Beating Depression: Skills-Based Group Programs for Depression-Free Living

"Beating Depression" is a signature program of The Well Being Project that has an established reputation for addressing and overcoming the debilitating symptoms of depression; helping people to take charge of their life and beat depressive illness.

How Is “Beating Depression” Different?

Most clinical group programs for depression focus almost exclusively on cognitive-behavioural approaches, and with generally successful outcomes, however, as with anti-depressant medication, although effective for some people, not all people respond well. However, as the symptoms of depression impact multi-dimensionally, to be most effective, treatment requires a multi-focused approach.

It is to be noted that there are ten diagnostic criteria for Depression that point to mood, or emotional, factors, issues of meaning, physiological and psychomotor factors, self-concept and self-esteem issues, and social factors as well as cognitive factors. Of these ten criteria, half, if met, warrant a clinical diagnosis of Depression. This means in terms of the practical reality of depression that different people have different depressive symptom constellations. In turn, this means that for optimal therapeutic outcomes, treatment programs must address more than merely either the physiological or cognitive sides.

The “Beating Depression” program is multi-focused because firstly, it is a complex interaction of several factors that is causative in the syndrome, and secondly, because each person needs to find the keys to the underpinning causal factors in their particular depression.

Although medication plays an important and sometimes critical role in treatment, the notion that depression is simply a chemical imbalance to be addressed via chemical means can convey the idea that the individual is merely a victim of their “chemical imbalance”. Such a simplistic (and inaccurate) viewpoint can support a way of thinking that invites a sense of powerlessness. It can be seen as reinforcing an outlook that has been identified in sufferers of depression that treatment seeks to overcome, and this view can be counterproductive.

The “Beating Depression” program seeks to empower the individual to take charge of their symptoms and to refuse the sense of victimization that their symptoms invite. This entails addressing therapeutically the full spectrum of lifestyle dimensions that can be implicated as causative factors.

What people have said about the course

At the end of each course, participants are asked to give feedback, anonymously. These are some of the comments that have been made.

“ It was a full on the button experience. ”

“ Every aspect was all very relevant. Could not be better. Extraordinarily helpful. ”

“ Right on target. All the segments are so interesting and extremely relevant. I enjoy coming immensely. ”

“ This course has helped me turn my life around and take my power back. ”

“ I like the personality of the speaker. She is pleasant without being authoritarian. She gave me lots to think about. Knows the subject well. ”

“ Excellent course. Well thought out. A1 presenter. ”

“ It was good talking about approaches other than medication. I enjoy the discussions with others about what they feel and what has helped them. ”

“ Well organized. Non-threatening. ”

“ Enjoyed all aspects, especially taking charge of Depression. ”

“ I like the various options and interesting variations. Looking forward to more. ”

“ Gentle and informative. A good pace for me. Its good to be in a group with others who are also working on beating their depression. ”

“ I have loved the course and all I have got out of it. Thank you for your support and professional guidance. ”

“ A wonderful course with an inspirational facilitator. ”

About the Course

There are six dimensions of depressive symptomology that are explored in the program.

When a person is depressed it can impact on any or all of these dimensions of their being.

The skills approach of the course provides a therapeutic self-help “tool kit” focused on each of these, and includes:

These are some of the skills needed for people to feel alive and well again.

Although the summary above isolates the skills offered into discrete categories, the approach of the course is integrative and interactive. Participants are encouraged with the view that each area affects all other areas, and making inroads into one will have spin-offs in other areas as well.

Research has identified six factors that are pivotal in well being (Ryff & Singer, 1996)*. These are attributes that have been found to be characteristic of resilient people – those who do not succumb to depression. They are self-acceptance, personal autonomy, environmental mastery, satisfying relations with others, personal growth commitment, and life-purpose. These are ways of being-in-the-world that are learned, (or have not yet been learned), and are personal resources that have been shown to help prevent depressive illness, underpin recovery and the avoidance of relapse.

These are therapeutic teaching goals in the “Beating Depression” course for recovery, resilience, life enrichment and mastery.

An under-development in any of these areas represent a risk factor that can invite the onset of depression, or relapse after initial recovery, which is one of depression’s distressing clinical characteristics. In the course participants learn how to take steps, however small, to cultivate these six factors in their life. Once even small steps are taken there is a therapeutic ripple effect.

Participants identify which of these attributes they might need to have more of in their life to increase their sense of well being.

The course investigates the tasks entailed in each area and participants devise practical tasks that represent doing something differently to develop these attributes in themselves. Participants learn how to create and maintain these factors in their life.

These are important personal attributes that need to be developed so that people stay feeling well.

*Psychotherapy & Psychosomatics 1996, “Psychological Well-Being: Meaning, Measurement, and Implications for Psychotherapy Research”.

Why join a group program? The Benefits in Treating Depression

For a lot of depressed people, the last thing they would want to do is join in a group program! This, however, is “Depression” and its “hide-away” symptom talking, and the first self-healing step is to tell “Depression” and those feelings about groups (and other people generally), to get lost! This challenge could be the first necessary therapeutic step on the road to recovery.

Effectiveness – what works - is the most important criterion. Comparing the success of group programs with the rate of progress and outcomes in one-to-one counselling for depression has shown that being part of a group is a very important contribution to the efficiency, effectiveness and pace of the healing process.

It is especially helpful to be part of a group as one factor in the pattern of depression symptoms is the tendency to withdraw socially. The group provides a mutually supportive social context that is a critical element in both treatment and recovery.

