Free CBT skill-building program for adults and youth (15+) with mild to moderate depression and anxiety Dr. Helen Chagigiorgis, Ph.D., C. Psych., & Dr. Christine Courbasson, Ph.D., C. Psych. Canadian Mental Health Association, York and South Simcoe Pri-Med 2018 Spring Conference Series - London Funded by the Government of Ontario Funded by the Government of Ontario
Obje jectives • Mental health facts • What is depression and anxiety? • Case studies • BounceBack: • What is this service? • Who is this service for? • Is it effective? • How do I refer?
Mental health facts • 1 in 5 Canadians will experience a mental health or addiction issue in their lifetime • By the time Canadians reach age 40, 1 in 2 have – or have had – a mental illness • Individuals aged 15-24 are more likely to experience mental illness than any other age group • Men experience higher rates of addiction than women, while women experience higher rates of mood and anxiety disorders • Depression and anxiety can be managed, but if left untreated, tend to get worse
Meet Ja Jackie • 40-year-old critical care nurse • Things she was able to deal with in the past, are more difficult now • Reports difficulty concentrating, feeling overwhelmed and emotional, struggling with time management, having low energy and a ‘short fuse’, detachment from family, waking frequently at night
Dia iagnostic Cri riteria for Majo jor Depressive Dis isorder Criterion A: Criterion B : Symptoms cause clinically significant (5 of the following, one of which must be 1 or 2; ≥ 2 weeks) distress or impairment in social, occupational, or other important areas of functioning. 1. Depressed mood. 2. Diminished interest or pleasure in all or almost all Criterion C : Not due to the effects of a substance or activities. medical condition. 3. Appetite changes. 4. Sleep problems. Criterion D : Not better explained by other psychotic. 5. Psychomotor agitation/retardation. 6. Fatigue or loss of energy. Criterion E : There has never been a manic episode or 7. Feelings of worthlessness or excessive or inappropriate a hypomanic episode. guilt. 8. Diminished ability to think or concentrate or indecisiveness. Diagnostic and Statistical Manual of Mental Disorders, 5th 9. Recurrent thoughts of death, recurrent suicidal ideation. Edition: DSM-5, American Psychiatric Association
Meet Sarah • 30-year-old new mom • Has difficulty coping with motherhood • Reports sadness, low energy, anxiety, sleeping problems to primary care provider at checkup • Is diagnosed with mild to moderate depression • Is prescribed cognitive behavioural therapy (CBT) without medication • Incurs long wait time to access in-person counselling
What does anxiety lo look lik like? • Excessively, uncontrollable, unproductive worry about negative events that might happen in the future • Usually begins as a "what if" question • Physical symptoms: heart racing, sweating, stomach discomfort • Feeling fidgety, restless or unable to sit still • Feeling irritable, getting easily upset, snapping at people for minor reasons • Being easily fatigued • Muscle pains (often in the neck and shoulders) • Sleeping and concentrating difficulties
What does panic dis isorder lo look lik like? • • Expected/unexpected panic attack : 4 or + (less Unreality (derealization) or detached from = limited) + one month oneself (depersonalization) • • Palpitations, pounding heart, or accelerated Fear of losing control or going crazy • heart rate Fear of dying • • Sweating Numbness or tingling sensations (paresthesias) • • Trembling or shaking Chills or hot flushes • • Sensations or shortness of breath or smothering Subsequent persistent worry about: Having • A feeling of choking another attack or consequences of the attack, • Chest pain or discomfort or significant maladaptive behavioral changes • Nausea or abdominal distress related to the attack • Dizzy, unsteady, lightheaded, or faint
What does agoraphobia lo look lik like? • • Anxiety - Fear Using public transportation • • Fear of places where it is hard to escape or In open spaces (parking lots, marketplaces or where help may not be available bridges) • • Actively avoided, require the presence of In enclosed places (shops, theaters, or cinemas) • someone, or are endured with intense fear or In line or being in a crowd • anxiety Outside of the home alone • Panic-like symptoms might develop • 6 months • Clinically significant distress or impairment in social, occupational, or other important areas of functioning
What does social phobia lo look lik like? • • A persistent fear of one or more social or Interferes significantly with normal routine, performance situations occupational (academic) functioning, or social • Exposed to unfamiliar people or to possible activities or relationships, or marked distress scrutiny by others about having the phobia • • Fear to act in a way (or show anxiety) that will 6 months be embarrassing and humiliating • Exposure: anxiety or panic attack • Fear is unreasonable or excessive • Avoid or endure with intense anxiety and distress
What does generalized anxi xiety dis isorder lo look lik like? • • Excessive anxiety and worry (apprehensive Anxiety, worry, or physical symptoms cause expectation), most days clinically significant distress or impairment in • 6 months social, occupational, or other important areas of • Number of events or activities (work or school functioning performance) • Difficult to control the worry • Anxiety and worry are associated with 3 or + (1 in children ) 1. Restlessness, feeling keyed up or on edge 2. Being easily fatigued 3. Difficulty concentrating or mind going blank 4. Irritability 5. Muscle tension 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfied)
Good news for more than 60,000 Ontarians
BounceBack
BounceBack: The approach Developed by Dr. Chris Williams, psychiatrist, expert in cognitive behavioural therapy, Professor of Psychiatry at the University of Glasgow.
