Reprinted from "CBT" issue of Visions Journal, 2009, 6 (1), p. 31
Depression and anxiety are the most common of all mental health problems. While everyone has bouts of low mood and excessive worrying, these are temporary for most of us. For others, however, the feelings don’t go away on their own and formal help is needed.
Many people are reluctant to take medications for their mental health problems, but family doctors may feel they have little else to offer their patients.
One very effective treatment, however, is cognitive-behavioural therapy (CBT). CBT has been shown to be as effective as medication in the treatment of anxiety and depression.1 Unfortunately, CBT is not readily available for doctors to access for their patients. There are long wait-lists for mental health services and a limited number of mental health clinicians who specialize in CBT.
Bounce Back Communities
Bounce Back is being delivered through CMHA branches across BC, serving the following communities and surrounding areas:
More help for more people
In 2007, the Ministry of Health Services awarded a grant to the Canadian Mental Health Association BC Division (CMHA BC) to develop CBT services to support family doctors in providing mental health care. The goal of the grant was to increase the availability of CBT. Through this funding, the Bounce Back program was developed.
The provincial launch of Bounce Back took place in the Okanagan in June 2008. The program works with health authorities and other community partners to help primary health care providers respond to the very large number of patients in need of mental health assistance. It was initially designed to support individuals living with a chronic disease or chronic pain. However, Bounce Back is now available to all patients with mild to moderate depression and anxiety, whether or not they have a physical health condition.
The program is delivered through branch offices of the CMHA and is now offered in 17 locations around the province (see sidebar next page).
Bounce Back: what does it offer?
Bounce Back offers two forms of CBT help. Both are based on the work of Dr. Chris Williams at the University of Glasgow in Scotland.
The first is a self-help DVD titled Living Life to the Full. It provides clear tips and strategies to manage your mood. The 45-minute DVD was originally filmed in Scotland and has been adapted for BC. It covers a number of the most useful CBT skills that people can learn to get more enjoyment out of life. The DVD is appropriate for those who aren’t ready for a more structured intervention like individual therapy.
The second is a telephone-delivered service. Bounce Back employs 20 community coaches who offer guided self-help over the phone to support people with mild to moderate depression and/or anxiety. The coaches support patients who are working through an effective, short-term mood improvement program. Their role is to teach new skills, help patients stay motivated, answer questions and monitor patients’ progress.
The program is based on the Overcoming Depression and Low Mood series2 of structured workbooks. The workbooks provide clear information and exercises to help people alter the way they think and act in order to bring about positive changes in how they feel.
Both forms of CBT help are available at no cost to patients. The DVD is available through your family doctor’s office. To access the telephone coaching program, a referral from your doctor is required.
Coaching typically involves three to five telephone sessions with a Bounce Back coach, which you can do in the comfort of your home.
Bounce Back coaches: what? who? how? when?
Research has demonstrated the benefits of guided self-help CBT interventions.3 The same research found that guided self-help programs don’t need to be delivered by a psychologist—they work just as well when provided by a paraprofessional. In cases of severe mood and anxiety conditions, however, specialist care is required.
Bounce Back coaches are not mental health specialists. Coaches come from a variety of backgrounds, such as nursing, medical office assistance and social work.
The coaches attend a mandatory three-day learning session on the CBT tools before they deliver services in their local community. Training is delivered by BC-based registered psychologists with CBT expertise. After formal training, coaches have weekly telephone consultation sessions with a psychologist. This provides the coaches with clinical support regarding cases and reinforces their CBT knowledge and skill development. In addition, coaches make audio recordings of telephone sessions with clients. These recordings can be reviewed by the psychologists to ensure program quality.
Bounce Back: results to date
Bounce Back has distributed over 18,000 self-help DVDs and nearly 2,000 referrals have been made to the program for telephone coaching. Program data from a provincial database shows that program participants generally experience improved mood, reduced anxiety and enhanced quality of life.
This is what would be expected through guided self-help CBT interventions. Early information from family doctors also shows that Bounce Back is considered a valuable community mental health resource.
The success of the Bounce Back program is being evaluated by independent consultants. An effectiveness study is also planned. Results will be available in 2010.
Bounce Back provides a CBT intervention with the potential to reach a very large segment of the population troubled by depression and anxiety.
For more information, see www.bouncebackbc.ca.
About the authorKimberley is a psychologist and consultant. She has provided consultation for several projects that focus on mental health and primary care. Currently, Kimberley is the Provincial Project Manager for the Canadian Mental Health Association BC Division’s Bounce Back program.
Canadian Psychiatric Association and the Canadian Network for Mood and Anxiety Treatments. (2001). Clinical guidelines for the treatment of depressive disorders. Canadian Journal of Psychiatry; 46(Suppl 1), 1-91S.
Williams, C.J. (2006). Overcoming depression and low mood: A five areas approach (2nd ed.). London: Hodder Arnold.
Gellatly, J., Bower, P., Hennessy, S. et al. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 307(9), 1217-1228.