ELIMINATING WAITING
LISTS
SHORT-TERM PREVENTION GROUPS FOR COLLEGE
STUDENTS
ACHA June 1, 2013
PROGRAM AUTHORS – CAMPUS
MENTAL HEALTH SERVICES
•
•
•
•
•
Shane Owens, Ph.D., ABPP, Assistant Director
Andrew Berger, Ph.D., ABPP, Director
Jill Bandura, Ph.D., Staff Psychologist
Christopher Browne, Ph.D., Staff Psychologist
2012-2013 Psychology Externs:
• Meredith McWillams, MS
• Kristin Lopez, MS
• Jameela Youssef, MS
ACHA June 1, 2013
INTRODUCTION
ACHA June 1, 2013
CAMPUS MENTAL HEALTH SERVICES
• Four Full Time Staff
• Three Licensed
• One License-Eligible
• Two Board Certified in Cognitive Behavioral Psychology by
ABPP
• Three Part-Time Psychology Externs
• Master’s Level
• In pursuit of Doctoral Degree
ACHA June 1, 2013
CAMPUS MENTAL HEALTH SERVICES
• All staff are on call 24 hours per day, 365 days per
year
• Services
• Individual, couples, and group psychotherapy
• Consultation and liaison services
• Education and outreach
• Works on an outpatient treatment facility model
• Multisymptomatic outpatient population
ACHA June 1, 2013
STATEMENT OF THE PROBLEM
• 29% of college counseling centers place limits on
sessions
• 48% promote themselves as short-term services
• Average number of sessions is 6.2
• 88% of directors report an increase in the number of
students on campus with severe psychological
problems
• 92% of directors report an increase in the number of
students seeking services
ACHA June 1, 2013
Source: National Survey of College
Counseling, Gallagher, 2012
STATEMENT OF THE PROBLEM (CTD.)
• More than half of schools that responded place
limits on number of sessions (as low as 5 sessions)
• Survey respondents are seeing an average of 223
new cases per semester
• Survey respondents indicated truncated hours
based on budget and placing services when most
needed
ACHA June 1, 2013
Source: Unpublished SUNY CCD
survey results, Owens & Berger, 2012
STATEMENT OF THE PROBLEM (CTD.)
• At Farmingdale, we do not, nor have we in the last
30 years, had a waiting list
• New patients are offered an appointment within 48
hours of calling or visiting the office
• ALL crisis cases are seen immediately (some afterhours cases are dealt with by phone with the
assistance of University Police and Residence Life
staff)
• University police attend the State Police Academy
• Not campus security
• Well-trained (most are EMTs)
ACHA June 1, 2013
Source: Internal Data from FSC
CMHS File Review
STATEMENT OF THE PROBLEM (CTD.)
•
•
•
•
No session limits
Average number of sessions at CMHS: 5.95
Modal number of sessions at CMHS: 1
Median number of sessions at CMHS: 2 (heavy
positive skew)
ACHA June 1, 2013
Source: Internal Data from FSC
CMHS File Review
PROGRAM DESCRIPTION
ACHA June 1, 2013
PROGRAM OVERVIEW
• 4 Sessions
• Delivered in groups of 4 to 8 students
• Content:
• Psychoeducation
• Training in specific cognitive-behavioral technique for stress
management
• Highlighting other ways to manage stress
ACHA June 1, 2013
SESSION 1: ICEBREAKER AND INTRO TO
GROUP WORK
•
•
•
•
Set goals
Set rules for the group
Ice breaker
Initial measurement of symptoms
ACHA June 1, 2013
SESSION 2: INTRODUCTION OF STRESS
MANAGEMENT TECHNIQUES
•
•
•
•
•
•
•
Stress reaction
Symptoms of stress
Long-term effects of stress
Sources of stress
Some coping mechanisms
Discussion of rational and irrational thought patterns
Assign REBT homework
ACHA June 1, 2013
REBT PRIMER
“PEOPLE ARE NOT DISTURBED BY THINGS, BUT BY THE VIEW THEY
TAKE OF THEM” – EPICTETUS – GREEK STOIC PHILOSOPHER
REBT
• A form of CBT created and developed by Albert
Ellis (1913-2007)
• Both a system of psychotherapy and a philosophy
• Largely based on the writings of Greek Stoic
philosophers
REBT
• Fundamental premise: we cause/increase
emotional disturbance by the way in which we view
events
• Through the language we use, our beliefs, attitudes, and the
meaning we give to events, others, and ourselves, we
create/increase emotional disturbance.
