Large-class CBT for common
mental health problems
WhatisStressControl?
StressControlisasixsession,90minute,didacticCBT/wellbeingtransdiagnostic‘class’(never‘group’)approachfor
thecommonmentalhealthproblems:anxiety,depression,panickyfeelings,insomniaandpoorwellbeing.
Itwasdevelopedover30yearsagobyDrJimWhiteforuseinalow-intensityclinicalpsychologyNHSservicein
Glasgow.Nowusedacrosstheworld,wellover100,000peoplehaveattendedaStressControlclass.
ItisextensivelyusedintheNHS,HSE(ROI),occupationalhealthsettingsandvoluntarycaresettings.
Thereisnodiscussionofpersonalproblemsthusthereisnolimitonthenumberswhocanattend.TypicalNHSclasses
runwith20-100participants,makingStressControlahighlycost-effectiveintervention.
StressControlaimstoteachindividualsto‘becomeyourowntherapist’.Thisaimissupportedby‘StressControlin
ninewords’:FaceyourFears,BemoreActive,BoostyourWellbeing.
‘Trainers’aresupportedbyPowerPoints,audioandvideo.Theclassavoidsjargonandtheelevenbooklets(plus
supplements)whichaccompanytheclassare‘easy’tounderstand(Flesch-Kincaidreadingease).
StressControlaimstohelppeoplewithanylevelofanxietyordepression(‘stress’)–mild,moderateorsevere–and,
forthosewithcommonandenduringcommonmentalhealthproblems,tohelpkeep‘headsabovewater’.Itcanalso
beusedasarelapse-preventionapproachorasearlyintervention/prevention.
StressControlisamongthebest-evidencedpsycho-educationalapproachesforcommonmentalhealthproblemsin
theworld.IndependentIAPTstudiesshowthat‘recovery’and‘reliableandclinicallysignificantimprovement’dataare
equivalenttoIAPTindividualtherapy.
"Thiscourseispotentiallylifechanging,definitelylife
enhancing"Sosaidoneofthemanyhundredsof
participantswhohaveattendedtheStressControl
coursesIhavedeliveredinIreland.DrWhitehas
developedthesingle-mosteffectivetooltoidentifyand
manageanxietyanddepressionIhaveever
encountered.Andtherearenumerousacademic
researchreportstobackupitseffectiveness.Stress
Controlpresentssearingpracticalitywith
comprehensiveinformationinaformatthatiseasily
understood.Asaprofessional,Ihavenever
participatedinamoresatisfyingpieceofwork.StressControl
rocks!"
DrMarkHarrold,SeniorClinicalPsychologistwiththeIrishHealthService.Author,broadcasterand
regularcontributortotheIrishTimesNewspaper.
WhyshouldyouconsiderStressControl?
InanNHSwheredemandwillalwaysoutweighsupply,StressControloffersanevidence-basedapproachthatlowintensityCBTtherapistscanbetrainedtodeliverafteronlyatwo-daycourse.Asaguided-self-helpapproach,itoffers
genuinechoiceforservice-users.Participantscanjointheclassatanysession,allowingrapidaccesstohelp.
DatafromGreaterGlasgowandClydeNHSshowthatStressControlismuchmoreeffectivethanindividualtherapyin
attracting‘hard-to-reach’groups:men(45%ofclasses),thosefromminorityethnicgroupsandthosefromdeprived
communities.Thebanonpersonaldisclosure,nowritingintheclass,theloweringofbarriers(self-referralisthemost
commonrouteintoclasses)andofferingeveningaswellasday-timeclasseshelpconsiderablywiththis.
StressControlcanhelpotherpartsoftheservice:CMHTandCATservice-userswithsevereandenduringproblemscan
attendStressControlclassestodealwiththehighlycomorbidproblemsofanxietyanddepression,thus,potentially,
reducingthenumberofsessionsofone-to-onerequired.
Inindividualtherapy,iftheservice-userfailstoattend,thetherapist’stimeiswasted.InStressControl,ifoneperson
failstoattend,thetherapiststillhasalargeclasstoteach.However,withaveragecompletionratesofover70%,itisa
highlyefficientapproachthatcompareswelltoanyotherNHSmentalhealthintervention.
Intougheconomictimes,StressControloffersinexpensiveevidence-basedcare.Radhakrishnanandcolleagues(Beh.
