Distress and Increase Treatment Readiness Dr Victoria Manning and Dr - PowerPoint PPT Presentation

Six-Step Brief Intervention to Reduce Distress and Increase Treatment Readiness Dr Victoria Manning and Dr Jane Oakes

The team… • Dr Jane Oakes • Dr Victoria Manning • Dr Simone Rodda • Ms Mollie Flood • Prof Dan Lubman

Developing a Brief Intervention to reduce distress

Brief Intervention Rationale

Problem Gamblers  <10% present to treatment (Evans & Delfabbro, 2005, Horche and Hodgins,2015)  Poor knowledge treatment options (Gainsbury et al, 2014)  Often first (and only) point of contact  Helpline staff influence counselling initiation (Valdivia-Salas et al, 2014)

Problem Gamblers  7/10 gamblers accessing GHO report psychological distress  9/10 experience negative emotions – helpline  Acute distress - common reason for seeking help (Rodda et al, 2014)  Don’t seek help until crisis (Evans & Delfabbro, 2005)

Problem Gamblers  21% helpline callers experience suicidal thoughts due to high distress (Ledgerwood et al, 2005)  50-75% offered referral - significant drop-out  (TP, 2014, Weinstock et al, 2011)  Improving tx readiness increases attendance  Increased attendance improves outcomes (Dunn et al, 2012)

Brief Intervention: OVERARCHING GOAL Increase successful referrals

Brief Intervention- Aims  Alleviate distress / stabilise client  Enable client to think clearly  Optimise motivation to change  Increase problem-focused coping  Assist client to engage with appropriate help

Methodology  Search online databases:  to identify relevant peer-review literature  to identify relevant resources  Building on existing interventions  Consultation

Caplan’s Crisis Intervention Framework • “Transient response to circumstances arousing anxiety to intolerable levels, undermining individual’s natural coping resources” • Stressful situations - detrimental effect on cognitive functioning, problem solving and erodes their belief in ability to manage • Informal supports & formal interventions are required to help contain emotional arousal & enhance problem solving capabilities (Caplan 1964)

Consultation Participants Number Gambling helpline counsellors 8 Crisis helpline counsellors 4 Academic addiction specialists 5 Consumers 1 Significant others 1 Group consultation – workshop 10 Total 29

Semi-structured interviews  What is distress?  How do you identify distressed clients?  How do you manage distressed clients  What works, what doesn’t work?  How do you get PGs to consider treatment/support?

Alleviate distress – PG can think clearer expert It is important to reduce distress …….a client may continue gambling to alleviate their distress, Getting the client to talk which is likely to only increase their is obviously important but distress when they lose more getting them to tell the money. details of their story, while in a state of ….a client in distress is not thinking distress, is unlikely to straight or acting normally. make them feel better.

Distress in help-seekers Lifeline’s approach Allows story telling to reduce distress, but not to the point where it immobilises practical coping It is helpful for a distressed caller for the person they are talking to (lifeline.org.au) remain calm and to use strength based approach where possible… we try to build on their own strengths and resourcefulness – review how the caller has coped in the past, where they are stuck now and how could they extend The focus is on how their resources and strategies for aspects of their situation managing. are affecting them right now.

Only immediate concerns - Don’t increase distress Seek sufficient understanding of what lies behind it to address immediate concerns . The focus is on how aspects of their situation are affecting them right now. Lifeline counsellors

Only immediate concerns - Don’t increase distress It’s unhelpful for the caller to be continually pouring It is helpful if they remain calm and to use out thought after a strength -based approach where thought with no real possible… we try to build on their own focus. strengths and resources – review how the caller has coped in the past, where they are stuck now and how could they extend their resources and strategies for managing the situation. Lifeline counsellors

• Increased distress 10 • Continued gambling Extreme distress 9 • Self-harm 8 7 Distress 6 level 5 Workable Zone 4 3 2 1 • Severity of situation minimised Relaxation 0 • Perceived permission Time with clinician to continue gambling