• Typically, people blame their emotional disturbance on
events or on people ‘doing things’ to them (‘he/she makes
me so angry!’) – REBT sees our beliefs, and specifically, the
meaning we give those events, as the cause of those
disturbances.
A-B-C MODEL OF EMOTIONAL
DISTURBANCE
• A: Activating event – can be external or internal
• B: Beliefs – include meanings, assumptions,
attributions, desires, demands, etc.
• C: (emotional/behavioral) Consequence
• To the extent that one’s beliefs are rigid, absolute, and
dogmatic, REBT predicts that individual will experience
emotional and behavioral consequences that are
frequently negative and self-defeating.
ELLIS: THREE CORE IRRATIONAL
BELIEFS – THE ‘3 MUSTS’
• I must do well and win the approval of others or I’m
no good
• Other people must treat me fairly and well 100% of
the time, in exactly the way I want them to treat
me, and if they don’t I’m no good and they
deserve to be condemned
• I must get exactly what I want, when I want it, and I
must never get what I don’t want. It’s terrible if I
don’t’ get what I want, and I can’t stand it
SECONDARY IB’S
• Demands: musts/shoulds/oughts
• Awfulizing/Catastrophizing: it’s awful, terrible,
horrible
• Low Frustration Tolerance: I can’t stand it!
• Self/Other/Life Ratings: I’m bad/worthless; life is not
worthwhile; he/she is bad/worthless
EXAMPLE INTERVENTION:
IDENTIFYING IB’S, DISPUTING THEM,
AND SUBSTITUTING RB’S
• A) Final exams, Final projects
• B) ‘it’s unfair! This professor expects too much from
us’ - unrealistic demand
‘I can’t stand it! There’s no way I can do
this’
- low frustration tolerance
‘I’m going to fail out of school!’ - catastrophizing
C) Emotional: Anxiety, anger, frustration; Selfdefeating Behavior (procrastination,
avoidance)
SESSION 3: REINFORCING THOUGHTCHANGING TECHNIQUES
• Review REBT homework
• Extend awareness of IBs and RBs to working toward
change
• Assign homework
ACHA June 1, 2013
SESSION 4: EXTENDING TECHNIQUES
TO THE REST OF YOUR LIFE
• Review homework
• Discuss any difficulty that participants had with
homework
• Elicit future problems and strategies for dealing with
them utilizing REBT principles
• Elicit feedback
• Encourage future help-seeking
• Administer post measures
ACHA June 1, 2013
RESULTS AND DISCUSSION
ACHA June 1, 2013
MEASURES USED
•
•
•
•
Beck Depression Inventory-Second Edition (BDI-2)
Beck Anxiety Inventory (BAI)
Beck Hopelessness Scale (BHS)
Patient Health Questionnaire-9 (PHQ-9)
ACHA June 1, 2013
PRE TO POST CHANGES
16
14
12
10
BDI
BAI
8
BHS
PHQ
6
4
2
0
Time 1
ACHA June 1, 2013
Time 2
PRE TO POST CHANGES
Measure
PRE (N = 4)
POST (N = 4)
T (df = 3)
D
M
SD
M
SD
BDI2
14.75
3.10
6.75
1.89
3.36*
3.10**
BAI
12.50
8.10
6.25
3.30
2.20
1.01**
BHS
5.25
3.40
2.25
1.89
1.23
0.36
PHQ-9
8.50
2.08
6.00
1.83
3.87*
1.28**
ACHA June 1, 2013
DISCUSSION
• This was in 2, imagine if we’d been able to do 4.
• Program is easy to administer and repeatable.
• Program can be extended in length and altered to
fit specific diagnoses.
• Program is efficient.
• A more desirable alternative to waiting list or referral
to outside providers.
• May be used in conjunction with traditional
approaches (e.g., individual therapy).
• Not for those with serious psychopathology.
ACHA June 1, 2013
QUESTIONS
ACHA June 1, 2013