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
A Retrospective Chart Review of Cognitive Behavioural Therapy with Mindfulness (CBTm) Classes in Military and Police Populations at the OSIC.
Natalie Mota, Cheryl Maxsom, Joanna Bhaskaran, Debbie Whitney, Shay-Lee Bolton, Jitender Sareen.
An evaluation of cognitive behaviour therapy with mindfulness (CBTm) classes and tele psychology utility in rural community settings. Journal of Rational- Emotive & Cognitive-Behavior Therapy, September, 2021.
Davidson, D., Kinley, J., Wong, J.Y., Whitney, D., Thakur, V.K., Paley, J., Sareen, J.
Background: Cognitive behaviour therapy with mindfulness (CBTm) classes are a group-based, psychoeducational, clinical service. Early research has suggested they are a promising low-intensity intervention for reducing psychiatric symptoms such as anxiety and depression (Palay in, Eur J Person Centered Healthcare 62:274, 2018; Thakur in BMC Psychiatry 19:132, 2019). Rural community members may benefit from these classes given the barriers they face in terms of available, accessible, and acceptable psychological treatment (Smalley in J Clin Psychol 66:479–385, 2010). Group-based telepsychology is one potential avenue for increasing access to psychological services in remote rural communities. Methods: This investigation evaluated the effectiveness of four-session weekly group CBTm classes taking place in rural Canada from November 2015 to December 2017, the impact of attendance via telepsychology (group-based videoconferencing at remote health centres closer to their homes) compared to in-person, and factors associated with class dropout. 376 CBTm class participants completed questionnaires during each class, providing a measure of their symptoms over time. Results: Anxious, depressive, and general psychiatric symptoms were reduced over the course of CBTm classes. Telepsychology attendance did not diminish class effectiveness. Predictors of class dropout were difficult to identify, except higher baseline anxiety, which predicted lower dropout rates. Conclusions: Group-based CBTm classes, whether delivered in person or via telepsychology, appear to be an effective avenue for improving mental well-being and service access among rural community members. Although encouraging, results also suggested a need for research on predictors of and reducing antecedents to class dropout in this population.
Creating Resilient Workplaces (CReW) Study: Looking to the future. Winnipeg Fire and Paramedic Service Peer Support Education Seminar, Winnipeg MB, January 19, 2021.
Creating Resilient Workplaces (CReW) Study: Preliminary findings. Operational Stress Injury Clinic Clinical Research Meeting, Winnipeg MB, February 18, 2021.
Invited to speak as a witness for the All Party Parliamentary Mental Health Caucus on findings from the research on Cognitive Behaviour Therapy with Mindfulness (CBTm) classes. Ottawa ON; May 19, 2021.
Bolton SL, Sareen, J.
Cognitive Behavior Therapy with Mindfulness (CBTm) Classes: Background, Implementation and Science. Department of Psychiatry Grand Rounds, Faculty of Medicine, University of British Columbia (virtual), September 14, 2021.
Bolton SL, Sareen, J.
A retrospective chart review of cognitive behavioural therapy with mindfulness (CBTm) classes in military and police populations at the OSIC (Poster presentation). Canadian Institute for Military and Veteran Health Research, Virtual, October 2021.
Mota, N., Maxsom, C., Bhaskaran, J., Whitney, D., Bolton, SL, & Sareen, J.
Evaluation of a class-based cognitive behavior therapy with mindfulness program for public safety personnel: A pilot randomized controlled trial. Oral Presentation at the Canadian Institute of Military and Veteran Health Research (CIMVHR) Forum, October 19-21, 2021.
Bolton SL, Wong J, Sala T, Mota NP, Maxsom C, Sareen J, Kinley J.
Cognitive Behavioral Therapy Intervention for Prevention of Anxiety and Mood Disorders in Public Safety Personnel. Walden Dissertations and Doctoral Studies, 2021.
Wong, Jacquelyne Yan
Due to repeated exposure to highly stressful work environments, public safety personnel (PSP) are at risk for developing symptoms of anxiety and mood disorders. The present study employed a quantitative, randomized-controlled trial (RCT) design to examine the impact of a novel cognitive-behavioral therapy (CBT) psychoeducational intervention on symptom levels of anxiety and depression. Participants were recruited from police, firefighters, paramedics, and emergency communications personnel. A total of 60 participants were randomly assigned to either the intervention arm or the waitlist comparison arm. General linear mixed models were used to examine the difference in symptom outcomes for those who participated in the intervention compared to those on the waitlist arm at two trend levels: (a) during the Cognitive Behavior Therapy with Mindfulness (CBTm) implementation period and (b) during the post-CBTm period. The results showed statistically significant improvement in symptoms of depression for those who participated in the intervention compared to those in the waitlist control arm during the CBTm implementation period, which was maintained during the follow-up period. There was also improvement in symptoms of anxiety for those who participated in the intervention during the CBTm implementation period, but the improvement in symptoms was not significantly different from the waitlist comparison arm. These preliminary findings serve to inform PSP occupational communities, clinical practice, and mental health policy about the use of a CBT psychoeducational intervention for PSP which may lead to positive social change.