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SCOPE Winter 2017 vol 1 issue 1

MAGAZINE

An inside view of family medicine in Victoria

RE-WIRING

OUR BRAINS Patients in Victoria are learning skills

to manage their own anxiety and depression through eight-week cognitive behavioural therapy groups

HIP TO KEEP COOL

More than 800 people throughout Greater Victoria have taken part in the eightweek, MSPfunded CBT skills group training sessions in the past year, with hundreds more slated for early 2017.

BY DR. JOANNA CHEEK | Psychiatrist, Assistant Clinical Professor

New CBT groups arming patients with skills to self-manage anxiety and depression Meara, a local retail store manager, has faced symptoms of anxiety and depression for more than a decade. AJ is on disability after struggling with chronic pain (and its associated anxiety and depression) for 22 years. Retired teacher ‘Elizabeth’ (who prefers not to use her real name), has experienced anxiety and depression for her entire life. When these three diverse strangers arrived for their first cognitive behavioural skills group training session, they discovered the thread that binds them together: the struggle of being human.

s humans, pain is an inevitable part of our lives. We crave security and certainty, but the world is constantly changing and unknown. No matter how courageous or competent we are, we can’t escape feeling failure, losing loved ones, getting sick, or being hurt. And at times, our emotions, habits, thoughts, and behaviours can lead us astray, feed us the wrong information, or drive us to react in ways that perpetuate anxiety and depression. So it’s not surprising that—according to a 2014 Island Health survey—29 per cent of Victorians experience clinical levels of depression and anxiety. If we included stress, burnout, anger, chronic pain, and addiction, that number would easily climb to include the majority of our population. But seeking help isn’t easy. Most people find the stigma of mental health challenges to be more debilitating than the symptoms of the conditions themselves. Stigma silences, and silence builds walls between us. So rather than our shared vulnerabilities bridging us together, we suffer alone. Even if we are brave enough to ask for help, mental health services are overburdened by the magnitude of so many people struggling alongside us. AJ was close to being lost in that system. “I saw psychologists who were unable to treat me on an ongoing basis, due to the enormous backlog of patients requiring their help,” she remembers. “Being on disability, I was unable to afford such assistance privately. I still found myself unable to manage my symptoms, and asked my GP about a referral to a

psychiatrist. But because my symptoms were not severe enough, the psychiatrist referrals were not accepted.” This hard reality brought a group of local psychiatrists and family doctors together over the past year to be a part of the solution. Thanks to new initiatives supported by the Shared Care Committee (a collaborative partnership of the B.C. Ministry of Health and Doctors of B.C.), and leadership from the Victoria Division of Family Practice, the group launched physician-run group medical visits, bringing together 15 people for an eight-week series of 90-minute sessions. In these cognitive behavioural therapy (CBT) skills groups, doctors teach the participants skills to manage their own difficult emotions, thoughts, and unhelpful habits that can trigger and intensify stress, anxiety, and depression. The purpose of the group format is not to cut costs (although the numbers speak proudly: each person receives 12 hours of instruction in a group at the same cost to the system as four 20-minute counselling visits with their family doctors). Rather, the group itself is therapeutic. “There’s so much stigma surrounding mental illness,” states ‘Sue’, who asked to use a pseudonym. “I still find it nerve-wracking to tell someone I have mental health issues because it’s a gamble: are they going to ‘get it’, or not? At the CBT skills group, we all ‘get it’, because we’re all there for the same reasons.” Meara didn’t seek help until she had become a heavy alcoholic, and had lost interest in her work

According to a 2014 Island Health survey, 29 per cent of people in Victoria experience clinical levels of depression and anxiety.

