Overview

Anxiety and depression are both mental health disorders that are debilitating and increasingly prevalent in today’s world. Depression is in fact labelled as the leading cause of disability according to the World Health Organization and affects about 121 million people worldwide.¹ Anxiety disorders are also the most common form of mental health disorders, affecting 1 in every 13 people and approximately 301 million people worldwide as of 2019. Despite the high numbers of people suffering from these illnesses, many (39% of adults and 60% of adolescents) do not receive treatment for their depression. There are many possible reasons for this lack of treatment including negative stigma associated with mental health disorders, affordability of treatment and lack of access to treatment especially in developing countries.¹ One treatment option that shows great promise for lessening anxiety and depression and circumvents many of these barriers is recreational therapy. Recreational therapy utilizes activity-based leisure activities to improve patients’ psychological and physical health. This kind of treatment can be effective for mental health disorders by encouraging social activities, promoting active lifestyles and being accessible to all people regardless of background.² This article aims to summarize the evidence for recreational therapy as a treatment for anxiety and depression and detail some of the different forms of this therapy that are being used.

Understanding anxiety and depression

Definition and symptoms

There are many different types of anxiety disorders that affect individuals. While all humans experience levels of worry in their daily lives, those with anxiety disorders experience more overwhelming worry that can end up interfering with daily life. People who suffer from general anxiety disorder experience consistent, unshakeable anxiety around day-to-day things while others such as those with social anxiety, experience extremely intense bouts of situational anxiety.³ Some of the symptoms of anxiety people experience include trouble concentrating and sleeping, irritability, heart palpitations, nausea and shaking. Some anxiety disorders can also cause panic attacks which are the body’s reaction to a sudden onset of extreme panic.⁴ There is also a very clear overlap between anxiety and depression, with both disorders commonly being seen to lead to the other. The prevalence of this intersection can be seen in over half of those diagnosed with depression also experiencing anxiety.⁵

As with anxiety, there are many different types of depressive disorders that affect people of all ages, genders and ethnicities. Major depressive disorder or unipolar depression is characterized by experiencing consistent depressive symptoms for weeks at a time. Some of these symptoms include feeling a loss of interest in hobbies, excessive fatigue, weight loss or gain, disruption to sleeping, feelings of worthlessness and suicidal thoughts.⁶ However, those with bipolar disorder experience depression in the form of depressive episodes that result in mood swings from extreme highs to extreme lows. Some also experience depression as triggered by a certain event or time of the year such as Seasonal Affective Disorder (SAD) or postpartum depression. There is also a less severe form of depression called Dysthymia where sufferers experience general feelings of depression for at least 2 years.⁷ All different forms of depression can negatively impact people in different ways and hinder sufferers from living a full life. 

Impact on daily life

Those with anxiety and/or depression experience negative impacts on their daily lives which reduce their overall quality of life. The symptoms of these illnesses often cause people to withdraw from society and experience extreme loneliness and isolation. Fatigue, stress and hopelessness can also cause people to neglect their physical health as a result. People often find their motivation to stay physically active and to eat in a balanced and nutritional manner to wane which tends to worsen mental health further in a damaging cycle.⁸ Moreover, loss of interest, issues with concentration and feeling overwhelmed with worry can lead to unreliability at work often causing mentally ill individuals to lose their job positions. Overall, anxiety and depression can both cause people to neglect their personal and professional relationships in ways that further isolate them from society.⁹ Various forms of treatment for these disorders are available but many require consulting with healthcare professionals which may not be desired or possible for some people. However, recreational therapy offers an alternative course of treatment which may better suit the needs of some individuals. 

Overview of recreational therapy 

Definition and principles

Recreational therapy involves using activity-based interventions to address a patient's physical and/or psychological recovery. Recreational therapists often facilitate the implementation of this therapy and work one-on-one with patients to monitor their progress within the 5 domains of recreational therapy.¹⁰ The 5 domains include:¹¹

1. Mental functioning - the ability to problem solve and reason 
2. Emotional functioning - awareness of own emotions to challenging situations
3. Physical functioning - becoming aware of overall strengths and weaknesses 
4. Social functioning - awareness of how one acts in social situations
5. Spiritual functioning - awareness of one's own belief system 

Historical context 

Although using recreational activities to boost health can be traced back to ancient times such as being used by the Greeks and Romans, recreational therapy as an official form of therapy only became recognized at the beginning of the 20th century.¹² Since then it has gained popularity and respectability in the field as an effective method of treatment for mental illnesses such as anxiety and depression. Recreational therapy can take many forms including physical activities such as sports, dance and community outings and more creative pursuits such as arts and crafts. 

