How many times have you purchased a workbook and then put it on your shelf, never to be opened again? (Trois pour moi.) Now compare that to the progress you made when the workbook was tied to a class and there was an element of accountability—probably got more done, huh?
A variant of this concept was recently tested by the National Health Service (NHS) in the United Kingdom. BBC News reported that in an effort to cope with high demand for therapy, more than 200 patients who had already been diagnosed with depression were assigned self-help cognitive behavioral therapy (CBT) workbooks. They were also given up to four guided sessions of approximately 40 minutes each with an adviser.
Results were measured at four months and again at 12 months using the BDI-II test, a common questionnaire for assessing the severity of depression. According to the study published in PLOS One, at the four-month mark, BDI-II scores were lower in the workbook group by 5.3 points (where scores above 29 indicate severe depression). At four and 12 months there were also significantly higher proportions of participants achieving a 50% reduction in BDI-II score in that group as compared to the control group, who received ‘treatment as usual’ from a general practitioner.
There is wide discussion about mental health care in the United States right now and along with individual rights and involuntary treatment, the cost of services is at the center of the debate. The UK’s NHS began its look at a guided self-help strategy for precisely that reason, and the same considerations could be applied to the mental health care strategy discussion in any country:
- Guided self-help can be delivered by an adviser or general practitioner (as opposed to requiring a psychologist or psychiatrist). Not only is this less costly, it would help in a situation or place where specialized resources are scarce.
- Patients receive less one-on-one time than with a traditional therapy routine without compromising their recovery
- It’s an active treatment as opposed to a passive treatment (and as with the idea that if you have ownership of your work, you’ll produce better results, the same could be true here)
- Patients have reference material to which they can go back (as opposed to the discussion in therapy that may or may not be retained in memory)
These are just a few things that I came up with, but if any other considerations or potential benefits jump out at you, please share them below.
I wrote this post with Internet activist Aaron Swartz in mind. PLOS One, who published the study referenced above, happens to be a leader in the open access (OA) movement, which seeks to make the results of all scholarly research accessible to everyone. In addition to his support of this movement, Swartz was also known to suffer from depression.
Great points! It would help people who don’t get treatment because of the stigma. Especially now that the gun control laws are aimed at blaming people with mental illness. UGH!
True, true, it’s a more ‘private’ way to get treatment. Thanks, Jodi!
Laura, did you ever hear of an online service called Moodscope? I came across it about a year or so ago and it’s fantastic – a brilliant, simple tool to help people recognise and deal with their own depression or similar issues. They also do a brilliant daily blog which delivers a supportive thought for the day each morning. That makes it sound a bit naff but actually I think it’s really powerful, especially for those who are either borderline needing treatment or nervous of seeking it out.
Most excellent, Debbie. I hadn’t heard of it before but will definitely check it out. Thanks for sharing.
I think your third bullet point is key: active vs. passive treatment. So often when we’re experiencing anxiety or depression, we feel that we’ve lost control of our emotional lives. Actively working on our own treatment would help overcome those feelings of powerlessness, and the immediacy of being able to dive into the workbook and resources on our own schedule would ensure that our successes are constantly reinforcing that feeling of regaining control.
Interesting post, Laura. I wonder if those workbooks are available in Canada.
You’re spot on, Kern. I think the ‘guided’ part of it is also key, to keep people on track. In the research study, they still lost a chunk of participants by the 12-month mark, but then again, that could also be because the patients were feeling so much better.
I have been meaning to call up the mental health services department of the Fraser Health Authority so will add this to my list of questions.
It’s a great idea (and a great post), the demand for therapy in the UK is so high many GP’s are actually telling patients it’s just not available, myself being one of those patients. I was told I could have antidepressants right away, but the therapy waiting list was over three years… You then think you’ll be sorted before you get therapy so you don’t ask to go on the list. However if you end up on the list maybe you’ll get therapy in time for the next bout of depression instead of the current one!
I’d love to have the CBT workbook, as I know I can manage my depression but just need a little guidance along the way. Shall be asking my GP about this next time!
Lisa, thanks so much for your comment. Wow to the three-year wait list! If you’re inclined to stop in here again some time later, I’d love to know if your GP had heard about this, and if you’re able to get the workbooks or if the books don’t get a widespread roll-out for a while. I’ll keep my eye out for follow-up stories and info on this, as well.
That’s the British NHS for you! My depression is good right now, have been on an even keel for a year, with the usual dips…but if it beats me again I’ll ask for these workbooks!
This post reminds me of a book I bought when I got to feeling really down after leaving my job and moving to the other side of the country. It was called The Depression Cure by Illardi. He offers an inclusive six-step program that would definitely lend itself to being used as guided self-help. I read it, tried parts of it, but in the end, would have benefited by a coach to supplement the book’s advice. Thank goodness time has lessened my blue moving mood a bit!
That book looks like a really good resource (and it got great reviews on Amazon). In my last mental health-related post, I talked about peer-led recovery groups. When practitioner-guided self-help isn’t available, a book like this might work well in the peer-recovery setting. Thanks for sharing, Jeri, and I’m glad you’re on the upswing!
I’ve found these CBT type workbooks very helpful (although in typical fashion I never completed any cover to cover). There’s one called Get Out of Your Mind and Into Your Life that’s quite powerful. Ultimately, as CBT has demonstrated, when you are your own therapist that’s empowering, and feeling empowered is very important in overcoming depression with a small or large D.
HA! That’s one of the workbooks on my shelf, Miranda. You know, one of the unopened ones… 😛
Totally agree on the empowerment front, and it’s hard to overcome that with depression because by the very nature of illness, you feel quite dis-empowered sometimes!
Not sure he has a workbook, but David Burns “Feeling Good” first taught me about cognitive therapy, and gave me an awareness that I could do it myself. I’ve passed that title on to so many friends and family in trouble. The title might seem trite but it’s powerful stuff and it works.
You know, that one was recommended to me back in 2008 or 2009, and I remember getting it from the library and but then not reading it. I was just thinking about CBT on Saturday, because I started reading Eckhart Tolle’s “The Power of Now.” He teaches to look at thoughts from the perspective of a “watcher,” and to be clear that you are not your thoughts. It’s a bit different than CBT, but I think also valuable. Both techniques teach us to slow down and evaluate as objectively as possible what’s going on in our heads.
Hi Laura !!
I like your article very much. Such great points you have mentioned. It would help people who don’t get treatment because of the stigma. Especially now that the gun control laws are aimed at blaming people with mental illness. I think when we’re experiencing anxiety or depression, we feel that we’ve lost control of our emotional lives. But active work can help us in overcoming from these feelings. Thanks and keep sharing more articles.
Regards:
Alice Gaunt
Worksheets aren;t a good fit for me, but this sounds like a great idea.
Hi Katia, if you’re more of a digital kind of person, there are now also ways to do similar work via an app. Joyable is one, and I’m guessing there may be others. Thanks for stopping by!