Res.&Ther.,51,2011)estimatedcostsof£1043per‘recoveredpatient’inlow-intensityIAPTservices.StressControl
costs,perattendee,arearound£711
1
Assuming20classesperyear,70ineachclass,runby2PWPsandanannuallicenseforapopulationof400,000.
Thesixsessions
1
Whatisstress?
2
Controllingyourbody
3
Controllingyourthoughts
4
Controllingyouractions
5a Controllingpanickyfeelings
5b Gettingagoodnight’ssleep
6a Boostyourwellbeing
6b Controllingyourfuture
2
Information:Thecommonsigns;the‘thoughts,body,life’model;
viciousandpositivecircles.Skills:‘StressControlinninewords’
Information:Howourbodiesfeedstress;fight/flight/faint/freeze
Skills:Caffeine,bellybreathing,exercise,progressiverelaxation2
Information:howourthoughtsfeedstress;radars,grasshoppers,and
blinkers.
Skills:Buildingthefoundation;theBig5Challenges;Breakingstressup
Information:Howouractionsfeedstress;avoidanceandbehaviour.
Skills:Faceyourfears;SteppingoutofyourComfortZone;Problem
Solving
Information:howpanickyfeelingsfeedstress;combiningprevious
themes:body,thoughtsandactions.Theroleofinterpretation
Skills:combiningalltheskillsalreadylearned;preventionskills.
Information:whyweneedtorechargeourbatteries;sleepcycles.
Skills:Sleepingtips(hygiene);Retrainingyoursleep(stimuluscontrol)
Information:‘languishing’and‘flourishing’.
Skills:‘Fouraday’;everydaymindfulness;gratitudeandcompassion
Information:Tyingitalltogether.
Skills:Dealingwithsetbacks;‘Settingyourcompass’:values
Allrelaxationandmindfulnessaudiotracksareavailableonafree-to-accesswebsite/app
Recentresearchfindings
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•
Amulti-servicepracticeresearchnetworkstudyoflargegrouppsychoeducational
cognitivebehaviouraltherapy.Delgadillo,J.,Kellett,S.,Ali,S.,McMillan,D.,
Barkham,M.,Saxon,D.,Donohoe,G.,Stonebank,H.,Mullaney,S.,Eschoe,P.,Thwaites,R.,Lucock.M.
BehaviourResearchandTherapy,87,2016,155-161.
“TheeffectivenessofStressControlinroutinepracticeappearstobecomparabletothatofotherbrief
interventionsincludingindividualguided-self-helpandCCBT.Thedeliveryratio(upto100participantsper2
facilitators)andminimalneedforclinical-patientcontactareuniqueaspectsthatenableStressControlto
considerablyenhanceaccesstopsychoeducationalsupportandlowcost”(p160-161)
“StressControl”asaLargeGroupPsychoeducationalInterventionatStep2ofIAPTServices:Acceptabilityof
theApproachandModeratorsofEffectiveness.Burns,P.,Kellett,S.,andDonohoe,G.Behaviouraland
CognitivePsychotherapy,2016,44,431–443.
“StressControlappearscomparativelyclinicallyequivalenttotheotherIAPTinterventionsandproducedhigher
recoveryratesthantheGreenetal(2014)andFirthetal(2015)analysesofone-to-onePWPwork”.(p140)
•
Respondingtomentalhealthstatutorydrivers:experienceofalowintensitycognitivebehaviouraltherapy
programme(2015).Mills,R.,Mowlds,W.,Dyer,K,Corr,P.,andKavanagh,M.IrishJournalofPsychological
Medicine.Doi:10.1017/ipm.2015.56.
“StressControlwaseffectiveandfeedbackwasoverwhelminglypositiveonthecourse.Thereremainsno
pressingneedtoaddresscoursecontentoritsdelivery”(p7)
LessonsfromIreland
StressControlhasbeensuccessfullyrolled-outacrosstheHSE,theRepublicofIreland’sequivalenttotheNHS.Ithas
alsobeenrolled-outacrosstheNHSinNorthernIreland.Twoexamplesofclinicalexcellencestickout:
Malahide
Malahide,atownof16,000inhabitants,holdsthecurrentrecordforthelargestStress
Controlclass.Runbyclinicalpsychologists,DrMarkHarroldandDrAlisonRooneyand
madepossiblebycommunityfund-raisingandeffectivelyadvertisedthroughradio,
pressandsocialmedia,thisclass,heldintheBallroomoftheGrandHotel,started,and
finished,with450people.Thisshowstheextentoftheunmetneedinour
communitiesandhow,bythinkingthatbitdifferently,wecanhelpmuchgreater
numbersthancancurrentlyaccessourservices.