Scope Magazine | Winter 2017

“We shared a lot of laughter.” Known for her playful and other things she enjoyed. Although initially enthusiasm, psychiatrist and group facilitator Dr. group therapy sounded intimidating, she explains, “I Wanda Crouse doesn’t find laughter incompatible was nervous about going at first (hello, anxiety!), but with talking about difficult topics. “I’m having a lot of after the first session, it became something I looked fun teaching both the participants, forward to every week.” and the family physicians,” she says. AJ comments, “I really Psychiatrists in the project considered myself to be a wear two hats. First, they act as colossal failure, because co-facilitators, teaching participants I couldn’t even manage strategies to support wellness. many simple things. So to Second, they mentor family hear that other people in AJ, CBT Skills Group Participant physicians to enhance their skills the group could identify in order that they can lead groups with the things that I on their own. considered particularly With studies showing that 80 per cent of damaged about myself really helped to lessen my people receive help for their mental health feelings of self-failure. For the first time in more than challenges within primary care, the goal is to teach a decade, I didn’t feel so alone.” family doctors how to support their patients within Elizabeth, who had used CBT strategies to the same system where they are already seeking support her own wellness and had taught these services. Dr. Crouse explains, “I know how hard skills to her students, decided she needed more family physicians work trying to provide quality care help after a chain of stressful life events caused her to their patients, and the frustrations of not being anxiety to resurface. “I enjoyed listening to how able to get help for those patients when it’s needed.” others succeeded Family physician Dr. Oona Hayes had been at applying offering brief CBT skills to support her patients the strategies individually in her clinic. each week,” However, at times she says. she felt her patients needed something more. “I found it

“For the first time in more than a decade, I didn’t feel so alone.”

Scope Magazine | Winter 2017

hard because some patients needed much more background information and understanding about the way the mind works,” she says. “Also, I see so many people who struggle with their mental health that I felt I was always repeating myself. When I was approached about this project, I was excited about the opportunity to teach skills that helped patients to manage their inner experiences, and to live fulfilling lives.” Facilitating groups is often a new skill for family doctors, who are typically trained to work one-onone with patients. Dr. Hayes reflects, “Doing group visits has been a learning curve, and has taken me out of my comfort zone. I was able to personally apply the CBT skills when I started feeling fears about how I would do as a group facilitator.” But physician anxiety is not something they hide in the groups. Rather, they often teach with examples from their own lives, illustrating that we all share in the struggles of the mind, and that no one is immune. It’s been just under one year since the first CBT skills group rolled out in Victoria. In 2016 alone, more than 800 people completed the training, with several hundred more slated for the early part of 2017. In that time, evaluations have shown that participant wellness scores improve on par with medication and individual CBT therapy—both considered gold standard treatments for depression and anxiety. Meara explains, “The course helped me to recognize certain obstacles that I was facing when trying to deal with my issues, and how to overcome them myself. I also learned about how the brain and body interact, and how to use that knowledge to my advantage when I’m in an extreme emotional state.” She continues, “Honestly, I have been so happy with what this group has done for me that I talk about it all the time. I have spoken with my family, friends, and staff about various aspects of it, because I feel that the information taught in this course can be beneficial for anyone—not just for those suffering with anxiety and depression. It really changed my life. I feel so much more confident in my ability to deal with any obstacles that come my way.” “I learned some very practical strategies. I love that it’s science-based, and solidly researched,” Elizabeth adds. Sue states, “I left the last session feeling proud of myself, and feeling empowered. I wish everyone fighting anxiety and depression could be offered these classes.” And indeed, that is the goal. Psychiatrists are continuing to train new facilitators, and communities across the province, and nationwide, are interested in adopting a similar program. Patients who wish to take part should visit their family physician and ask for a referral.

98% of participants in 2016 reported that they use their CBT workbook on a regular basis, often taking it with them to the workplace to help them manage day-to-day challenges. A completely revamped and revised workbook that incorporates suggestions from participants, psychiatrists, and family physicians is due out in early Spring. For more information about the CBT Skills training groups in Victoria, visit divisionsbc.ca/victoria/cbtskillsgroup or email cbtskills@divisionsbc.ca

“I feel that the information taught in this course can be beneficial for anyone—not just for those suffering with anxiety and depression. It really changed my life.” Meera, CBT Skills Group Participant

Scope Magazine | Winter 2017