BounceBack: Tel elephone coaching & workbooks Telephone coaching using skill-building workbooks: • Coaching is available in 16 languages • Coaches assist participants with skill development, provide motivation, and monitor progress • Coaches are not counsellors, but trained in educational and motivational coaching • Coaches conduct 3-6 sessions with participants using workbooks chosen collaboratively and based on clients’ current needs
BounceBack: Workbooks 1. Starting out…and how to keep going if you feel stuck 2. Understanding low mood and depression 3. Doing things that boost how you feel 4. Noticing extreme and unhelpful thinking 5. Changing extreme and unhelpful thinking 6. Practical problem solving 7. Understanding panic and phobias 8. Understanding worry and stress 9. Understanding how we respond to illness 10. Facing fears and overcoming avoidance 11. Overcoming sleep problems 12. Being assertive 13. Building relationships with your family and friends 14. Using exercise to boost how you feel 15. Helpful things you can do 16. Unhelpful things you do 17. Alcohol, drugs and you 18. Understanding and using anti-depressant medication 19. Planning for the future 20. Information for families and friends – how can you offer the best support
BounceBack: Short format & youth booklets
Booster Further support, reinforce Session skills (15-30 min) (within 6 BounceBack: months of completion) Participant jo journey Establish contact & confirm contact details (If unreachable, Initial letters sent to referrer and client) Contact (within 5 business days of referral) Eligibility assessment & pre- Close case, post-program Completion Session 1 program scores + send initial Session scores , letters sent to Assessment (2-3 weeks (within 2 package including introductory participant and referrer from final weeks of session) workbooks or short format booklets initial (30 min) contact) & a short letter to referrer (45 min) Sessions 3-6 Session 2 (2-3 weeks Coaching , send next workbook(s) (2-3 weeks Coaching , send next workbook(s) (15-20 min) between from S1) (15-20 min) sessions)
BounceBack: Onli line vid ideos BounceBack Today online video series: • Offers practical tips on managing mood, sleeping better, building confidence, increasing activity, problem solving, healthy living • Available in English, French, Mandarin, Cantonese, Punjabi, Arabic, Farsi Watch videos at: bouncebackvideo.ca (access code: bbtodayon)
BounceBack: Evidence-based benefits Pilot program in CMHA York and South Simcoe with 461 clients who completed the program from August 2015 to December 2017 showed coaching-program effectiveness: Patient Health Questionnaire Generalized Anxiety Disorder (PHQ-9; depressive mood) (GAD-7; assessment scale) 14 11.6 12 10.6 Depression and 10 anxiety decreased by 8 7.2 almost 40% 6.5 6 4 2 0 Pre-BounceBack Post-BounceBack
BounceBack: Benefits Satisfaction survey conducted by CMHA York and South Simcoe with 119 clients who completed BounceBack showed: 92% 94% 95% would recommend found the CBT liked receiving the BounceBack to a friend workbooks easy to service by telephone or family member read and helpful
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