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About

"I hope you tell kids that this really does work and I am an example."

Lifting the Fog of Depression

Freer's first outcome research effort was a doctoral dissertation by Steven Wall in 1992 No. 1.) Steve wanted to know whether Freer was effective in treating depression. Using the Beck Depression Inventory, he found that:

While Steve's answer had to be tentative due to its small client number, three subsequent studies have also explored depression and, taken together, have come to a solid "yes."

A 2002 Ph.D. dissertation by Dr. Jeff Clark (No. 8), using the MACI (Millon) and a sample of 70 Freer clients, showed that the four Millon scales dealing with depression all showed significant decreases in depressive feelings and symptoms over the three weeks of a Freer trek, and in each case the effect size was large. ("Statistical significance" indicates how likely it is that the observed results were produced by chance; .02 indicates the results could be a product of chance two out of a hundred times. "Effect size" indicates how large the observed change was: an effect size of 0.5 to 1.0 is considered moderate, 1.0 to 2.0 is large, and over 2.0 is very large.) Those Millon scales, and their effect sizes, were Doleful/Depressive, 1.29; Depressive Affect, 1.19; Suicidal Tendency, 2.07, and Self-Devaluation, 1.53.

In 2004 Amy Nortrom, a Freer wilderness therapist, finished her excellent M.A. dissertation on depression treatment at Freer. (No. 11.) Amy used both numerical test data to establish that the clients were improving from a statistical point of view, and her own very good clinical skills to give beautiful qualitative descriptions of how several of those clients worked with their depression (and other issues) on treks on which she was their therapist.

Amy's qualitative descriptions of her clients' changes over their three week treks give meaning to the statistical changes. Her work with one of her clients, "Richard," is described below.

One of Amy Nortrom's clients in her dissertation study, whom she calls Richard (not his real name), she describes as defensively non-communicative in his first week. He was both depressed and addicted to marijuana. "In the second week, Richard was able to identify that he felt empty and hopeless and lacked passion in his life.... Richard struggled to connect with himself on a deeper emotional level and often remained numb and unexpressive... He stated, 'I want to feel more like a part of my family; like I know what's going on in my parents' lives and they know what's going on in mine.'" Richard and his family decided together that he should stay with the program for its four-week Extended Expedition, and by the end of his seventh week his depression score had dropped significantly, he was feeling much better about himself and more open, and he was able to go home and stay sober and feel good about managing his life and his relationships more successfully, instead of just watching them happen to him.

A large-scale research project published by Keith Russell in 2006 (see below) drew 872 clients from five OBHRC programs, including Freer. The depression part of that study showed that of 79 clients who entered wilderness treatment as "extremely severely" or "severely" depressed, 45 (57 percent) were less or no longer depressed after treatment. (No. 20c.)

That left one question open. Depression is a mental health problem that can fluctuate from month to month or even hourly at times. Not surprising that our kids felt good after living outdoors for several weeks. How about months later; were they still feeling better? The OBHIC clients in Dr. Russell's study answered the same questions about depression six months later, and their scores showed that the girls were feeling substantially less depressed than when they left Freer, though the result did not quite reach statistical significance. The boys were feeling even more improved, and the change in their scores was statistically significant.

So we can feel confident that wilderness therapy at Freer can alleviate depression for most adolescents, and that for most of them the results are lasting. This is intuitively obvious to those of us who work as therapists and guides for Freer, because so much of what happens for young people living outdoors is exactly what is prescribed for treatment: plenty of long muscle exercise, interesting activities and social interactions, exciting events when possible, successfully taking care of one's daily needs while also getting dependable support from people who care about you, healthy food, good sleep at more or less regular hours. We watch one or more kids emerge from the fog of depression on almost every trek. And we reinforce the natural effects of living outdoors with caring people by teaching our clients what it is that is helping them get well, and how they can continue that when they get back home. We pass on that same information to their parents in our weekly telephone contacts and our all-day end-of-trek meetings, so that they can help their children maintain those gains.

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