Free CBT skill-building program for adults and youth (15+) with mild - - PowerPoint PPT Presentation

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
• verwhelmed 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: (5 of the following, one of which must be 1 or 2; ≥ 2 weeks)

• 1. Depressed mood.
• 2. Diminished interest or pleasure in all or almost all

activities.

• 3. Appetite changes.
• 4. Sleep problems.
• 5. Psychomotor agitation/retardation.
• 6. Fatigue or loss of energy.
• 7. Feelings of worthlessness or excessive or inappropriate

guilt.

• 8. Diminished ability to think or concentrate or

indecisiveness.

• 9. Recurrent thoughts of death, recurrent suicidal ideation.

Criterion B: Symptoms cause clinically significant distress or impairment in social, occupational, or

• ther important areas of functioning.

Criterion C: Not due to the effects of a substance or medical condition. Criterion D: Not better explained by other psychotic. Criterion E: There has never been a manic episode or a hypomanic episode.

Diagnostic and Statistical Manual of Mental Disorders, 5th 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

= limited) + one month

• Palpitations, pounding heart, or accelerated

heart rate

• Sweating
• Trembling or shaking
• Sensations or shortness of breath or smothering
• A feeling of choking
• Chest pain or discomfort
• Nausea or abdominal distress
• Dizzy, unsteady, lightheaded, or faint
• Unreality (derealization) or detached from
• neself (depersonalization)
• Fear of losing control or going crazy
• Fear of dying
• Numbness or tingling sensations (paresthesias)
• Chills or hot flushes
• Subsequent persistent worry about: Having

another attack or consequences of the attack,

• r significant maladaptive behavioral changes

related to the attack

What does agoraphobia lo look lik like?

• Anxiety - Fear
• Fear of places where it is hard to escape or

where help may not be available

• Actively avoided, require the presence of

someone, or are endured with intense fear or anxiety

• Panic-like symptoms might develop
• 6 months
• Clinically significant distress or impairment in

social, occupational, or other important areas of functioning

• Using public transportation
• In open spaces (parking lots, marketplaces or

bridges)

• In enclosed places (shops, theaters, or cinemas)
• In line or being in a crowd
• Outside of the home alone

What does social phobia lo look lik like?

• A persistent fear of one or more social or

performance situations

• Exposed to unfamiliar people or to possible

scrutiny by others

• Fear to act in a way (or show anxiety) that will

be embarrassing and humiliating

• Exposure: anxiety or panic attack
• Fear is unreasonable or excessive
• Avoid or endure with intense anxiety and

distress

• Interferes significantly with normal routine,
• ccupational (academic) functioning, or social

activities or relationships, or marked distress about having the phobia

• 6 months

What does generalized anxi xiety dis isorder lo look lik like?

• Excessive anxiety and worry (apprehensive

expectation), most days

• 6 months
• Number of events or activities (work or school

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)

• Anxiety, worry, or physical symptoms cause

clinically significant distress or impairment in social, occupational, or other important areas of functioning

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

Initial Contact (within 5 business days of referral) Session 1 Assessment (within 2 weeks of initial contact)

BounceBack: Participant jo journey

Close case, post-program scores, letters sent to participant and referrer (30 min)

Session 2 (2-3 weeks from S1) Sessions 3-6 (2-3 weeks between sessions) Completion Session (2-3 weeks from final session) Booster Session (within 6 months of completion)

Further support, reinforce skills (15-30 min) Coaching, send next workbook(s) (15-20 min) Coaching, send next workbook(s) (15-20 min) Eligibility assessment & pre- program scores + send initial package including introductory workbooks or short format booklets & a short letter to referrer (45 min) Establish contact & confirm contact details (If unreachable, letters sent to referrer and client)

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:

Depression and anxiety decreased by almost 40%

11.6 10.6 7.2 6.5 2 4 6 8 10 12 14 Pre-BounceBack Post-BounceBack

Patient Health Questionnaire (PHQ-9; depressive mood) Generalized Anxiety Disorder (GAD-7; assessment scale)

BounceBack: Benefits

Satisfaction survey conducted by CMHA York and South Simcoe with 119 clients who completed BounceBack showed:

would recommend BounceBack to a friend

• r family member

92%

found the CBT workbooks easy to read and helpful

94%

liked receiving the service by telephone

95%

Referral form can be accessed or submitted

• nline at: bouncebackontario.ca

Criteria:

• 15 years or older
• With mild to moderate depression (PHQ-9) score

between 0-21 (with or without anxiety)

• Not at risk to harm self or others
• Not significantly misusing alcohol or drugs
• With no personality disorder and no psychosis or manic episodes

within 6 months

• With sufficient concentration and motivation to

engage in the program For telephone coaching + workbooks (referral required) For online videos (referral not required)

Fax completed referral form to: (905) 430-1768 , email to bb-referral@cmha- yr.on.ca, or submit through EMR, if available. The form can also be downloaded from bouncebackontario.ca

BounceBack: How to refer

BounceBack: Who to contact

For more information on BounceBack or to access the referral form or resource materials: Visit: bouncebackontario.ca Questions about telephone coaching or referral form: Contact BounceBack team at: 1 (866) 345-0224 Questions related to marketing opportunities: Contact BounceBack engagement coordinators at: bounceback@ontario.cmha.ca

Thank you! Any questions?