The Core Program: Outcomes
The following is an update on the results of data collection from clients participating in the Changeways evidence-based group program (the Core Program) on-site in Vancouver. The data represent outcomes with several hundred consecutive participants.
Changeways participants in Vancouver were asked to complete the battery of questionnaire measures upon intake (PRE), about 2-3 months later upon completion of the Changeways depression group (POST), and at 6 months followup (F/U). All significance figures are based on simple t-tests.
If you are implementing Changeways yourself, you may find this information useful in several ways:
1. Selecting assessment tools for your own program. (Please consult the Core Program Trainer's Guide for more information on obtaining measures.)
2. Comparing your clients' PRE-test measures with those listed here, to see whether your population resembles those seen in the original program.
3. Comparing your clients' PRE-POST changes to see whether you are getting the same degree of change obtained in the original program.
Two cautions should be used in interpreting these results:
1. Only a subset of clients completed the 6-month followup questionnaires, so the numbers of patients for PRE to F/U and POST to F/U are smaller than for PRE to POST. Where means (averages) are given, the PRE and POST figures are for all patients supplying both PRE and POST data; F/U means are for the smaller group supplying these additional measures.
2. We are not currently running a randomized control trial, so there is no comparison group. We are not able to say from these data alone that changes observed are attributable to our treatment and not to natural recovery from depression or other interventions. Nevertheless, at least our participants appear to be moving in the right direction.
Nature of the Treatment Population
Most participants at the Changeways program at UBC Hospital in Vancouver had been hospitalized for depression within the 12 months preceding admission to the program, and had been diagnosed with Major Depressive Disorder. Here are a few demographics:
Average age at intake (& standard deviation) 40.49 (11.58)
Gender Ratio (F to M) 1.64 to 1
Years of Education (& standard deviation) 14.20 (2.38)
Lifetime Inpatient Admissions (& standard deviation) 1.99 (2.09)
Average DSM Global Assessment of Functioning (GAF) at intake (& standard deviation) 47.15 (12.54)
Beck Depression Inventory II (BDI-II)
Depression scores decline from 26.3 (high moderate range) at PRE to 14.9 (low mild) at POST and 7.2 (minimal) at F/U. Declines from PRE to POST are statistically significant (p<.001), as are PRE to F/U (p<.01). Declines from POST to F/U approach significance (p<.06). These figures suggest that patients are improving quite sharply between intake and group completion, and continue to make gains over the ensuing 6 months.
Beck Anxiety Inventory (BAI)
The group does not target anxiety specifically, and so marked changes in anxiety scores are not anticipated. Nevertheless, BAI anxiety scores decline from 19.1 (moderate range) at PRE to 13.9 (high mild) at POST and 12.7 (high mild) at F/U. Declines from PRE to POST and PRE to F/U are statistically significant (p<.001); declines from POST to F/U are nonsignificant. These figures indicate that patients report somewhat less anxiety upon group completion than at intake, and that these declines are maintained at followup.
Quality of Life Inventory (QOLI)
Pre: -0.54 (2nd percentile)
Post: +0.39 (6th percentile)
Followup: +0.81 (10th percentile)
Changeways participants start out markedly low on the QOLI, averaging -.54 (the 2nd percentile) at PRE. Perceived quality of life improves at POST (.39; 6th percentile) and further improves at F/U (.81, 10th percentile). All comparisons are significant (.001; POST to F/U at .05). These gains are modest in terms of percentile improvement but clinically important, indicating marked improvements in self-reported life satisfaction.
Multidimensional Perfectionism Scale (MPS)
Self Oriented Perfectionism:
Self-oriented perfectionism is the degree to which individuals hold unrealistically high standards for themselves. Scores decline from PRE (69.6) to POST (65.5) to F/U (65.1), significantly so from PRE to POST and PRE to F/U (both p<.001).
Other Oriented Perfectionism
Other-oriented perfectionism is the degree to which individuals have unrealistically high expectations of others. This is not targeted by the Changeways group. Scores decline somewhat from PRE (54.8) to POST (52.3) and rise slightly at F/U (53.7). Only the PRE-POST comparison is significant (p<.01).
Socially Prescribed Perfectionism
Socially prescribed perfectionism is the degree to which individuals imagine that others have unrealistic expectations of them. This form appears particularly linked to depression. Scores decline from PRE ( 60.4) to POST (56.4) to F/U (54.6), all significant at p<.001 except POST to F/U.
Each form of perfectionism declines from intake to post-group, and gains are generally maintained. Socially prescribed perfectionism starts out unusually high relative to the nondepressed population (who average in the 50.0 range) and declines toward normal levels. This suggests that participants are becoming more realistic and less concerned about the opinions and expectations of others.
Self Control Scale (SCS)
The Self Control Scale assesses an individual's approach to life problems. Positive scores suggest an active, engaged style in which problems are broken into components and dealt with in a step-by-step manner. Negative scores suggest an avoidant style in which the person becomes overwhelmed and easily gives up. Scores on the scale rise from -8.5 at PRE to +5.1 at POST and +12.7 at F/U. All comparisons are significant (.001; POST to F/U at .05). This result suggests that Changeways participants begin to adopt a more active and effective problem-solving style between intake and post-group, and that they continue to improve over the next 6 months.
In sum, patients attending Changeways groups at UBC Hospital improved on each of the above measures between intake and the end of the group program. In general, gains are maintained and/or extended at 6 months followup. These improvements seem to bode well for the likelihood of relapse. Although without a randomized comparison group it is difficult to attribute these changes with certainty to the Changeways program, at minimum one can say that these individuals appear to be moving in a healthful direction.
Many thanks to Shawnda Lanting for completing the analyses of the data.
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