Changeways Clinic

The Core Program: A Group Intervention for Depression


Introduction

The Changeways Core Program is a psychoeducational group therapy protocol designed to introduce clients to basic psychological self-care concepts. It has been offered in Vancouver since 1992 and has gone through several major revisions since that time. Over 5000 clients at mental health facilities across Canada have taken the program. An open-trial evaluation with clients recently discharged from inpatient care for depression produced an 8% rate of rehospitalization within six months relative to a 30% rate for a comparison group (as well as a reduced length of stay among those hospitalized). The program was most recently revised in 2006 based on extensive feedback from clients and from other therapists offering the program. The two-day training workshop for therapists emphasizes strategies for conducting the group.

Click
here to see a recent summary of outcomes from on-site implementations of the Changeways Depression Program.

What does the Core Program cover?

The protocol provides clients with instruction in a variety of problem-solving and lifestyle management skills. It is designed to run for six to ten weeks (one session per week) in most outpatient settings. Many inpatient programs have adapted the program for ward use, however, and here sessions are generally shorter but more frequent. As well, some outpatient settings have adapted the group to an open-ended (rotating) format.

The emphasis is on providing specific, research-based strategies for dealing with life problems. The contents include:

  • Identifying problems and transforming them into goals for change.
  • Breaking goals down into manageable steps.
  • Learning about stress.
  • The signs, symptoms, and causes of depression.
  • The effects of diet, exercise, sleep habits, caffeine, and drugs and alcohol.
  • The importance of building recreation into one's daily life.
  • Strategies for developing a more satisfying social life.
  • An introduction to assertiveness skills.
  • Identifying negative and self-defeating thought patterns.
  • Learning to think in a more balanced and realistic manner.
  • Preventing mood problems from becoming unmanageable.

Which clients are appropriate for the Core Program?

The program is applicable to a variety of client populations. It is provided most often to clients experiencing major depression, dysthymia, bipolar II disorder, generalized anxiety disorder, and adjustment disorder. It has also been offered to clients experiencing major life stressors or transitions (such as retirement, immigration/acculturation, and dealing with chronic illness). The protocol is sufficiently flexible that it can be tailored to specific client concerns and to the therapist's own style. One centre has used the protocol as the core of a group for caregivers of patients suffering from Alzheimer's disease. Another centre has offered several groups for impoverished single mothers.

The program is mainly applicable for adults, though selected older teens may also benefit. The Client Manual is written at the grade six reading level, though clients functioning below this level may benefit if they have help. The program is not designed for clients with a psychotic disorder, borderline personality disorder, current alcohol or drug abuse problems, head injury, or developmental delay.

The Client Manual

The Core Program provides clients with a 92-page workbook that presents all of the concepts in a pleasant, easy-to-read format. It includes a number of suggestions and exercises that clients can work on at home. The manual is presented in a modular format for maximum flexibility. Therapists can choose to use the entire manual with a group or an individual client, or they can use only those sections of the manual that directly pertain to the client's presenting problem.

An earlier version of the workbook has been translated into Chinese (suitable for Mandarin and Cantonese speakers). It is available in either the nonabbreviated (original) character set in use in Hong Kong and Taiwan, and the simplified set used in the People’s Republic of China. The translated version is available for purchase upon request.

The Clinician’s Guide

The Clinician’s Guide is a 220-page resource for therapists. It includes a description of the populations likely to benefit from the program, suggested formats for six-, eight-, and ten-session groups, extensive notes on the teaching of each section of the Client Workbook, a reference and resource section, a set of brief session notes for therapists to use as reminders, and an appendix of forms and measures to assist with the group.

The Core Program Training Workshop

The Core Program training workshop is a two-day instructional seminar designed to give professional therapists much of the information that they need in order to conduct a group based on the model at their own facilities. The workshop presumes psychotherapeutic expertise on the part of those attending, plus a degree of familiarity with cognitive-behavioural models and with group therapy. The workshop should not be construed as basic therapy training nor as complete training in cognitive-behavioural technique or group work. The instructional style is lecture format with substantial opportunity for interaction, questions, and feedback. Here is the workshop schedule:

Day One

Registration
Introductions
Orientation to Changeways
Creating a psychoeducational group
Leading the Core Program

Lunch

Beginning the group
Orienting clients to the cognitive-behavioural model
Goal-setting to build confidence and motivation

Day Two

Stress and depression
The balanced lifestyle
How thoughts influence emotion and behaviour

Lunch

Altering negative or distorted thinking
Social support
Assertiveness
The road ahead: Preventing future difficulties
Ending your group


Who should attend the workshop?

The workshop is intended for professional therapists (including clinical counselors, psychologists, psychiatrists, psychiatric nurses, and other trained psychotherapists). It is likely to be particularly helpful for those therapists wishing to conduct empirically-based psychoeducational groups for the acutely distressed nonpsychotic adult population.

Are the materials included in the cost of the workshop?

Yes. Workshop participants receive the following:
  • The Client Manual.
  • The Clinician’s Guide.
  • A CD-ROM with master copies of the Client Workbook and related group materials.
  • Permission to reproduce the Client Workbook for use with your own clients.

Feedback on this program

“Thanks so much! Excellent work. I hope to co-facilitate this program in future.”
“The materials are very user-friendly.”
“An excellent presenter and a well-organized course. Thank you!”
“It was very interesting. I enjoyed the humour and stories used to describe the points being made.”
“Very well-organized. The presenter obviously ‘wrote the book’ and read the audience well.”
“So very excellent. Thank you for your common sense and knowledge in applying all the strategies. The material is simple to read and well organized.”
“Our facility is hoping to run a group based on this model continuously.”
“Thanks so much - a really enjoyable two days.”

How to register

Check the Calendar for information on upcoming workshop dates, locations, and prices. Print a copy of the workshop flyer for the program you wish to attend. Alternatively, call us at 604 871 0490 or email us at and we will mail you a copy.

If there is an indication that the workshop is nearing capacity, or if the registration deadline is approaching, call us at 604 871 0490 or fax the registration form to us at 604 871 0495 and we will save you a spot.

If paying by credit card, enter your card information on the registration form and fax or mail it to us. If paying by cheque, mail a copy of the form and your cheque (made out to "Changeways Clinic") to us at Changeways Clinic, Suite 718, 2525 Willow Street, Vancouver BC, V5Z 3N8.

If you have any questions about the program or about registration, call us at 604 871 0490 or email us at
.

If you know of additional staff members who might be interested in the program, call us and we can send out brochures via email or regular mail. Your help in contacting others will be most appreciated.

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