In the adult comedy TED, a handsome, strong alpha male specimen, becomes emotionally attached to an unusual character, a much smaller in size but cute teddy bear, wise beyond his apparent years, in spite of relying a bit too much at times, on a rather ‘colourful’ vocabulary to make his point. The unlikeliest friendship is starting to evolve where our main character, the ideal alpha male, learns to rely on his best friend TED, during episodes of crisis and more.
Before understanding where and how TED comes in, it is important to explore the context and the current clinical climate. The standard approach to the treatment of psychopathology is rooted in the medical-disease model (MDM) which is essentially a causal model. In the case of depression and anxiety, the most common pathologies, those disorders occur (according to the MDM), as a result of a chemical imbalance or insufficient amounts of neurotransmitters like serotonin, norepinephrine and/or dopamine. As such, depression and anxiety are treated by replenishing these neurotransmitters with SSRI medication that helps specific brain cells or neurons either produce more of the chemicals or stop the chemicals from being broken down after they are produced, so that they remain in the system a little longer. This is the concept behind SSRI medication treatments – which is short for Selective Serotonin Reuptake Inhibitors. SSRIs are by far, the most appropriate medication for depression and/or anxiety to date, according to data.
However, recent research also points towards the limitations of the traditional medical-disease model. It appears that 95% of body’s serotonin, aka the ‘joy’ chemical, is produced in our gut, which is an extremely sophisticated system responsible for more than just straight forward digestion. The human gut is populated by microbiome, which is among other things, producing GABA (gamma-aminobutyric acid), a neurotransmitter that helps us feel calm and relaxed. And this is why our gut health is closely linked to our mental health. It suddenly becomes clearer why certain diets are more effective than others and, have a positive impact on mental health. An individual can support the gut diverse microbiome by eating foods which contain live bacteria, for example natural sources of pre & probiotics like Greek yoghurt, kefir, garlic, green bananas or sauerkraut.
Diving deeper into the area of affect regulation – emotional regulation or self-regulation, refers to our ability to exert control over our own emotional state. It may involve cognitive-behavioural, attention-training or imagery-based methods for example, self-hypnosis, self-to-self dialogue, rethinking a challenging situation to reduce anger or anxiety, hiding visible signs of shame, sadness or fear, or focusing on images that create a sense of joy or peace.
‘TED’ was introduced to the therapy scene more than 15 years ago as a self-regulation tool that brings attention to the Body-Brain-Affect triangle which significantly impacts on the quality of our lives and health overall according to the most recent research.
TED is like a personal guide, an imaginary trusted friend or simply a checklist with a series of specific reminders and actions which may be summarised in one statement: ‘Tired – Exercise – (and) Diet your way out of trouble!’
The “T”
“T” or ‘Tired‘ is the character symbol that represents being physically tired and exhausted which ought to remind us of the need for some basic sleep hygiene. It is perhaps, also symbolic of a new beginning by saying to yourself, ‘ aren’t you tired of it all ? Well then let’s sleep, exercise and diet your way out of this pickle…’
It is extremely well evidenced by now, that sleep deprivation is the number one risk factor for a range of mental health problems. In 20 to 30 years of research, we have not been able to discover a single psychiatric condition in which sleep is normal and this fact has taught me everything I need to know about this interesting relationship between healthy sleep and our mental health. I’m sure everyone has visited a friend who is also a parent on a bad day. Your friend looks up at you, holding their crying child, and they might explain to you that they all just didn’t sleep well the previous night. Parental knowledge that bad sleep the night before equals bad mood and emotional reactivity in regulation the next day is interesting. Sleep scientists became fascinated by this link years ago but could not really unearth the basic science that would help us explain what was going on. A team of experts at Berkley University conducted an initial study where they took two groups of healthy people with no signs of psychiatric illness or emotional instability. One group had the benefit of a healthy sleep, whilst the other group was sleep deprived. The following day, they had brain scans whilst being exposed to a whole range of emotional and unpleasant visual images. Scientists were looking at how the brain was reacting to those emotional experiences with sleep versus without sleep. The structure that they initially focused on, is called the amygdala a peanut size region situated closer to the spine for easier communication with the body. The amygdala seems to be one of the centre regions, though not the only one, for the generation of emotional reactions both positive and negative. And this fact is interesting in itself, since for many years, it was believed that this region is in charge of ‘fear’ and negative emotions only. So, people are being shown images with varying degrees of emotionality, including images that are known to evoke negative averse emotions, like fear, anger, disgust, revulsion and so on. It became almost immediately evident that, the sleep deprivation group increased the activity in the amygdala to such images by 60% – and this is relevant because we now have evidence that contexts or situations that previously do not feel particularly emotional would start to become rather emotional (leading instantly to states of negative arousal) when/if individuals are not getting sufficient sleep, because of a reactive amygdala and heightened sensitivity of the initial triggering of the emotional response. The reason for a reactive and uncontrolled amygdala during an episode of sleep deprivation lies within another structure – the medial prefrontal cortex, the frontal lobe, located between our eyes which, with a normal night of good sleep, remains strongly connected to the amygdala. It appears that, the human frontal lobe is very good at acting like a rational-control-mechanism on our deep emotional brain centres. But without sleep, the connection is severed and therefore without sleep individuals become emotionally sensitive and reactive with very little regulatory control.
