Depression Management Group in a Day Hospital Setting

1
Depression Management Group in a Day Hospital
Setting
2
Aims

• Share our experience of what have seemed the
  helpful / unhelpful features of the 2 CBT based
  depression management groups for OP that we have
  run
• Present current format and some of our thoughts
  about future developments
• Hear something of other peoples experience

3
Background

• Psychological work with depression all 1 to 1 so
  need for a group intervention
• Clients with moderate to severe depression
  attending DH on average 6 months
• Good evidence for individual CBT with OP but
  little for CBT groups with OP
• Decided to run a CBT based group with OP but with
  the question
• What are the most helpful elements of such a
  group for our clients?

4
Assessment

• Examined the following areas
• A discussion about the group and what it
  entailed.
• Client interest motivation to attend the group.
• The practicalities of attending, (transport,
  holidays and appointments etc).
• Sensory deficits.

5
DEPRESSION MANAGEMENT PROGRAMME.

• Week 1
• Ground rules
• Group aims objectives
• Psycho-education re depression
• Week 2
• Client descriptions of depression
• Learning about Hot cross bun model
• Homework Activity diary
• Week 3
• Revisit Hot cross bun model
• Learning about behaviour and mood link
• Homework Activity scheduling

6
DEPRESSION MANAGEMENT PROGRAMME.

• Week 4
• Introduce thought biases e.g. black white
  thinking, personalisation
• Client descriptions of biases
• Homework Thought diary
• Week 5
• Review of group
• Client examples of thought diaries
• Homework Thought challenging
• Week 6
• Learning about setbacks
• Relapse prevention
• Summary evaluation

7
Client Evaluation Themes For What Was Helpful

• Insight into problems / depression
• Learning the link between how I feel and what I
  am doing and how I think
• Normalisation
• Better understanding of what others go through
  who also have depression
• Being able to manage depression
• Being able to now balance negative thoughts with
  more positive ones
• When I start getting depressed, being aware that
  to do some things that I enjoy can help

8
Client Evaluation Themes For What Was Difficult

• Some of the language used
• Demands of some writing tasks
• Identifying thoughts challenging to get used to
  doing this and to make more positive

9
Facilitators Reflections

• Modify language to suit that of clients
• Use client examples to illustrate new learning
  rather than book or made up examples
• Always relate examples back to model
• More conversational feel not teaching
• Adapt group / be more flexible
• Use boards
• Emphasising CBT model as a model of mood not just
  depression
• Move from Ive got depression to how can I manage
  my mood?

10
Future Developments - Assessment

• Did not give a sense of individual clients or
  how they might function in the group.
• Consider
• Confidence with written material
• Previous efforts to cope with depression /
  treatments
• Clients sense of agency in managing their
  depression and experience reflecting on own
  thoughts.
• How their depression manifests itself in
  behavioural and cognitive terms?
• Assessment as a guide to how group could be made
  to fit client not to judge suitability for a
  fixed group.

11
Future Developments The Group(Client and
Facilitator Reflections)

• A tailored group with a menu of topics to work on
• Flexible working staying with topic that group
  find difficult or abandoning it
• Encourage clients to make greater contribution to
  choosing content of sessions
• More room to discuss written materials in
  sessions

12
Future Developments The Group(Client and
Facilitator Reflections)

• Consider taping sessions / written material
• Increasing use of white board / diagrams
• More time training clients to recognise thoughts
  and increase their confidence that they can
  change themselves
• Introducing mindfulness techniques
• Greater focus on successful episodes of coping