In a nutshell: A Danish randomized controlled trial study concludes that a 7-weeks peer-to-peer self-management workshop for people with anxiety and/or depression is at least as good an intervention as treatment with medicine or psychotherapy.
The team lost, but Pernille won
Two months ago, Pernille had to take her son and some of his friends to the final match between her all-time favorite football team Aarhus GF and FC Copenhagen. Pernille has lived with social anxiety and depression for more than 20 years. The thought of travelling to the capital city, entering a stadium with 40.000 other spectators and having the responsibility for her son and friends would normally be too much for her. But instead of cancelling the trip, she used the problem-solving and action planning techniques she learned at the CDSMP mental health workshop.
She started by identifying things that could trigger an anxiety attack during the match. She found out that she had to know
- where exactly their seats in the stadium were
- what kind of help she could expect, if necessary
- which were her escape possibilities.
She formulated an action plan, called the staff at the stadium and explained her situation and needs.
Having taken these measures for preventing an anxiety attack, she went on the trip. Unfortunately, Aarhus GF lost – but Pernille and her group had a great day and made a good memory. And she didn’t have any symptoms of anxiety or stress during the entire trip.
Before the workshop Pernille used a lot of medicine to cope with everyday life. During and after the workshop, she began reducing the amount of medication in cooperation with her doctor. By now she has achieved to stop taking any medication at all.
When she entered the stadium, she felt butterflies in her stomach for the first time in 20 years. A feeling she had almost forgotten after being medicated for so long.
Active self-help as good as medical treatment and psychotherapy
The Danish Committee for Health Education (DCHE) holds the national license for operating the Chronic Disease Self-Management Program (CDSMP) in Denmark. The DCHE was founded in 1964 and is a non-profit non-governmental organization with close working relations with public authorities like the Ministry of Health, the National Board of Health and private organizations in the health field. Fore more information about the CDSMP in Denmark, have a look at my previous blog post.
The DCHE conducted a randomized controlled trial study, which concludes that the CDSMP mental health workshop has significant effects on symptom reduction and increase in self-efficacy. In other words: the research study results support the experiences of Pernille. The participants with moderate symptoms of anxiety or depression have effect sizes as good as treatment with medicine or therapy. Read the full report in Danish
From ‘New beginning’ to ‘LÆR AT TACKLE angst og depression’
10 years ago, Denmark implemented the Stanford-developed CDSMP on a national scale. After 3 years with CDSMP, the Danish Committee for Health Education introduced CPSMP, a pain self-management program developed in Canada by Professor Sandra LeFort and Professor Kate Lorig. CPSMP is a derived version of CDSMP. Up to 40 % of the participants had moderate to severe symptoms of anxiety and/or depression, so the natural next step was to introduce a mental health version of CDSMP as well. In the United Kingdom, the national health service had developed a CDSMP derivative called ‘New beginnings’. This workshop is focused on all kind of mental health issues. In Denmark, we narrowed the purpose to focus only on anxiety and depression.
The workshop is about creating plans and strategies for preventing anxiety attacks and periods with depression in the future, combined with the traditional self-help tools such as action planning, problem solving and decision making.
The workshop leaders are peers who have experienced anxiety and/or depression themselves and function as good role models. The workshop group meets once a week for 2½-hour sessions over seven weeks. So it is a small, intensive intervention.
The Danish Committee for Health Education (DCHE) celebrated the 10-years-anniversary of CDSMP in Denmark this spring with 250 volunteer peer leaders.
An example of a perfect randomized controlled trial
The study was done by researchers at Aarhus University. The Danish Committee for Health Education (DCHE) had no access to any data. In fact, the study was initiated by the Ministry of Health. The analysis and results were discussed among experts at the National Board of Health before publication.
37 municipalities participated and 51 workshops were included in the study. 853 individuals (age 18-81 years old) participated, and 1/3 went into a control group. The participants answered questionnaires beforehand, afterwards and after 3-4 months. In addition to the quantitative study, a qualitative study of group dynamics was conducted in order to complement the data from the questionnaires. This means that the intervention has been tested in the same setting that it will be operated in. This set-up gives the results even more credibility.
Looking into the future
Right now 49 Danish municipalities are running the workshops and they are experiencing waiting lists to participate. A great operational success!
Furthermore, the municipalities have started testing the intervention on youngsters (age 15-25), and as an online workshop for people suffering from social anxiety. Experience from Canada shows, that people who have attended an online workshop are more likely to say yes to a traditional workshop afterwards. So this is a way to reach out to the most fragile potential participants.
In general, DCHE are testing the workshops in various settings at the moment to find out potential target groups, who can benefit from CDSMP. For example: self-management workshops to prevent stress for people with a higher education, and to create a workshop in “easy danish” to immigrants with poor language skills (see also the project “Evivo Migration” for Switzerland in this regard).
All reports and knowledge will of course be presented in this blog. We’ll keep you posted!
Tell us your thoughts
- What do you think is important when delivering self-management workshops?
- What are your worries about peer-leaders delivering workshops?
We would appreciate your comment below!