Donegal
TheHSEteaminDonegalhavebeenhighlysuccessfulinnotonlyrunningclassesinthe
maintownsinthecountybutalsoingettingintothemostremoteandsmall
communities,e.g.villagessuchasDunfanaghywithapopulationof312and,inBloody
Foreland,runningaclassfor25peopleinthefrontroomoftheParochialHouseafter
thelocalcommunityrequestedStressControlbedeliveredthere.
What do people think about the class?
Liz, interviewed about attending a class in Belfast on BBC Radio Ulster in 2015:
“The benefit was that there were so many people there; of all age groups. I could just walk
Whatdopeoplethinkabouttheclass?
in. There was no pressure on me to explain who I was or where I had come from”
Liz,interviewedaboutattendingaclassinBelfastonBBCRadioUlsterin2015:“Thebenefitwas
thatthereweresomanypeoplethere;ofallagegroups.Icouldjustwalkin.Therewasno
pressureonmetoexplainwhoIwasorwhereIhadcomefrom”
Harry:
“The course is delivered in a way that respects my ability to apply the techniques myself”
Harry“Thecourseisdeliveredinawaythatrespectsmyabilitytoapplythetechniquesmyself”
Diane“Ifeltrelaxedandcouldtakeonboardeverythinginmyowntimeandway”
Diane “I felt relaxed and could take on board everything in my own time and way”
3
3
tostate:“Therewasanalmostpalpablesatisfactionwith
TheabovetwoquotesledMillsandcolleagues
The above two quotes led Mills and colleagues
to state: “There was an almost palpable
StressControlthatmanifestedinunpromptedexpressedgratitude[towardsthetrainers]”
satisfaction with Stress Control that manifested in unprompted expressed gratitude
[towards the trainers]”
Rod“BeforetheclassIfelttotallyoverwhelmedbymystress.StressControlwassensible,practicalandgaveme
everythingIneeded-easilyunderstoodinformationaboutstress,greatskills,nojargon,nononsense
andenoughbeliefinmyselftosortoutthestressandgetbackontopoflife.Imustalsosaythatitwas
Rod “Before the class I felt totally overwhelmed by my stress. Stress Control was sensible,
practical and gave me everything I needed - easily understood information about stress,
veryenjoyable.Thetrainerquicklymadeyoufeelateaseand,astheclasspromises,givesyouthe
great skills, no jargon, no nonsense and enough belief in myself to sort out the stress and
confidencetobecomeyourowntherapist”
get back on top of life. I must also say that it was very enjoyable. The trainer quickly made
you feel at ease and, as the class promises, gives you the confidence to become your own
therapist”
3
IrishJournalofPsychologicalMedicine.doi:10.1017/ipm.2015.56.
ExamplesofsomeoftheslidesusedinStressControl
Stress Contol
Developments
StressControlYP
Schools
Aroundhalfofalladultmentalhealthproblemsstartbeforetheageof15andwithasignificantincreaseinadolescent
mentalhealthproblemsandwithCAMHSservicesabletoseeonlythetipoftheiceberg,thereisaneedforschoolsto
offerstraight-forwardinterventionstohelpthoseteenagerswithexistingproblemsandthosewhomaybeatriskof
developingproblemslaterinlife.StressControlYoungPersonsaimstodothis.
Aimedat14-15yearolds,StressControltrainspastoralcareteacherstoruntheclassover8single,weeklyperiods.By
includingthisinPersonalandSocialDevelopment,allpupilsaretaughttheskills,thusensuringhard-to-reach
individualshavetotakepart.ResearchcarriedoutatStPaulsSecondarySchool,Glasgow,inoneofthemostdeprived
areasintheUK,showedsignificantchangepretopostwithgainsmaintainedat9monthfollow-up.Parallelclassesfor
parents(andteachers),runintheeveningintheschool,allowsteenagersandparentstobetterhelponeanother.
CAMHS(availablemid-2017)
Thismoreinvolvedversion,forCAMHSstaff,canbeusedforteenagersattendingChildandAdolescentServiceseither
asastand-aloneinterventionorasasupplementaryapproachforthoseinvolvedinindividualtherapy.
With mental health problems costing employers £26 billion each year in the UK through lost working days, staff
turnover and low productivity, companies are well-placed to offer employees Stress Control as a way to decrease
absenteeism and the much more common problem of presenteeism. Designed to be delivered by non-CBT trained
OH/HR staff, this six session version covers the same issues and teaches the same skills but is designed for use in
non-clinical settings. Examples are the HSE in Ireland using it for employees as a way to boost wellbeing at work.
