A comparative study recently published in the Community Mental Health Journal evaluated two approaches to treating depression and anxiety symptoms in young adults, a 13-week program with overlapping biopsychosocial components and outpatient psychiatric care that included medication only. The research team, led by Shannon Hughes of Colorado State University, looked at both the short- and long-term effects of both treatment approaches.
The results showed that the biopsychosocial, holistic treatment program had significant effects on the relief of symptoms of depression and anxiety after the intervention was completed and two months after the intervention. The intervention results with drugs only were independent and comparatively poor – which shows that[n]o Indications of changes in each result. “Although the comprehensive treatment program can be more resource-intensive than drugs alone because of its comprehensive nature for customers and providers alike, these results are compelling.
“The model of medical illness in relation to distress and the associated psychiatric diagnoses has been criticized because it is too reductionist, rejects complex life experiences and has no scientific validity. There are innumerable ways to understand and process psychological and emotional stress in such a way that a psychiatric diagnosis and the use of medication are not favored, and young people in particular indicate preferences for such approaches. “
Depression and anxiety are both considered internalization disorders that differ in symptomology and effects. They share many similarities in terms of cause and representation (e.g., social determinants and implications) and popular treatment strategies (e.g., cognitive behavioral therapy and pharmacological intervention). Although the identification and intervention efforts associated with both have intensified in recent decades, research suggests that the prevalence in young adults continues to increase.
According to a 2017 study cited by Hughes and colleagues, 12.7% of young people in the US over 12 years old reported taking antidepressants in the past month. Despite questionable evidence of efficacy, the potential for complex side effects, and growing evidence of lifestyle and behavioral treatment approaches, psychiatric drugs remain a common intervention strategy.
“Safety concerns, including suicidal ideation and behavioral toxicity, are routinely underestimated in drug-funded clinical trials of antidepressants and other psychiatric drugs, suggesting that antidepressant prescribing practices may be based on flawed evidence of relative benefits and harms.”
Hughes and colleagues’ project extends previous research by integrating a range of research-backed elements into a single, discrete, holistic program – the Learning & Self-Development Collaborative (LSDC) – to combat anxiety and depressive symptoms. In this study, the participants in the comparison group were exposed to antidepressants as an alternative due to their popularity in standard outpatient treatment.
The LSDC is a comprehensive treatment program that includes nutritional, exercise and psychosocial elements. Since the participants needed a lot of time and commitment, those involved in the study by Hughes and colleagues received a financial grant to offset the burdens involved.
LSDC challenges the medical model by focusing on naturopathic techniques, awareness-raising, and the emphasis on active participation through engagement in individual and small-group service and participation in community-based activities.
“The participants in the program group were registered […] in a package of services over 4 months including: (1) An evaluation and three monthly follow-up visits with a naturopathic doctor for coaching on diet, sleep, and lifestyle that can affect mood. (2) a daily supply of a comprehensive multivitamin and multi-mineral supplement as well as a medicinal grade fish oil supplement […], (3) a weekly non-clinical group of trained facilitators who offer six units of an awareness curriculum alternating with seven weeks of peer support, and (4) a monthly grant of $ 100 (total of $ 400) for community-based activities for participants . choose. “
A sample of young adults, ages 18-26, was recruited through social media, community flyers, and referrals from vendors. Screening measures were carried out to determine suitability (ie the extent of symptoms of depression and / or anxiety) and to sort participants according to treatment conditions.
Those who met the eligibility criteria were assigned to the holistic intervention group if they did not use psychiatric drugs or only used them rarely within the last 60 days (n = 26), or if they reported daily or almost daily psychiatric use (n = 13) . Both groups were demographically similar – predominantly white and female.
The study results were assessed using self-report measurements on depression, anxiety, quality of life (QoL), physical QoL, psychological QoL, social QoL, empowerment and social connectedness. Within the holistic LSDC treatment group, significant improvements in all areas except physical and social quality of life were observed at the end of the intervention.
Significant improvements in depression, anxiety and psychological quality of life were also achieved two months after the intervention. Immediately after the intervention or two months afterwards, no significant effects were observed in the comparison group for drugs only. Follow-up focus groups were also carried out to clarify the areas of impact.
“In follow-up focus groups, participants highlighted the following key components of the program: personal hygiene through diet and lifestyle, maintaining relationships with oneself and others, promoting social connections and activities, validating lived experiences in a non-judgmental manner, and taking a holistic approach . “
The main limitations of this study include a lack of randomization, small and uneven treatment group sizes, characteristic differences between groups (i.e. socioeconomic factors), possible pre-intervention perspectives on psychiatric drugs, and the overall homogeneity of participants.
Components of the holistic treatment approach of LSDC can also be difficult to make accessible to those who could best benefit because of its comprehensive structure. However, this study adds to an ever-growing body of evidence that interventions that target lifestyle and behavioral factors can provide significant relief to young people with symptoms of anxiety and depression.
“A holistic self-learning model based on diet and lifestyle, self-development education, peer support and activity research is a viable and potentially inexpensive alternative to standard outpatient care for young adults.”
Hughes, S., Rondeau, M., Shannon, S. Sharp, J., Ivins, G., Lee, J., Taylor, I. & Bendixsen, B. (2021). A holistic self-learning approach to depression and anxiety in young adults compared to drug treatment as usual. Community Ment Health J. 57, 392 – https://doi.org/10.1007/s10597-020-00666-9 (Link)