Brief Intervention Model Identify distress Step 1: Acknowledge & Measure Distress Step 2: Normalise and Reduce Distress Step 3: Optimise motivation for change Step 4: Provide a Sense of Hope Step 5: Measure Distress Step 6: Explore Treatment/Support Options

Beginning the intervention: Identify distress • People concerned about gambling frequently describe experiencing a distressing event, being in crisis or “hitting rock - bottom” as reason for contacting help services • Identifying distress - begin brief intervention (Evans and Delfabbro, 2005)

Beginning the intervention: Identify distress Are they agitated or sounding panicky?… is their speech fast or slow? whether or not they are Crying, sobbing loudly, crying….and if so are they pressured speech, struggling to talk? heightening anxiety, breathless, anxiety Not thinking ridden rationally Lifeline counsellor GHL Counsellor GHL Counsellor

Beginning the intervention: Identify distress Distress causes powerless In my experience anxiety is steeped in the future and creates a feeling of powerlessness. Therefore, it is always helpful to bring the client back to the here and now. Consumer

Step 1: Acknowledge and measure distress Clients feels heard/understood Shows empathy

Step 1: Acknowledge and measure distress Measuring distress at this point: • baseline distress level • Allows clinician to later check distress has reduced so client can engage constructively

Step 1: Acknowledge and measure distress The Subjective Units of Distress Scale (SUDS) (Wolpe, 1969) Valid measure of emotional discomfort (Tanner, 2012) Scale rating from: ‘0’ No distress…. to….. ’10’ Extreme distress

Step 2: Normalise and reduce distress Avoidant coping strategies common among people with gambling issues (Yi, 2012). Normalising distress important Encourages clients to tolerate feelings of distress Stabilises emotions, make positive changes, rather than relying on avoidant coping strategies A crisis state is inherently time-limited (Caplan, 1964; Kalafat, 2002)

Step 2: Normalise and reduce distress Relaxation/breathing control skills reduces anxiety (Townshend et al, 2014) Reduce distress by completing a breathing exercise Suggested breathing exercise (Centre for Clinical Interventions. The Calming Technique: Breathing)

Importance of breathing exercises in reducing distress Mindfulness-based strategies could be helpful to reduce the client’s arousal. There are a number of breathing techniques that are designed to bring the client into the here and now. Expert

Step 3: Optimise Motivation for Change Light bulb moment - client realises current distress is the result of behaviour that needs to change Turning Point “transformative moment” a state of weakness to a state of empowerment

Step 3: Optimise Motivation for Change Teachable moment when client has a concern directly related to unhealthy behaviours, a link is made by clinician between concern and behaviour in attempt to motivate change (Cohen et al, 2011) “Cueing events” naturally occurring health events/circumstances that leads individuals to make health behaviour changes (McBride et al, 2003 )

Step 3: Optimise Motivation for Change Empathic curiosity to facilitate change/decision making (McEvoy et al, 2013) Evoking change talk for clients who are ready to change (Miller, 2015)

The Readiness Ruler To determine " How important is changing gambling behaviour to client right now , on a scale from zero (not at all important) to 10 (extremely important)

Step 4: Provide a sense of hope Hope is required for contemplation of change (Bradshaw et al., 2014) Self-efficacy is an important predictor of positive behaviour change (Kadden and Litt, 2011) Information on how others have tackled gambling problems and simple statistics on tx outcomes can empower people to start dealing with own problems (psychology.org)

Congratulate client for taking first steps helps instil hope I always make sure to congratulate them for having gotten in touch, for having taken the first steps to dealing with their problem. Expert

Step 5: Re-measure distress Re-measuring distress allows the clinician to determine if distress has reduced enough for client to engage constructively in considering treatment/support

Step 6: Explore support and treatment options Encourage the client to reflect on their strength and social supports

Step 6: Explore support and treatment options Referral is complex- involves providing information and helping the client make an informed decision with all of the facts