Ruiter w11

Improving Mental Health by Sharing Knowledge

Positive psychology in primary care

Marijke Ruiter

Odile Smeets

Brigitte Boon

• Mentaalvitaal.nl; online psychoeducation & exercises

• Psyfit.nl; self help program

• Mini interventions for complaints on stress, sleeping problems andworrying

© Trimbos-instituut Positive Psychology in Primary Care ECPP 2014

02-07-2014 2

Positive psychology in primary care

& Discussion: share your ideas!

• A lot of patients have light psycho socialproblems, related to life problems

• Physical complaints can have a relation withpsycho social problems, like stress and sleeping problems

• Focus in primary care is on reducing complaints. Mental, or emotional, fitness and resilience canbe an important addition


02-07-2014 3

Primary care


02-07-2014 4

Portal mentaalvitaal.nlthe site for reliable information on

mental health

Target groups?

1. Adults > 18 years old

2. How can I improve my emotional condition? Anyone working on well-being and mental resilience (health promotion, prevention)

3. How can I deal with everyday problems like stress, feelings of sadness, worrying?

4. Where can I find information about mental disorders for myself or my relatives?

5. As an adjunct in the treatment of (mild) mental problems (relapse prevention, recovery)

6. Supplementation on the care of people with chronic (psychiatric) diseases (quality of life)

02-07-2014© Trimbos-instituut Positive Psychology in

Primary Care ECPP 20145

Mentaalvitaal.nl is:

• A free website with reliable information on mental health

• Everyone looking for information, tips and advices on mental health

• Accessible self-management portal

• Exercises, based on CBT, mindfullnessand positive psychology

• Online interventions

• Offline help

• Proposition: 'How can I feel and stay mentally fit, in such a way that I can cope well with life's challenges and setbacks?'




02-07-2014 7

Read more about moods and mental disorders


02-07-2014 8

Searching for:

Assertiveness

Balance

Energy

Flow

Happiness

Mindfullness

Relaxation

Optimism ….

Suffer from:

Fear

Loneliness

Negative thoughts

Insecurity

Worrying

Sleeping problems

Sadness ….

Mental disorders:

ADHD

Autism

Depression

Anxiety

Borderline personality

disorder

Schizofrenia

Alcohol addiction

Read more about …


02-07-2014 9

Read more about Worrying

Introduction of the subject

Concrete tips toworry less

What to do ifworrying gets too

serious

Referral to exercise “Stop worrying”


02-07-2014 10

Online exercises

Exercise “Stop

Worrying”


02-07-2014 11

Tools & Therapy

• Exercises

• Referral to

online

selftest and

treatment

programs

• Decision

making tool:

selection on

theme,

support,

costs of the

programs

• 92% of the respondents score mentaalvitaal.nl 7 or higher (on a scale from 1 – 10)

• 37% reports that the information on the website helped partly or fully to reduce complaints

• 85% want to return at mentaalvitaal.nl and 92% would recommend mentaalvitaal to relatives


02-07-2014 12

Customer satisfaction survey

• I refer my patients to specific information about worrying, or stress for example, anddiscuss it in my next appointment

• I often refer to the online relaxationexercises

• I referred a patient to the online program Psyfit.nl for mental fitness and I’ll hope she will learn to use “helping thoughts”


02-07-2014 13

Reactions of professionals in primary care

1. Personal mission statement and goal setting

2. Think optimistically

3. Hold grip on your life

4. Live here and now

5. Invest in relationships

6. Live healthyNot only grounded on positive psychology, but also based on

principles from mindfulness, cognitive behavioral therapy and healthy lifestyle advices


02-07-2014 14

Six principles for mental fitness and resilience


02-07-2014 15

Psyfit.nl: mental fitness online

Measurement of

moods during the

week

6 principles: 6

modules:

1. Mission & goals

2. Positive

feelings

3. Hold grip on

your life

4. Live here and

now

5. Positive

relationships

6. Thinking and

feeling

• 6 modules mental fitness

• One module of 4 weeks with self test, psycho-education and exercise

• Films of experts

• E-mail reminding

• “Moodmeter”: measurement of dailymoods

• Forum exchange and support

• Tip of the day

• Help desk


02-07-2014 16

Psyfit:


02-07-2014 17

Introduction: What am I going to

learn?

