Self-Management Tool Helps Patients Navigate Depression

Family physician Patrice Ranger estimates that she sees about 10 depressed patients a week at the student health services clinic at the Simon Fraser University campus in Burnaby, B.C. That's about 10% of her practice.

However, she can help a fair number of those patients by encouraging self-management techniques that involve just one or two office visits and often no medication. “Whether it's mild, moderate, or severe depression, there's always room for this type of tool—perhaps as a sole treatment in a mild depression, or as an adjunctive tool in more moderate or severe depression,” she said in an interview.

Supported self-management draws on the principles of cognitive-behavioral therapy (CBT) and is based on the premise that patients can actively participate in their own depression treatment by using techniques to change attitude and behavior. The approach is guided by a workbook or an online interactive program that teaches skills for combating the negative thought patterns that contribute to depression.

Self-management is overseen by a coach or supporter who is often a health care provider, but also can be a family member or friend, said Dan Bilsker, Ph.D., a psychologist at the university who developed the workbook Dr. Ranger uses.

Self-management of depression—also known as guided self-management—is becoming a standard component of the mental health care system in the United Kingdom and Australia, Dr. Bilsker said. “It's as low cost as any intervention gets; it's low risk, user friendly, and evidence based.”

Yet not much is known about it, nor is it widely used in the United States, even though it fits “with the emerging paradigm of collaborative health care and serves to maximize the impact of an existing health care system by extending the reach of primary care,” he said in an interview.

And it is ideal for a primary care setting. “Primary care is carrying the burden of most intervention for depression. [Most] people with depression see only a primary care physician and have no contact at any point with the psychiatric system.”

Given the time constraints and patient load of most primary care physicians, medication is often the treatment of choice for depression, although there is little evidence to support its benefit in minor depression, Dr. Bilsker said. Supported self-management, on the other hand, is an initial treatment that is as time efficient as medication, with a more favorable risk profile. “It gives an alternative [and] leaves open the option of the physician adding medication later.”

Dr. Ranger said she advises the approach to most of her patients as a first step. “You don't just give it to them and send them away. [They] come back within 2 weeks to discuss how they're feeling.”

Even if she decides that medication is needed, she retains the self-management techniques as an important part of the treatment. “This is one way of learning skills that can help over your lifetime. The medicine may be needed for the here and now or for a longer time, but that's only part of the treatment. The other part is looking at a person's skills and thought processes. People can learn that they have some control with very practical things such as goal setting and self-care.”

Dr. Bilsker noted that the supported self-management approach is also attractive to patients. “Studies show that many people want to be actively involved. They don't always want to hand it over to a professional. This is part of an overall shift in the management of all chronic diseases … to give the patient[s] tools, training, and support so they are a part of their recovery process.”

The workbook can be downloaded, for free, by going to www.carmha.ca/publications/resources/asw/SCDPAntidepressantSkills.pdf

Family physician Patrice Ranger estimates that she sees about 10 depressed patients a week at the student health services clinic at the Simon Fraser University campus in Burnaby, B.C. That's about 10% of her practice.

However, she can help a fair number of those patients by encouraging self-management techniques that involve just one or two office visits and often no medication. “Whether it's mild, moderate, or severe depression, there's always room for this type of tool—perhaps as a sole treatment in a mild depression, or as an adjunctive tool in more moderate or severe depression,” she said in an interview.

Supported self-management draws on the principles of cognitive-behavioral therapy (CBT) and is based on the premise that patients can actively participate in their own depression treatment by using techniques to change attitude and behavior. The approach is guided by a workbook or an online interactive program that teaches skills for combating the negative thought patterns that contribute to depression.

Self-management is overseen by a coach or supporter who is often a health care provider, but also can be a family member or friend, said Dan Bilsker, Ph.D., a psychologist at the university who developed the workbook Dr. Ranger uses.

Self-management of depression—also known as guided self-management—is becoming a standard component of the mental health care system in the United Kingdom and Australia, Dr. Bilsker said. “It's as low cost as any intervention gets; it's low risk, user friendly, and evidence based.”

Yet not much is known about it, nor is it widely used in the United States, even though it fits “with the emerging paradigm of collaborative health care and serves to maximize the impact of an existing health care system by extending the reach of primary care,” he said in an interview.