To make matters worse, during a typical psychotherapy session, nobody seems to want to talk about sleeping patterns, although it is crucial for emotional regulation. It may be useful to not only identify the challenging aspects of sleeping well, but to also to identify some of the benefits that sleep can provide in the longer term.
Sleep training ought to be within the repertoire of every therapeutic plan. The basic rule of thumb is 8 hours of sleep during the night – and I mean during the night ! This is the time when metabolism switches off, the digestive system slows down, though different parts of the brain remain active, processing, re-organising data and memories and rebooting. The regulation of sleep is processed by the homeostatic physiology of the circadian rhythm, the sleep-wake cycle. Circadian rhythm is the 24-hour internal clock in our brain that regulates cycles of alertness and sleepiness by responding to light changes in our environment. As such, it is important to sleep during the dark hours, and this is easier said than done during the shorter summer nights. No strength training and definitely no food three to four hours (and even longer in some cases) before falling asleep would help improve the quality of the sleep with a direct impact on your bloodwork (blood test results).
Please consider following Dr Matt Walker’s research in this particular area; Dr Walker is a professor of Neuroscience and Psychology at the University of California, Berkeley, founder and director of the Center for Human Sleep Science, he delivers excellent presentations and workshops on a range of sleep relating topics.
The “E”
‘E‘ or ‘Exercise‘ is a symbol for physical strengthening and the need to exercise on a daily basis. Again, it has been shown time and time again that a daily regular routine does not only boosts the immunity but helps with hormonal regulation, protein synthesis (much like sleep does) and can help with a range of, if not all mental health conditions. In the following section ‘D’, we will explore the positive impact that muscle size and growth has on our glucose levels (and vice-versa), which brings further evidence that physical, in particular muscle-strengthening exercises, have indeed an impact on both our physical and mental health states.
This is in fact, in line with evolutionary theories since, it is clear that human bodies have not been built around static jobs and sugar-rich foods but on the contrary, humans evolved by being creatively active, often aggressive, which implies physical strenght, healthy and, thirsty for adventure and discovery. Humans used to be and, hopefully still are, the most ‘curious’ mammal species on earth. It is arguably this curiosity, alongside inner resilience and outer physical strength, that helped humans push boundaries and eventually ensured total domination of the world, as we know it.
Of course, it is important to remember that physical strengthening programmes ought to be individually tailored to age, sex and physical ability. And within the context of a (NA-CBT) therapy session at least, the advice must include not only muscle strengthening or ‘tensing’ exercises but also ‘muscle relaxation’ exercises. Because what tenses up has to also come down, in order to recover and, start again! This is usually achieved through a process called ‘Progressive-Muscle-Relaxation’ (PMR), consisting mainly of abdominal breathing and a focused attention. During this exercise, which was firstly introduced by Edmund Jacobson in the 1930’s, attention is gradually directed towards different muscle groups, tensing and relaxing different muscles and thus learning firsthand how feeling ‘tense’ versus feeling ‘relaxed’ actually feels. This would eventually train our mind and brain to recognise stress in the body, identify the exact location and de-stress the muscle by simply breathing the tension out of it. Certain types of Yoga and Mindfulness programmes are very useful in that regard and designed for this very purpose. And so, ideally and when physical health allows it, one should train daily and alternate between muscle strengthening exercises and relaxation or destressing-attention-training exercises like PMR, yoga or mindfulness.
