FaReWell Depression – a randomized controlled trial of a physiotherapeutic program for the facial rehabilitation of wellbeing in depression

Introduction Facial feedback mechanisms can modulate affective states. A series of clinical trials have shown that injection of botulinum toxin A can improve the symptoms of depression, probably via the disruption of proprioceptive afferences from the glabellar region to the brain. In extension of this research, we developed a physiotherapeutic program for the facial rehabilitation of wellbeing in depression (FaReWell Depression) with the objective to relax key facial muscles involved in the expression and experience of negative emotions and to tone and strengthen key facial muscles for the expression and experience of positive emotions. The program comprises a massage module with a focus on the glabellar (corrugator supercilii and procerus muscles) and perioral (mentalis and depressor anguli oris muscles) regions and a strength-training module with a focus on the cheek region (zygomaticus and orbicularis oculi muscles). We tested the therapeutic potential of this program in a randomized controlled trial. Methods We assigned 49 patients with mild to moderate depression to either do a daily 15 minutes training session with the FaReWell Depression program or a rest exercise for the same duration as a control condition. The primary endpoint of the study was the change on the Montgomery-Åsberg Depression Rating Scale (MADRS) from the baseline to the point in time six weeks later. Results The repeated measures analysis of covariance (ANCOVA) of the MADRS scores showed a significant group × time interaction effect ( F = 6.37, p = .017, partial η² = .166), indicating lower depression severity in the intervention group (mean pre = 20.64, SD pre = 5.56, mean post = 13.29, SD post = 7.76) compared to the control group (mean pre = 20.10, SD pre = 7.23, mean post = 18.26, SD post = 6.78) after the training. Secondary outcome measures of among others anhedonia, short-term mood changes, facial self-perception, and facial appearance did not show significant group differences over time. Discussion These findings provide preliminary evidence that a self-applied facial physiotherapeutic intervention can improve the symptoms of depression and warrants further investigation into this novel treatment approach.