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Supported Self-Management of Depression and Anxiety

Posted By Dan Bilsker, Wednesday, March 16, 2011
Updated: Friday, June 10, 2011

After spending 25 years as the psychologist in an emergency psychiatric unit, as well as treating depressed individuals with Cognitive Behavioural Therapy, it has become clear to me that our North American health system does a poor job of sharing knowledge regarding effective methods for individuals to manage their own psychological difficulties. Our systems are heavily focused upon delivering treatments, generally pharmacological ones, and often leave patients in a passive role. If all we expect a depressed individuals to do is be adherent to prescribed medication, we are missing the boat in terms of the potential for collaboration between healthcare provider and recipient.

It is worth noting that antidepressant medication, the most widely applied treatment for depression, is not particularly effective for milder cases, although it does have the same worrisome level of side effects. Given the high rate of sexual dysfunction associated with antidepressant medication, one would like to be confident that the benefit outweighs the risks of reduced quality of life, impaired self-esteem and damaged relationships. At least within the Canadian system, the vast majority of depressed individuals have no practical access to evidence-based behavioural interventions. It is crucial that healthcare providers have training and support to deliver behavioural interventions. One such alternative is the intervention we refer to in our research unit asSupported Self Management (SSM).

In SSM, the health care provider (typically in the primary care system) serves as a facilitator and "coach” for the patient in learning and applying mood self-management skills. There is a significant amount of outcome research supporting this approach. Our research unit has conceptualized this as a form of collaborative knowledge exchange between policymakers, researchers, health care providers and care recipients—we have focused our investigative efforts upon methods for fostering this kind of knowledge/practice exchange among key stakeholders. We developed a depression self management tool (Antidepressant Skills Workbook) that is available for free download from our website as well as several variants for particular contexts and populations: depressed adolescents (Dealing With Depression), depression in the workplace (Antidepressant Skills at Work); and depression or anxiety difficulties associated with chronic illness (Positive Coping with Health Conditions). The basic adult workbook is available in several languages and as an e-book – all of these tools are free. Also available on this website is a relaxation training audiofile and self-help guides for dealing with suicidal thoughts.

Approximately 100,000 copies of these various workbooks have been downloaded from the website over the past six years. With support from healthcare agencies, we have trained over 500 family physicians to deliver SSM to their depressed patients. We carried out an implementation study to determine the degree of update one could attain using sophisticated knowledge exchange strategies: we studied 85 family physicians who each received a one-hour training session and access to the workbook for enrolled patients (an envelope the patient could return for a copy of the workbook). These physicians distributed the request envelopes to 1300 patients over a six-month period, and 55% of these patients sent back the envelope to request the workbook. This degree of adherence to a prescribed therapeutic action is comparable to the adherence to prescription of antidepressant medication. Given the minimal cost in time and financial resources of this system intervention, we consider this to be an impressive outcome. The bottom line is that dissemination and support for psychological self-management should be a core component of all mental health systems. Collaboration in mental health care should include not only primary and specialist care providers, but also care recipients.


Bilsker, D., Anderson, J., Samra, J., Goldner, E.M., & Streiner, D. (2008). Behavioural interventions in primary care. Canadian Journal of Community Mental Health, 27, 179-189.

Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S & Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37, 1217-1228.

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