It is equally appropriate to consider a condition-specific sport. For example, martial arts training would be particularly appropriate for someone who struggles with confidence, assertiveness or low self-esteem. Whereas social anxiety might be better aided by a team sport. At the other extreme, body building might not be appropriate for a male that suffers from BDD (or body dysmorphic disorder).
The “D”
‘D‘ or ‘diet‘ refers of course, to eating and drinking – the link between nutrition and mental health disorders is surprisingly straight forward and supported by a long list of studies and data, of course outside the field of psychology, where this field is largely ignored.
This is a significant oversight since evidently humans’ relationship with food is complex and integral to our survival. But humans relationship with food goes far beyond mere survival. Unlike other animals, we attach deep cultural, emotional, and even spiritual significance to what we eat. Fasting is a perfect exampleโit exists in many religious traditions, not just as a means of physical discipline but as a tool for spiritual growth, self-purification, or even social solidarity.
Food also plays a role in identity, social bonding, and rituals. Think about how different cultures celebrate major life events like weddings, funerals or holidays, all with very specific foods that carry particular meaning. Even our personal comfort foods often tie back to childhood memories and emotions. One could argue that cultural influence sometimes overrides nutritional logic. For instance, people might continue eating traditional diets even when theyโre not the healthiest option.
There is a growing body of research showing an association between our diet, internal inflammation and depression, pointing in particular toward a Mediterranean style diet which can lead to a 30% reduction in symptoms of depression, alongside 40% improvement in cognitive flexibility. This is related to internal inflammation which contributes to the activation and maintainenance of mental health symptoms. Inflammation is dangerous and could lead to many health complications associated with chronic conditions such as insuline resistance, pre-diabetes, diabetes, large deposits of visceral fat, cardiac problems, etc. Healthy diets are anti-inflammatory and, are rich in B-vitamins and folate which is equally important for brain function. It has been demonstrated that a healthy diet helps improve neuroplasticity which in turn improves new learning and cognitive flexibility.
Let’s examine another area of particular relevance. According to WHO, at least one billion people in the world have diabetes or pre-diabetes, mainly characterised by unhealthy glucose levels (spikes) and insulin resistance. The interesting thing about diabetes is that it does not have many aggressive physical symptoms to begin with, but a lot of mental health symptoms such as worry, other types of negative thinking, sleeplessness, irritability, short temper, lack of motivation, lower libido, low confidence, in other words recurring episodes of depression and/or anxiety. So, this condition often goes under the radar, until eventually discovered by accident. At the same time, most mental health practitioners would not be inclined to request a blood test during the initial consultation. And yet, treating the patient for depression or anxiety without dealing with the underlying chronic condition, cannot possibly lead to long lasting positive outcomes.
Consuming large amounts of foods, rich in sugar or carbs (carbohydrates) or starches (white bread, rice, pasta, potatoes, etc.) is very easy these days, those are widely available, cheap and tasty and, even comforting, not least because all such products lead to the release of high levels of dopamine which translates affectively into ‘pleasure’ and eventually an addiction to specific glucose rich products. In fact, the neurobiological and behavioural process is not much different from an addiction to alcohol or cocaine.
Sugar addiction is indeed a ‘thing’ and probably the modern world’s number one enemy. Here is why… Glucose in excess is stored in the form of fat which leads to an array of chronic problems including faster aging of various organs, diabetes and cardiac complications alongside mental health symptoms from the depression and anxiety spectrum. Glucose is in fact useful, even essential to the human body since it ought to provide the right amount of energy in order for the organism to survive and thrive, but when you have too much of it, the body eventually collapses under the pressure, much like a plant that is watered too much and drowns. At some point, one continues to ‘need’ sugar since the organism is addicted to the glucose but ironically the individual feels weaker and less energised because after years of sugar-abuse, one becomes overweight, suffering with diabetes or cardiac problems or worse.
There are basically several processes that take place in the body when one experiences regular glucose spikes. Glucose is over-supplied and stored into fat cells for later use, this increases inflammation in the body and accelerates the process of glycation, which is an aging of the cartilage. This translates into the internal aging of various organs and externally, the aging of the skin and, this is just for starters.
