A Cognitive-Behavioural Group Therapy Program for Seniors
Reprinted from "Seniors' Mental Health" issue of Visions Journal, 2002, No. 15, pp.33-34
Wanda* is a seventy-eight year old widow. Her husband of 54 years died suddenly two years ago, just a few months after the couple moved to Kelowna from their prairie farm to be closer to their children and grandchildren. For the first few months after her husband’s death, her children and a neighbour were attentive and considerate. However, as time went by, they called and visited less often, and Wanda found herself feeling increasingly depressed and anxious. Suicidal thoughts prompted her to seek help from her physician, who prescribed antidepressant medication and referred her to the Elder Services Program for additional support and assistance. She was visited by an Elder Services Program nurse, who suggested that she join the next Therapeutic Activation Group.
The Elder Services Program (ESP) at Kelowna Mental Health has offered an eight week Therapeutic Activation Group (TAG) for women for several years, and piloted a similar group for men over the past two years. Both groups are modeled on the Changeways Program developed at UBC Hospital, but have been specifically adapted for either senior men or women. [Changeways is a group-based psychoeducational program that incorporates the techniques of cognitive-behavioural therapy.] At the present time, only the women’s TAG is operational, due to staffing and budget constraints. Participants are cognitively-intact people over the age of 65 who have experienced depression, anxiety, panic or other difficulties adjusting to changes associated with aging. The purpose of the group is, over the eight sessions, to provide information about health and illness, enhance self-understanding, provide support and encourage individual strength.
Both TAG groups have been held at the Water Street Seniors’ Centre in downtown Kelowna, a location intended to decrease the stigma associated with mental illness. It also encourages group participants to become more socially and recreationally active by introducing them to at least one community resource. When possible, the last meeting of the group is held in a private room at the nearby public library, thus acquainting group members with an additional community resource.
Facilitators of the women’s group are Pam Mason, a Recreation Therapist contracted from the CMHA, and either Eleanor Fox or Lynn Fairey, Registered Nurses from the Elder Services Program. These same nurses from the ESP have also facilitated the men’s group. Transportation for group members who do not drive is provided in partnership with the CMHA which supplies a bus and driver, Phil Abrams. Phil also provides rides for those who choose to attend the Primetimer’s Group, a group for women who have previously attended TAG. Because the women already know and trust Phil, they are more likely to attend Primetimers and this further assists them in remaining active and well. Primetimers and a Therapeutic Pool Exercise Group are special programs facilitated by Diane Muric under another partnership of the Elder Services Program and the CMHA.
The TAG sessions last for two hours with a brief break in the middle. Following the formal meeting, participants move to a dining area where a delicious soup and sandwich lunch is supplied at a nominal cost. If this is a financial hardship for any member, the cost is discretely paid with funds from the Mental Health Centre. Many of the ladies live alone and welcome an opportunity to share a meal and fellowship with others. Mealtimes facilitate the informal sharing of both social and therapeutic information by both group participants and leaders.
The formal group sessions consist of verbal presentations by the leaders and occasionally by guest speakers. These presentations are augmented by use of flip charts and printed handouts which may be kept for future reference. Group members are invited to participate in discussions and to ask questions, but are not required to speak if they are not comfortable.
Many topics are discussed over the course of the eight sessions. These include the causes and symptoms of depression, anxiety, and panic, and strategies for coping effectively. Helpful ways of adapting to stress are reviewed and time is spent practicing various relaxation techniques. A model for changing one’s behaviour, thinking, and emotions is demonstrated, and each group member is encouraged to set and attain small, achievable goals each week.
Successes in achieving goals are lauded and difficulties are viewed as opportunities to learn more about oneself. Group members are asked to find one or more “highlights” each week and report them to the group. These may be as simple as enjoying watching birds nesting in a backyard tree, but these “highlights” promote the positive habit of actively seeking out enjoyment and pleasure on a daily basis. This is done because depressed individuals often lack energy or motivation to participate in previously-enjoyed activities, and may now derive little pleasure from them.
The importance of maintaining a balanced lifestyle, including good nutrition, sleep habits, and making time for emotional, spiritual, and physical activities is also stressed. Developing strategies for augmenting social support networks is a topic of particular importance as many group members suffer from social isolation. Unlike the women’s group, the men’s group complained of difficulty finding meaning in their lives after retirement, and time was devoted to addressing this key issue with them. Both men and women benefit from practicing assertive communication skills, and some groups express a need to explore grief and mourning. Anger management is identified as an important topic for men, while both groups appreciate information about medications presented by a family physician or mental health pharmacist. At the last session, ways of maintaining good health and preventing relapse are discussed. At the conclusion of the eight sessions, group members are given an opportunity to provide written and verbal evaluations of the experience, which provides helpful information for facilitators planning subsequent programs.
Women are strongly encouraged to join a Primetimers Group at the end of their participation in TAG. If Diane Muric, Primetimers facilitator, notices that a participant is becoming unwell, she requests permission to contact the appropriate ESP team member and the woman is visited to provide support and prevent the development of more serious problems. There has been no Primetimers Group for the men and so a men’s support group has been formed. This group meets every second week, facilitated by an ESP nurse, and provides ongoing support, activation and social opportunities for the men. Both men and woman have found that the TAG sessions and integrated follow-up groups are helpful in assisting them to maintain optimum health and to prevent relapse.
Wanda* attended all of the TAG sessions and participated enthusiastically. Although initially nervous about the group, she quickly realized that others shared her feelings and she felt relieved to find that her experiences were not so unusual. She particularly enjoyed meeting the other women and her weekly goals included phoning them and later going for walks with several of them. With the encouragement of the group, she decided to join a church near her home and found some new friends and activities there. She joined the Primetimers Group and continues to participate actively. She is now more aware of her health and notices if her stress levels increase. If that occurs, she speaks with Diane or requests a visit with her ESP therapist. She is doing very well and now describes TAG and Primetimers as “the best thing that has happened to me since I moved here.”
About the authorLynn is based in Kelowna. He is a Registered Nurse and works out of Kelowna Mental Health’s Elder Services Program
* Wanda is a fictitious person who represents a composite member of the group.