Recreational therapy techniques

Recreational therapy can take many forms including physical, creative, social activities and even relaxation techniques. Examples of a few different sports that are encouraged as part of recreational therapy are aerobic sports such as swimming, group activity sports such as football and anaerobic sports such as weight lifting. Moreover, other forms of physical activity such as outdoor activities are also encouraged such as hiking and gardening.² Recreational therapy can also take the form of creative outlets such as art therapy including drawing and painting or music therapy. Some recreational therapists may encourage participation in group activities such as volunteer work or group games. Lastly, mindfulness-based techniques have also been adopted such as meditation.¹⁰

Benefits of recreational therapy for anxiety and depression 

There are many ways that recreational therapy can benefit people suffering with mental illnesses. Participation in many activities can promote the release of mood-boosting hormones such as endorphins and dopamine. Physical activity specifically has been shown not only to improve patients’ overall physical health but also to stabilize serotonin levels which is known to relieve symptoms of depression where serotonin levels are abnormally low.¹³ In general, recreational therapy can also provide patients with a sense of purpose, encourage the formation of supportive and fulfilling friendships and provide a healthy distraction from the difficulties of living with a mental illness.

Case studies and research evidence

Many studies have shown physical exercise to reduce the symptoms of anxiety and depression. One such study showed that 2 thirds of depressed patients participating in a 3-month aerobic exercise program for cardiac rehabilitation reported significantly improved symptoms as a result.¹⁴ Anaerobic exercises’ potential to treat depression was also tested by a study where 21 women experiencing depression were either assigned to participate in 21 weeks of strength training or to a control group. This study found that the women participating in the strength training program reported a reduction in depression compared to the control group, signifying the role of anaerobic activity as a treatment mechanism.¹⁵ Brosse et al provide a reliable and comprehensive review that demonstrates the positive effect that exercises can have on anxiety and depression. 

Some studies have also shown outdoor activities to specifically be an effective mechanism of treatment. A comprehensive meta-analysis looked at 50 studies that utilized “nature-based therapy” for the treatment of anxiety and depression. This study found that overall, nature-based therapy, especially gardening, lessened the patient’s depressive episodes and reduced anxiety.¹⁶ Specifically, the most effective outdoor recreational therapy was found to be gardening conducted in groups for a minimum period of 12 weeks for consistency. This type of therapy was found to reduce anxiety and depressive symptoms in long-term sufferers. 

Moreover, another systematic review looked at over 75 studies that utilized creative arts as recreational therapy for treating mental illness. These creative studies included 17 art, 13 dance, 4 drama and 4 music-based therapies. Therapies were held consistently for 1 to 2 hours a week over a period of 12-15 weeks on average. The authors found that 51 out of the 75 studies analyzed, indicated the positive effect of art therapy on depression in patients with art being the most effective and music being the least. The most important factor overall however that came to light was consistency in participation in the therapy rather than the medium of therapy itself.¹⁷

Practical considerations and implementation

Recreational therapy holds great promise as a treatment for mental health illnesses but several considerations should be made to maximize its potential. As evidenced by numerous studies, consistency is the key to the success of recreational therapies as a treatment tool and efforts should be made to promote consistency. This is an area where recreational therapists can play an important role in providing support, accountability and monitoring generally to keep track of progress. It is also important to keep in mind that what may work for some may not work for others and that recreational therapy is most effective when used in combination with other forms of treatment such as medication and cognitive behavioural therapy for treating depression and anxiety. 

Summary

Recreational therapy that focuses on encouraging patients to participate in both physical and creative activities has grown in popularity as a potential treatment for mental illnesses such as anxiety and depression. The types of activities used vary from aerobic individual sports such as swimming, to group sports, outdoor activities, arts, music and volunteering. All activities have been shown to benefit patients in some way by promoting physical health, providing purpose, distraction and aiding individuals to find a community. This has proven effective in lessening the symptoms of anxiety and depression and it is encouraged for individuals to work with recreational therapists for the best results as well as remain open-minded to using recreational therapy alongside other forms of treatment for optimal success.