In response to excessive glucose, the pancreas sends a hormone called insulin out in the body, to grab all the extra glucose molecules and store them away, so they do not cause any damage. The insulin therefore, stores glucose into the liver, and muscles and then, when those are fully stocked, the insulin starts storing glucose away into fat cells which is one of the ways that an individual builds a lot of visceral fat. Muscular people and those who practice sports regularly are at an advantage at this stage, because big muscles need more energy. But for everybody else, the insulin itself has consequences and is the main driver of type-2 diabetes and insulin resistance.
What happens inside the gut is equally fascinating and gives a whole new meaning to the saying ‘Trust Your Gut‘. Scientists, like Dr Maya Kaelberer and colleagues, have established clear links between our gut and the brain, not necessarily through an analysis of the diversity of the microbiome that exists within our gut, although this would be equally relevant but also by paying attention to the actual structure of the gut at a cellular level. Dr Kaelberer discovered a pathway from the gut directly to the brain that essentially allows sensing of what is happening in the gut in order to inform specific ‘feelings’ of pleasure or disgust or cravings, which is incredible, and it partly explains why regular practising of mindfulness or paying calm attention inwards, could lead to a shift in feelings and better emotional regulation. This process happens via neuropod cells with electrical sensors within the gut structure that are able to select and specialise in various chemicals like glucose or amino acids, they organise digestion and send information (electrical signals) to the brain which will make further โinformedโ decisions and it would eventually provide an individual with the full experience of what it means to consume sugar, both the pleasure and increased energy. Experiments on mammals like mice, have shown a preference towards sugary-water over aspartame-water which suggests that even though both type of liquids are sweet, gut cells have adapted for the full experience of glucose resulting from proper sugar and therefore the proper sugar-water is chosen every time even in the absence of other conditioning stimuli, like prettier labels, packaging and so on. Some cell sensors have even adapted to detect the temperature of a hot cup of tea and adjust the temperature within two seconds in order to accommodate the liquid inside the gut and successfully extract necessary nutrients.
So, the secret has been out for some time… indeed, you are what you eat… and research clearly shows that how, when and what we eat and drink throughout the day makes a difference to our mental health. On apositive note, this seems to be an area of growing interest, and as such, the internet is simply overwhelmed with interviews, podcasts and articles on this topic. With the risk of sounding like a broken record, I would attempt to recount some fun facts from recent research studies that correlate wellbeing with nutrition and have clinical implications for therapists.
About the all-important “C“
In addition to considering the impact that a daily diet has on mental health, research has also started to focus on the role of specific vitamins and minerals. Vitamin C is one such micronutrient that has drawn significant attention in the diet and well-being landscape. Vitamin C is in fact one of the few hormones that humans do not naturally produce, hence our predisposition to fruits and vegetables. In fact, if one considers the human anatomy, we could easily notice that we are a particular type of mammal lacking in the department of adequate equipment for the consumption of tough or raw animal meat. Most of us, do not possess strong fangs or tough long nails, therefore historically, it has always been much easier to rely on a vegetarian or even vegan diet, evidently rich in vitamin C and fibers. Not only that, but this simple water-soluble micronutrient that humans, along with several other species, are unable to synthesize themselves, remains an absolute requirement for a range of important biological functions. This contradiction between an absolute requirement for vitamin C and our speciesโ loss of ability to synthesise it, has been explained earlier, as such our early ancestors relied on diets rich in vitamin C which led to the eventual pruning of genes involved in endogenous vitamin C synthesis. Therefore, vitamin C must be obtained exclusively from diet, principally through the consumption of fruits, vegetables or more recently supplements. Vitamin C acts as an antioxidant and free radical scavenger and is an essential cofactor in numerous enzymatic reactions including that of dopamine ฮฒ-hydroxylase, an enzyme that is central to the synthesis of adrenaline from dopamine. Vitamin C also acts as an essential cofactor in the metabolism of tryptophan, a necessary requirement for the synthesis of serotonin. Altered dopamine ฮฒ-hydroxylase activity has been described in a range of psychiatric conditions including mood and anxiety disorders and disorders of the digestive tract and acute tryptophan depletion has been associated with reduced serotonin levels and lowered mood states. Emerging work in the field of epigenetics indicates that vitamin C contributes to epigenetic modifications in early development which in turn may influence key psychological and physiological outcomes across the lifespan. Reinforcing its role in neurocognitive functioning, the highest concentrations of vitamin C in humans are found in the brain and cerebrospinal fluid and vitamin C is preferentially retained in these areas even when plasma and other organs in the body are depleted of vitamin C.
