accompanied with NRT. The study found significant reductions in CVD risk and smoking, and participants indicated high levels of satisfaction with the program.
In a similar trial, Goracci and colleagues [376] implemented a three-month community healthy lifestyle intervention to people with either recurrent depression or bipolar disorder. The intervention involved weekly individual 45-60-minute sessions focusing on lifestyle factors such as sleep, exercise, nutrition, life balance, energy, and smoking cessation, although everyone in the trial was also receiving ongoing pharmacotherapy for their respective mental disorder. Compared to people receiving pharmacological maintenance augmented with clinical management visits, people who received the lifestyle intervention were less likely to experience relapses of depressive and manic symptoms and demonstrated greater reductions in body mass index (BMI) and waist circumference. Relative to baseline, people receiving the intervention also experienced improvements in sleep quality [376].
In the only trial conducted among people with co-occurring mental disorders and AOD use, Juel and colleagues [377] evaluated a community lifestyle intervention encompassing smoking cessation guidance, dietary advice, and structured exercise. Relative to baseline, participants reported consuming fewer fast-food meals and caffeinated beverages, as well as improved quality of life, after the 24-month intervention. However, sleep duration decreased over the study period, and AOD use remained unchanged [377].
Kelly and colleagues [210] recently conducted an RCT to evaluate Healthy Recovery; an eight-session group-based intervention focused on addressing multiple CVD risk factors within an AOD treatment setting. The five-week intervention focused on reducing smoking, increasing fruit and vegetable intake and levels of physical activity, using a combination of health-focused psychoeducation, goal setting, monitoring, MI, and CBT. In evaluating the intervention, Kelly and colleagues [210] found that people randomised to receive Healthy Recovery significantly reduced the number of cigarettes smoked daily and increased the variety of fruit consumed relative to AOD treatment alone, though levels of physical activity and servings of fruit and vegetables did not change.