• Randomized controlled trial

• Outcomes: well-being, depressiveand anxiety symptoms

• Measures: pretest, posttest, follow-up (6 months)

• Inclusion: moderate well-being and depressive symptoms

• ITT analysis (sensitivity analysiscompleters only and per protocol)

Research design


02-07-2014 18

RCT Psyfit, N = 284

Self-registration onlinen = 845

Eligibility assessment n = 744

Excluded n = 455•No informed consent, n = 9•Incomplete data, n = 31•CES-D score too high (>24), n=184•CES-D score too low (<10) /MHC-SF too high (flourishing), n=209•Suicidal thoughts, n = 13•No internet, n = 5•Too young, n = 4

Randomizationn = 284

Intervention condition Psyfitn = 143

Control condition Waiting listn = 141

2 months loss to follow up, n = 70 (24.6%)

Posttest T1 at 2 months n = 89 (62.2%)

Loss to follow-up at 2 months n = 54 (37.8%)


Loss to follow-up at 6 months n = 48 (33.6%) 6 months loss

to follow up n = 86 (30.3%)





Eligibility criteria fulfilled n = 289

Baseline questionnaire completed n = 284

Bolier, L., et al. (2013b). An Internet-Based Intervention to Promote Mental Fitness for Mildly

Depressed Adults: Randomized Controlled Trial. J Med Internet Res, 15, e200.



• Drop-out analysis

• Mean age 44 years (21-81), 73% high-education, 80% female

• Significant enhancement of well-being and reduction in depressivesymptoms and anxiety symptoms

• Sustained effects at 6 months foranxiety and depression

• Small effect sizes

Results


02-07-2014 20

Psyfit can be used as an accessible and effectivemental health promotion strategy for a wideaudience in stepped care prevention of depression

General Practitioner and/or “Practise nurses formental health” can refer and motivate patients tothis online selfhelp program, and can offer guidance during the program to raise adherenceand treatment effects

Costs: €29,95 per person

Psyfit in primary care


02-07-2014 21

- Focused selfhelp training modules for complaints:

- 1. stress, 2. sleeplesness, 3. worrying.

- These complaints are connected with depressionand anxiety disorders (Smit et al., 2011) AND

- These complaints are associated with high costsof care and ab/presenteism (Smit et al., 2011)

- Face to face group interventions followed byonline and migrant-adapted versions

- Online modules exist of 4-5 exercises

- Modules and exercises can be chosen at random

Next step interventions


02-07-2014 22

Sleep better Worry less Less

See indications

Sleeping habits (4 exercises, all

done)

Relaxation (5 exercises, 1 done)

Learn how to think positively

(about sleep) ( 5 ex., 2 done)

Worry less (about sleep) (5 ex.)

Example: how to distinguish between

positive (“helping”) and negative ( “non-

helping” thoughts

Quiz for sorting thoughts into helping and non helping categories

• Investigate the effects of the selfhelpinterventions & compare to effects of groupversion (wellbeing, depression, anxiety, sleep, stress, worrying)

• Make a guide for GP/practition nurse (PN): indications, execution of guided version

• Investigate needs of GP/PN

and conditions for use

(i.e. need to know

what patient does)

• Implement adaptation for

migrant patients

Next plans (2014)


02-07-2014 29

• RCT with 292 participants (half experimental, half waitlist control)

• >18 years; SES; m/f

• Experiencing complaints: sleep, stress, worrying

• Effects primarily on complaints; depression, anxiety, wellbeing = secundary outcomes

• Baseline and 3 + 6 mo. follow-up

• KEA

• Process evaluation: feasibility, useability forparticipants

• When (cost-)effective and useful for participants: suited for use in primary care


02-07-2014 30

Trial online interventions

- GP/Practition nurse selects patients with sleeping-, stress- (anxiety) or worrying problems

- Introduction of the intervention; explanation whythis might help this person

- Instructions for patients how to use the intervention: log in, fill out forms/questionnaires, do exercises; have fun!

- Make appointment within 2 weeks to check progress

- Make appointment within 2 months to check results i.e. by asking patient about amelioration; and/or by filling out questionnaires for complaintsand depression/anxiety

Online KMI’s in primary care: anoutline


02-07-2014 31

• Do you have or do you know of similar websites or interventions in your field of work?

• What are your experiences?

• What are your thoughts about theirpotential use in

primary care?


02-07-2014 32

Discussion


02-07-2014 33

Thank you!

Marijke Ruiter

[email protected]

Odile Smeets

[email protected]

Brigitte Boon

[email protected]

Presentations & Public Speaking

Ruiter w11