There are several other important supplements which impact on our mental health, that are currently being investigated including magnesium, zinc, also proteins, and of course links have been established between depressive states and our gut bacteria. Results are conclusive enough for general medicine to at least start paying more attention.
About the “Mg“
Both physical and emotional stress, a constant reality in our multi-tasking society, drain the body of magnesium. In fact, studies show inverse relationships between serum cortisol and magnesium, the higher the magnesium, the lower the cortisol. Stress robs the body of magnesium, but the body must have magnesium to respond effectively to stress. Magnesium deficiency afflicts 90% of all people with ADHD and triggers symptoms like restlessness, poor focus, irritability, sleep problems, and anxiety. These symptoms can lessen or vanish one month after supplementation starts. And furthermore, magneยญsium can also prevent or reverse ADHD drug side effects.
Chronic stress and sleep deprivation due to exam stress impairs the blood flow and reduces intracellular magnesium levels according to observational studies (Takase et al., 2004).
Clinicians found that 125 to 300 mg of magnesium glycinate at meal times and at bedtime produces clinically significant benefits in mood. This form of magnesium is gentle on the digestive tract. 200 to 300 mg of magnesium glycinate or citrate before bed supports sleep onset and duration through the night. We also know that sleep deprivation can deplete magnesium levels and this creates a cycle affecting sleep quality. Observation studies have shown that adults with higher dietary magnesium intake often report better sleep quality.
Magnesium in powder or liquid form could be effective alternatives to capsules, particularly for children with ADHD. Ways to increase the bioavailability of magnesium include supplementing with vitamin D3, which increases cellular uptake of the mineral. Vitamin B6 also helps magnesium accumulate in cells. Taking the mineral in divided doses instead of a single daily dose. Taking it with carbohydrates, with improves absorption from the intestine. And taking an organic form, such as glycinate or citrate, which improves absorption by protecting the mineral from antagonists in the digestive tract. It may be best to avoid giving magnesium in enteric-coated capsules, which decreases absorption in the intestine. Magnesium oxide is poorly absorbed and tends to cause loose bowels. Magnesium-l-threonate has been shown to readily cross the blood-brain barrier, and animal studies show that it supports learning ability, short and long-term memory and brain function.
It may be important to highlight, that the therapeutic response to magnesium normally takes several weeks, as levels gradually increase in the body.
Although a lot less research on this topic is carried out in the UK in the US there is a growing interest. A cross-sectional, population-based data set, the National Health and Nutrition Examination Survey, was used to explore the relationship of magnesium intake and depression in nearly 9,000 adults. Researchers found significant association between very low magnesium intake and depression, especially in younger adults. And in a recent meta-analysis of 11 studies on magnesium and depression, people with the lowest intake of magnesium were 81% more likely to be depressed than those with the highest intake.
About the fatty acids “Omega-3“
Significant research supports the consumtion of anywhere between 1000-2000mg daily of Omega-3 fatty acids, found in fish oil (supplements or natural sources). It has been shown to have significant effects on focus and concentration levels as well as levels of depression. EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid) found in Omega-3, are equally beneficial for heart health and help reduce internal inflammation.
Research specifically indicates that supplementation with around 1000 mg of EPA daily can provide relief from depressive symptoms comparable to some traditional antidepressants like SSRIs. In studies, 1000 mg of EPA was found to be as effective as fluoxetine in reducing symptoms of major depression 1. EPA is thought to exert its effects by influencing neurotransmitter systems and reducing inflammation in the body, which has been linked to mood regulation. Studies have shown that higher dietary ratios of omega-3 to omega-6 fatty acids can result in significant mood improvements, potentially lowering the risk of depression 1. It has been suggested that individuals consider taking 1000 mg to 2000 mg of EPA daily for optimal mood enhancement. Additionally, some individuals may find that combining EPA with lower doses of SSRIs could enhance the overall antidepressant effect and reduce side effects associated with higher SSRI doses 2. Overall, the inclusion of omega-3 fatty acids in one’s diet can be a valuable strategy for improving mood and managing depressive symptoms, suggesting a multifaceted approach to mental health that combines dietary, exercise, and therapeutic techniques.