Continental, the multi-national company, began offering the class to employees in its Germany plants. Due to the
success of this venture, they have now rolled-out Stress Control and offer the class routinely to all employees in its
factories across the world, e.g. Romania, Slovakia, Mexico, USA and China.
“Stress Control is a core piece of our Continental Mental Health Prevention
Program. It offers exactly what we were looking for: An efficient, well-evaluated
stress management training suitable for everyone from production worker to
engineer. Stress Control helps us to prevent chronic stress, burnout, depression
and anxiety in our workforce. We use it as a global tool and are highly satisfied
with the results.”
Dr. Anja Rivera de la Cruz Director, Corporate Health
Mental health problems are the norm in prisons. These individuals are,
typically, ‘hard-to-reach’ when they are in the community. Having them,
literally, as a captive population, allows services to deliver straight-forward
CBT (with very easily understood, shorter booklets) to large numbers of
people who, otherwise, would be unlikely to receive any help.
Being offered materials designed for the general population can frustrate those who are living very restricted lives.
Stress Control: Prison is a dedicated version that inmates should see as personally-relevant and offering skills to help
them through their sentence and which can be used when back in the community.
“Participants’ anxiety significantly decreased and their wellbeing increased after completing Stress Control.
Prisoners were satisfied with the intervention and there was a small attrition rate”
Breese, L., Maunder, L., Waddell, E., Gray, D. and White, J. (2012). Stress Control in Prison Health Care: an
audit. British Journal of Forensic Practice, 14, 292-301.
DrJimWhiteprovidesatwo-daytrainingforupto24CBT-trainedtherapists(clinicalversion)or18HR/OH/voluntary
sectorworkers/teachers(otherversions).Thispracticaltrainingwillequipthoseattendingtoimmediatelyset-upand
runtheirownclasses.StressControlLtdcanonlyoffertrainingtoservicesandorganisations-notindividuals.
License
Servicestakeoutathree-yearcontract.Thelicensecostisusuallybasedonthesizeofpopulationserved.Contact
StressControlLtdforaquote.Thelicenseallowstheclasstoberunasoftenandforasmanypeopleasitwishes.
ThepackageincludesPowerPointsforeachsessionalongwithtwopre-sessionrollingpresentations.‘StressControl
slide-by-slide’accompaniesthesepresentations,explainingeachslideandofferingadviceonhowbesttoteacheach
session.Thereare11participantbookletsplusthreesupplements.ThesearegiveninWordformat.Servicesthen
print/copybookletsforparticipants,adding,ifrequired,servicelogos.Anonlinelicenseallowsservice-userstoaccess
electronicbooklets(andacomprehensiveinteractiveself-assessment).Thislicense,althoughmoreexpensive,can
quicklysaveonprintingcosts.Accesstotherelaxation/mindfulnesswebsiteallowsparticipantstostream/download
exercisesfree-of-charge.ServicesmaywishtoburnsomeCDsforthosewhodonothaveonlineaccess.Session
summarysheetsandvariouspracticeformscompletethepackage.
OptionalservicesincludeemailsupportfromStressControlLtdfortrainersandsixmonth/oneyearfollow-upvisitsto
helpmaintainquality.
DrJimWhiteB.A.,M.App.Sci,Ph.D,
CharteredPsychologist
CharteredScientist
Fellow,BritishPsychologicalSociety
Fellow,BritishAssociationforBehaviouralandCognitivePsychotherapies
Co-editor,OxfordGuidetolow-intensityCBTinterventions
Creatorofthe‘GlasgowSTEPS’low-intensitymodel
JimdevelopedStressControloverthirtyyearsagoasaway:
•
•
•
•
•
toallowmanymorepeopleaccesstoevidence-basedCBT
toattracthard-to-reachindividuals,particularlyfromdeprivedareas,whowouldnotfeelcomfortableinan
interactivegroup
tosimultaneouslytacklethefrequentlyco-existinganxietyanddepressionproblemsfoundinlow-intensity
services
toofferalternativestoone-to-onetherapy
togetthebestbalancebetweenclinicaleffectivenessandcost-effectiveness
For more
information, please see
www.stresscontrol.org
Formoreinformation,pleasesee
or call 07966 704 194
www.stresscontrol.org
or email
[email protected]
orcall07966704194
[email protected]