Therapy

Can You Cook Your Way to Better Mental Health?

New research suggests a note of caution about cooking therapy.

Posted May 21, 2019

For some people, cooking is a dreadful chore, but for others, it’s a means to achieve personal satisfaction while also providing sustenance for you, your friends, and your family. Cooking can be a creative enterprise, then, with the added benefits of providing sensory pleasure. Research suggests that digging back into those old family recipes can be a way to connect to your past. However, in a recent segment on “culinary therapy" airing on CNN’s weekend news edition of “Staying Well," the claim was made that bringing your therapist into your kitchen, coaching you as you chop your vegetables and fry your fish, could produce significant mental health benefits by making you more mindful of your experiences. The question is, does research support this claim?

Mindfulness therapy is gaining acceptance in empirical tests of its effectiveness. These tests involve controlled trials and have gradually become incorporated into standard cognitive-behavioral therapy. When you pay attention to the details of what you’re doing, you can stop a racing mind and quell your negative thoughts. If you applied this approach to cooking, you would have ample opportunities to put this method into practice. All of this sounds sensible, but what about the idea that your therapist comes into your kitchen and works alongside you? Rather than sitting with a therapist and just talking, as reported in the story, this method would give you something to do. Of course, in cognitive-behavioral therapy, you are talking to your therapist, but you’re not just lying on a couch and free-associating. You receive concrete instructions to follow in “homework,” and you learn to modify your thoughts so that they become less counterproductive.

The real test of culinary therapy would involve controlled studies in which matched groups of patients are randomly assigned to treatment vs. either delayed treatment or some other type of therapy such as the conventional cognitive-behavioral approach. No such studies exist in the literature, however. Instead, in a 2018 study, NIH’s Nicole Farmer and colleagues examined the side benefits to mental health of cooking-based interventions as a means of improving nutritional status for people with various chronic conditions. People with diabetes, cardiovascular disease, and cancer need to learn healthier ways to prepare their meals. As reported by Farmer et al., these interventions were successful in helping individuals prepare their meals with less sodium, sugar, and fat and higher amounts of fiber. At the same time, the people who went through this treatment gained in “cooking self-efficacy” (confidence in their cooking ability), and more favorable attitudes toward cooking. Therapist-guided cooking groups can also benefit individuals with eating disorders.

Within the context of rehabilitation, then, cooking treatments can be useful tools to improve health. Additionally, the NIH team argues that cooking can help individuals gain in the ability to plan (so-called “executive function”), while evaluating a person’s ability to cook can be diagnostically useful to understand any compromises to this planning ability of the brain. At the same time, the authors point out that “a successful food system that relies on cooking would benefit from activity that promotes positive mood, self-concept, and self-esteem in order to promote exchange of food and ideas.” Additionally, cooking groups incorporated into community kitchens “may help foster socialization and improve social isolation” (p. 168). Studies that examine psychological benefits as an offshoot of treatment that is supposed to train in important life skills are a far cry from the claims that culinary therapy can replace traditional cognitive-behavioral therapy in the treatment of such disorders as depression and anxiety. The studies that Farmer and her colleagues reviewed focused on the psychosocial outcomes “related to” cooking interventions. Out of a potential 337 studies involving some form of training in cooking, only 11 met the scientific inclusion criteria the authors needed to evaluate the findings.

The outcomes evaluated by the NIH study included improvements in confidence and self-esteem, socialization, and mood and affect. Even the studies meeting the inclusion criteria “contained significant weaknesses and limitations” (p. 176). Only one of the large-scale programs involving community groups used randomization. Many had small sample sizes, and in some cases, the person providing the cooking instruction also did the evaluation introducing a source of measurement bias. Across studies, there were no consistent outcome measures. With these provisos in mind, however, the authors concluded that they found some interesting leads related to mental health benefits including decreased anxiety, improved psychological well-being, and better quality of life. Supporting the idea that cooking can tie you back into your family experiences, Farmer et al. report that cooking interventions provide a “reminiscence therapy experience” in which individuals recall pleasant memories from their past.

Again, though not sufficiently tested with randomized studies, the NIH researchers suggest that learning or re-learning how to cook can, furthermore, provide individuals with a chance to experience mastery on a repeated basis. Every time you prepare a tasty and healthy meal, you have the chance to feel rewarded. Finally, eating healthier meals could actually improve your mental health given the relationships, as they note, between diet and mood disorders. People can also benefit from cooking in a group where they can gain socialization skills.

As comprehensive as the Farmer et al. review was, there was no evidence related to the question of whether bringing a single therapist into the kitchen of a single individual could stand on its own as an alternative to cognitive-behavioral or mindfulness treatment. The authors touch upon the use of in-home methods, but as a way to teach individuals how to prepare meals with the tools and ingredients that they have readily available.

The NIH study was inconclusive, then, and although suggesting possible links between mental health and cooking interventions, cannot be considered a ringing endorsement for cooking with your own therapist in your own home. One other study provides insight into the possibility that cooking therapy in the context of a group setting could have benefits for mental health. Heather Nickrand and Cara Brock, of AMITA Health Alexian Brothers Medical Center and Roosevelt University’s College of Pharmacy (2017) reported on their experience in running a “Cooking for One Series” as part of a bereavement counseling program in a hospice. This program was designed for individuals who were experiencing complicated grief reactions, in which their psychological symptoms following the death of a loved one produced painful feelings in the course of carrying out the everyday activities involved in running a household. By combining cognitive-behavioral therapy, conducted in a group setting, with instruction about meal planning and preparing, the authors believed that they could facilitate the grieving process while at the same time helping individuals maintain a healthier approach to food. In other words, the “Cooking for One Series” provided the components of a grief support group in a culinary setting.

Clearly, then, the group cooking workshops were intended to improve psychological functioning by alleviating unresolved grief, but these were not conducted within the home. The series included teaching the participants chef-demonstrated recipes, sessions in which individuals worked in pairs while they baked holiday cookies, a demonstration session on weekly meal planning, and a summer barbecue, led by a chef, but conducted in pairs. The cognitive-behavioral element involved helping participants address their irrational thoughts about not being able to live without a loved one, process memories of their loved ones without losing the ability to carry on in their daily activities, and re-establish their sense of identity as they “readjust to a new normal without their loved one and discovering a new sense of meaning, purpose, and happiness” (p. 182).

As described in the Nickrand and Brock report, the intervention was favorably received by participants. The program has become highly successful, and there are often waiting lists of people attempting to sign into the workshops. However, as the authors point out, there were no formal attempts made at program evaluation, nor were there any experimental controls or even outcome measures. Therefore, the study also fails to meet even the minimum criteria needed to be able to support the claim that culinary grief therapy is superior to cognitive-behavioral, or any other kind, of intervention.

To sum up, food-related activities involving shopping, cooking, planning, and, of course, eating, can serve as useful tools for helping individuals feel better about themselves, enjoy shared experiences with others, and adopt desirable health habits. However, with unproven efficacy, it would be wise to wait until the data are in before you and your therapist put on your aprons.

References

Farmer, N., Touchton-Leonard, K., & Ross, A. (2018). Psychosocial benefits of cooking interventions: A systematic review. Health Education & Behavior, 45(2), 167–180. doi: 10.1177/1090198117736352

Nickrand, H. L., & Brock, C. M. (2017). Culinary grief therapy: Cooking for One Series. Journal of Palliative Medicine, 20(2), 181–183. doi: 10.1089/jpm.2016.0123