Manitoba Patient Access Network – Final Report, March 23, 2017
Cognitive Behavior Therapy (CBT) and Dialectical Behavior Therapy (DBT) Classes for Adults and Adolescents with Mood, Anxiety, and Substance Use Disorders and their Caregivers
Dr. Jitender Sareen, Dr. Tanya Sala, Ms. Jacquelyne Wong, Dr. Debbie Whitney,
Dr. Jolene Kinley, Dr. Laurence Katz, Dr. Adrian Hynes, and Dr. Josh Nepon
An evaluation of large group cognitive behaviour therapy with mindfulness (CBTm) classes
Vishal Thakur, Jacquelyne Wong, Jason Randall, James Bolton, Sagar Parikh, Natalie Mota, Debbie Whitney, Joshua Palay, Jolene Kinley, Simran Diocee, Tanya Sala, Jitender Sareen
Ensuring equitable and timely access to Cognitive Behaviour Therapy (CBT) is challenging within Canada’s service delivery model. The current study aims to determine acceptability and effectiveness of 4-session, large, Cognitive Behaviour Therapy with Mindfulness (CBTm) classes.
A retrospective chart review of adult outpatients (n = 523) who attended CBTm classes from 2015 to 2016. Classes were administered in a tertiary mental health clinic in Winnipeg, Canada and averaged 24 clients per session. Primary outcomes were (a) acceptability of the classes and retention rates and (b) changes in anxiety and depressive symptoms using Generalized Anxiety Disorder 7-item (GAD-7) and Patient Health Questionnaire 9-item (PHQ-9) scales.
Clients found classes useful and > 90% expressed a desire to attend future sessions. The dropout rate was 37.5%. A mixed-effects linear regression demonstrated classes improved anxiety symptoms (GAD-7 score change per class = − 0.52 [95%CI, − 0.74 to − 0.30], P < 0.001) and depressive symptoms (PHQ-9 score change per class = − 0.65 [95%CI, − 0.89 to − 0.40], P < 0.001). Secondary analysis found reduction in scores between baseline and follow-up to be 2.40 and 1.98 for the GAD-7 and PHQ-9, respectively. Effect sizes were small for all analyses.
This study offers preliminary evidence suggesting CBTm classes are an acceptable strategy to facilitate access and to engage and maintain clients’ interest in pursuing CBT. Clients attending CBTm classes experienced improvements in anxiety and depressive symptoms. Symptom improvement was not clinically significant. Study limitations, such as a lack of control group, should be addressed in future research.
Grand Rounds, March 6, 2018
University of Manitoba, Rady Faculty of Health Sciences, Department of Psychiatry.
Presented by Dr. Jitender Sareen, Dr. Tanya Sala and Ms. Tara Brousseau-Snider.
Feasibility of Large Group Cognitive Behavioural Therapy Education Classes for Anxiety Disorders
Joshua Palay, Jacquelyne Y Wong, Jason R Randall, Tanya Sala, James M Bolton, Patricia Furer, Shay-Lee Bolton, Debbie L Whitney, Vishal Thakur, Sagar V Parikh, Jitender Sareen
Rationale, aims and objectives
Cognitive behavioural therapy (CBT) is effective in treating anxiety disorders. In publically funded systems, CBT is not easily accessible due to long wait times. In order to provide quicker access, a large group CBT intervention was implemented in a tertiary care clinic. This study describes the design, feasibility and acceptability of such an intervention as part of stepped care for anxiety disorders.
The intervention followed a 2-session curriculum, consisting of 90 minutes classes providing didactic instruction on key CBT topics and self-management strategies. Classes accommodated 30 patients and were led by staff psychiatrists formally trained in CBT. A retrospective analysis of patients referred to the clinic during the first year of class implementation was performed to determine class completion rate, patient satisfaction (using a usefulness Likert Scale and Session Rating Scale [SRS]) and symptom trajectory (using the GAD-7).
The implementation of large group CBT classes reduced waiting times from approximately one year to approximately 3 months. One hundred and thirty-one patients were screened by the clinic, 88 of whom (67%) completed the intervention. Sixty-eight percent of patients rated the classes as useful; however, SRS findings indicated that only 46% of patients were satisfied. GAD-7 scores decreased by 1.57 (95% CI 0.2 to 2.95; SMD=0.24).
This analysis contributes preliminary evidence that large group CBT education classes may be an acceptable means to reduce waiting times for CBT for anxiety disorders. Further controlled research is required to elucidate the benefit and cost effectiveness of such classes.
Keywords: Anxiety disorders, cognitive behavioural therapy, cost effectiveness, evaluation, health services research, patient expectations, patient satisfaction, person-centered healthcare, self-management, waiting times