And finally… “Creatine“, not just for athletes !
Creatine, a naturally occurring compound known for its role in energy metabolism, has long been used as a dietary supplement to boost physical performance. It plays a key role in producing adenosine triphosphate, the main energy source for cells, which is critical for maintaining optimal cellular function, especially during periods of high energy demand. Recent clinical studies have started to explore creatineโs antidepressant potential. Both animal and human trials have shown early evidence of creatineโs positive effects on mood. In animal models of depression, creatine has been found to reverse depression-like behaviors, improve brain plasticity, and modulate key areas of the brain involved in mood regulation, with some trials in particular, indicating that creatine can improve symptoms of major depressive disorder and bipolar depression, especially when used alongside standard antidepressant treatments such as SSRI’s (Juneah et al., 2024).
So what do we really know and what can we do about it…
One of the most compelling frameworks within NAโCBT is the TED module, which uses an imaginal friend or a personal coach or a guide to help maintain focus on a daily basis on essentially what could only be described as significant lifestyle changes that aim to improve health and immunity overall as well as psychologically increase self-appreciation and self-love. Tiredness, Exercise, and Diet, each of these areas have strong empirical links to emotional and cognitive wellbeing.
Tiredness (lack of sleep):
Poor sleep disrupts both emotion regulation and brain function. Insomnia is strongly linked to heightened emotional reactivity, reduced cognitive control, and increased risk for mood disorders (Baglioni et al., 2011; Goldstein & Walker, 2014). Research shows that high sleep quality is associated with more effective use of adaptive cognitive emotion regulation strategies, such as reappraisal, which are in turn linked to lower self-reported levels of depression and anxiety (Palmer & Alfano, 2017; Kalmbach et al., 2018). Conversely, sleep deprivation impairs top-down regulation mechanisms like distraction and reappraisal, leading to heightened emotional reactivity (Ben Simon et al., 2020; Mauss et al., 2013). NAโCBT therefore prioritizes sleep tracking and the promotion of restorative sleep within its treatment model.
Exercise:
Aerobic and regular physical activity produce significant benefits for emotional health. These include improved emotion regulation, reduced stress hormones, enhanced mood, and reductions in depression and anxiety comparable to psychotherapy or pharmacotherapy (Craft & Perna, 2004; Kandola et al., 2019). Exercise improves neurotransmitter balance (e.g., serotonin, endorphins), increases BDNF (brain-derived neurotrophic factor), and reduces cortisol levels, enhancing neuroplasticity and emotional resilience (Phillips, 2017). A large meta-analysis found that combining exercise with CBT improved depression outcomes more than CBT alone (Stathopoulou et al., 2006).
Diet:
Diet quality, especially one rich in fruits, vegetables, whole grains, and omega-3 fatty acids, predicts better mood, reduced symptoms of anxiety and depression, and improved emotional resilience (Lassale et al., 2019; Jacka et al., 2010). Although the evidence base for diet as a standalone treatment is less extensive, it is increasingly recognized as a major contributor to mental wellbeing. For example, in a study of the “Big Three” predictors of mental health, sleep quality emerged as the most important, but both physical activity and healthy diet significantly contributed to lower depressive symptoms and greater overall flourishing (Conner et al., 2017). Nutritional psychiatry has also linked ultra-processed diets to increased systemic inflammation and poorer mental health, while whole-food diets support improved mood and cognition (Marx et al., 2021).
It may be equally important to understand that an increase in fibers, proteins and pre/probiotics in parallel with a significant decrease in glucose-based products, including carbs will bring a lot of benefits to mental health and reduce internal inflammation, improve immunity and decrease the chance of telomere degradation, associated with age-related diseases.
A recent cross-sectional study surveying university students found that poor sleep, suboptimal diet, and low physical activity were independently associated with worse cognitive function, emotional regulation, mood, and stress resilience (Schlitt et al., 2022).
Implications for Psychotherapy Practice
Lifestyleโmental health integration: The TED model (Tired, Exercise, Diet) highlights modifiable factors that strongly influence craving intensity. Therapists can incorporate sleep hygiene, physical activity, and mindful eating into treatment plans, reinforcing how daily habits affect emotional regulation and impulse control.