And it is ideal for a primary care setting. “Primary care is carrying the burden of most intervention for depression. [Most] people with depression see only a primary care physician and have no contact at any point with the psychiatric system.”

Given the time constraints and patient load of most primary care physicians, medication is often the treatment of choice for depression, although there is little evidence to support its benefit in minor depression, Dr. Bilsker said. Supported self-management, on the other hand, is an initial treatment that is as time efficient as medication, with a more favorable risk profile. “It gives an alternative [and] leaves open the option of the physician adding medication later.”

Dr. Ranger said she advises the approach to most of her patients as a first step. “You don't just give it to them and send them away. [They] come back within 2 weeks to discuss how they're feeling.”

Even if she decides that medication is needed, she retains the self-management techniques as an important part of the treatment. “This is one way of learning skills that can help over your lifetime. The medicine may be needed for the here and now or for a longer time, but that's only part of the treatment. The other part is looking at a person's skills and thought processes. People can learn that they have some control with very practical things such as goal setting and self-care.”

Dr. Bilsker noted that the supported self-management approach is also attractive to patients. “Studies show that many people want to be actively involved. They don't always want to hand it over to a professional. This is part of an overall shift in the management of all chronic diseases … to give the patient[s] tools, training, and support so they are a part of their recovery process.”

The workbook can be downloaded, for free, by going to www.carmha.ca/publications/resources/asw/SCDPAntidepressantSkills.pdf

Family physician Patrice Ranger estimates that she sees about 10 depressed patients a week at the student health services clinic at the Simon Fraser University campus in Burnaby, B.C. That's about 10% of her practice.

However, she can help a fair number of those patients by encouraging self-management techniques that involve just one or two office visits and often no medication. “Whether it's mild, moderate, or severe depression, there's always room for this type of tool—perhaps as a sole treatment in a mild depression, or as an adjunctive tool in more moderate or severe depression,” she said in an interview.

Supported self-management draws on the principles of cognitive-behavioral therapy (CBT) and is based on the premise that patients can actively participate in their own depression treatment by using techniques to change attitude and behavior. The approach is guided by a workbook or an online interactive program that teaches skills for combating the negative thought patterns that contribute to depression.

Self-management is overseen by a coach or supporter who is often a health care provider, but also can be a family member or friend, said Dan Bilsker, Ph.D., a psychologist at the university who developed the workbook Dr. Ranger uses.

Self-management of depression—also known as guided self-management—is becoming a standard component of the mental health care system in the United Kingdom and Australia, Dr. Bilsker said. “It's as low cost as any intervention gets; it's low risk, user friendly, and evidence based.”

Yet not much is known about it, nor is it widely used in the United States, even though it fits “with the emerging paradigm of collaborative health care and serves to maximize the impact of an existing health care system by extending the reach of primary care,” he said in an interview.

And it is ideal for a primary care setting. “Primary care is carrying the burden of most intervention for depression. [Most] people with depression see only a primary care physician and have no contact at any point with the psychiatric system.”

Given the time constraints and patient load of most primary care physicians, medication is often the treatment of choice for depression, although there is little evidence to support its benefit in minor depression, Dr. Bilsker said. Supported self-management, on the other hand, is an initial treatment that is as time efficient as medication, with a more favorable risk profile. “It gives an alternative [and] leaves open the option of the physician adding medication later.”

Dr. Ranger said she advises the approach to most of her patients as a first step. “You don't just give it to them and send them away. [They] come back within 2 weeks to discuss how they're feeling.”

Even if she decides that medication is needed, she retains the self-management techniques as an important part of the treatment. “This is one way of learning skills that can help over your lifetime. The medicine may be needed for the here and now or for a longer time, but that's only part of the treatment. The other part is looking at a person's skills and thought processes. People can learn that they have some control with very practical things such as goal setting and self-care.”

Dr. Bilsker noted that the supported self-management approach is also attractive to patients. “Studies show that many people want to be actively involved. They don't always want to hand it over to a professional. This is part of an overall shift in the management of all chronic diseases … to give the patient[s] tools, training, and support so they are a part of their recovery process.”

The workbook can be downloaded, for free, by going to www.carmha.ca/publications/resources/asw/SCDPAntidepressantSkills.pdf