Craving as learned response: By framing cravings as conditioned associations between flavors, energy states, and reward pathways, therapists can apply established behavioral techniques (exposure, response prevention, habit reversal) to weaken these associations.
Psychoeducation tool: TED provides a simple language to explain to clients how body states drive cravings, reducing self-blame and empowering clients with self-regulation strategies.
Motivation and self-efficacy: A structured model allows therapists to set small, trackable goals (e.g., improving sleep regularity, reducing ultra-processed foods, introducing movement) that can strengthen self-efficacy and reinforce broader therapy progress.
Integration with Neuroscience: The TED model, integrated into NeuroAffective-CBT, represents a natural progression in psychotherapyโs dialogue with neuroscience. By explicitly linking lifestyle-driven neurobiological states (e.g., sleep-hormone regulation, dopaminergic modulation via exercise, gutโbrain signaling through diet) with cognitive and behavioral processes, it enriches the therapeutic toolkit with embodied, brain-based leverage points.
This emphasis dovetails with third-wave approaches such as ACT and DBT, which already foreground acceptance, mindfulness, and values-based action. TED/NA-CBT add a physiological grounding to these practices, showing how shifts in bodily states can either amplify or hinder psychological flexibility, emotion regulation, and distress tolerance. In this way, TED and NA-CBT are not alternatives but extensions, providing therapists with a language and structure to operationalise lifestyle neuroscience within established third-wave paradigms. The broader implication is the emergence of what could be called a fourth wave of CBT:
- First wave: Behavioural conditioning (observable learning).
- Second wave: Cognitive restructuring (thoughtโemotion links).
- Third wave: Contextual and acceptance-based models (ACT, DBT, mindfulness).
- Fourth wave (emerging): Neuroscience-informed, embodied CBT, explicitly integrating brain, body, and lifestyle science into psychotherapeutic practice.
- This โfourth waveโ is not about replacing previous waves but synthesising them, using neuroscience as a unifying lens to explain why behavioural and cognitive interventions work and how therapists can amplify their effects by attending to bodily states.
- Forth wave CBT ought to also evolve and include an understanding at both micro (interanal world) and macro level (external world). For instance what are the true implications of the recent digitalisation of life and the increase reliance on AI platforms, how can this be used effectively in therapy.
Final thoughts…
By embedding empirical findings into the TED framework, NAโCBT demonstrates both depth and scientific integrity, bridging theory, neuroscience, and lifestyle-based interventions. This strengthens the modelโs relevance to contemporary therapeutic challenges, indeed a worthy model belonging to the the latest wave of cognitive and behavioural therapies. Within the new field of NeuroAffective-CBT, TED is one of the most compelling self-regulation frameworks. It uses the idea of an ‘imaginal friend‘ or ‘inner guide‘ to help the client stay focused on daily choices that support meaningful lifestyle changes at a micro and macro level. These changes strengthen both physical health and immunity while also building psychological resilience, self-appreciation, and self-love preparing the individual for confident relationships in the future.
It has been evident for some time that a better sleep, a healthier diet and more physical activity can improve our health overall. We now know that, the big three – T, E & D (aka my good friend TED) can no longer be separated from our need to evolve and remain balanced. We still do not have a clear idea about all of the mechanisms involved, and what is worse, research is divided, confusing and split between different areas of interests within medicine. However, the good news is that we know enough already to make informed and correct decisions and new research, alongside non-intrusive technology offer incredible insights.
A final and very important reminder – these articles do not aim to substitute real professionals or live clinical assessments. Regular bloodworks and health-checks via GPs or family doctors are a must post-adolescence but not only, if we are to consider a consistent increase in the incident of diabetes reported within the adolescent population. It would be wise to use regularly a personal trainer, a qualified a nutritionist or even consider an assessment with your NeuroAffective-CBT therapist, who will no doubt look at your bloodwork and try to understand how your lifestyle, daily choices and habits, impact on your mental health. Supplements in general, cannot and should not, replace psychiatric medication they operate differently and at a completely different level. However, some of the supplements mentioned in this article would very likely improve your prospects and perhaps bring you closer to your goals and health aspirations.
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