The support and encouragement of other group members, of those who are in a similar position and who understand what depression is like, is experienced as a very positive therapeutic factor. This understanding from others is often lacking in the lives of those who are depressed.

On the other hand, one-to-one counselling is time-limited and goes for perhaps fifty minutes per week or per fortnight. This might not allow the time that is needed to explore and develop skills, which have been identified as necessary in the successful treatment of depression. The “Beating Depression” program provides over 17 hours of therapeutic input and exercises.

Affordability is important. Group programs tend to cost less than one-to-one counselling, whether it is private or through subsidized agencies that are providing the service, seemingly free, or by means-tested low fees to clients. For some people it can be hard to justify the cost of counselling, and they may put spending to meet others needs before meeting their own needs. And there are always other financial demands and priorities.

Sometimes people are reluctant to seek one-to-one counselling because it seems like it shows a personal failure, whereas a skills development group can seem as a more socially acceptable treatment approach. And a group program provides “safety in numbers” so is therefore more likely to be taken up, resulting in higher levels of recovery across the community in general.

Many individuals with depression have very difficult life histories to be integrated. For such people counselling can be very important, particularly in the first stages. However, moving on can present difficulties. Challenging clients to change ineffective life strategies can only be done after the development of a very trusting relationship, and this can take many sessions.

Imparting skills, structuring practical exercises and providing information constitutes a “teaching” rather than a counselling approach. Research into treatment programs for Depression has shown that skills-based therapies are very successful in terms of measurable outcomes. As well as helping people understand where their symptoms come from they provide people with practical tools to help them better manage and overcome their symptoms. This is a critical factor for effective treatment as a characteristic of this disorder is falling back into symptoms.

Teaching the skills that can help prevent this relapse aspect of depression can be more effective in a group context and so has faster therapeutic outcomes. As well as time effectiveness, a group program can assist between 6 to 15 individuals per therapeutic hour, offering many times over the cost effectiveness of the one-to-one counselling situation.

Many individuals report having read many “self-help” books that are excellent, but in fact have not helped them much. This can be explained by the “in one eye – out the other” phenomenon. Such books may be packed with good ideas and strategies, however once read, with the vague commitment to trying those ideas out sometime soon, the book goes back onto the bookshelf and becomes an equally vague memory of possibilities.

Good therapeutic ideas must be exercised in practical ways to result in behaviour changes that have healing outcomes. This is the role played by practical group experiential processes. With such processes, and with the accompanying motivational charge and mutual social support, learning can happen, change can happen, and then healing can happen.

“Courses offer the social and informal feedback that a book can’t match” Dr. John Irvine, Psychologist and writer of the “Family ” column in “ Brisbane News”.

Is the program effective? Does it work?

Prior to course commencement each participant completes a self-report psychometric assessment of their symptom levels using is a highly recognized standardized measure of depression. This measure is anonymous and is also completed at the end of the course.

Each course cohort has shown on average a 30% remission of symptoms, some higher, a result that has been held across the board in each of the courses run to date. Some participants have shown small improvements, but in the majority of cases individuals reach recovery level over the duration of the course. Some have even moved from the level of severely depressed to non-depressed.

Although it would be foolhardy to attribute these recovery levels in absolute terms to participation in the course, these results still stand as testimony to the course being a substantive contributing factor to the increased wellbeing of those who take on board the opportunities provided.

Individuals who fail to demonstrate in their self-reported symptom assessment measure a positive shift of at least 20% are invited to re-take the course free-of-charge and are offered personal counselling at a discounted rate.

When are courses held?

There are day, evening and weekend programs available. The day and evening courses run over five sessions, which are held each week for five weeks. Each session is of three and one half hours duration, with a tea break. Courses run consecutively every five weeks within school terms.

More about the Course and Course Sessions

Sessions consist of therapeutic information to raise awareness, and of experiential group processes that translate this information into possibilities for behavioural change. The sessions include theory and practical tasks, gentle exercise, relaxation and integrative guided imagery. Homework tasks are offered each week and participants are invited to give mutual support in between sessions.

All participants currently have or have recently experienced Depression. Participants either bring a referral letter from their GP or complete a statement that they are depressed, or have recently been depressed. Participants who have not had a formal diagnosis or are self-diagnosed are interviewed prior to enrolment to ensure they are genuinely depressed. A standardized symptom assessment measure is filled out prior to course commencement to determine participants symptom levels.

The group program and course is not a counselling program. There is no expectation to disclose personal history, and very little time to do so as the course material is very tight. There is opportunity for disclosure of the nature and history of participants’ depressive symptoms, and this is encouraged only to the extent that people feel comfortable about doing so. There is no pressure otherwise with regard to self-disclosure.

Participants may use the opportunities in paired exercises to discuss personal aspects if they wish to with the person that they are working with in an exercise. Participants are expected to fully involve their self in the practical exercises and processes in order to gain maximum benefit from their course. All information shared in the group is to be kept confidential, and all group members make an agreement to that effect.

Each session course contains clinically important therapeutic material and processes that address a fundamental area of symptom presentation and treatment approaches. Attendance at all sessions is expected, not only to benefit fully, but also for mutual support, group cohesion and morale.

Personal Counselling is available through The Well Being Project with Irene MacFarlane or Jonathan Daw, and for those who have completed the group program, at a discounted rate.

Course Fees

Course fees are GST free and health insurance rebates apply (with private cover).

For the day and evening courses, the Registration Bond of $35 is refunded at the end of the course if all five sessions have been attended. This is a financial incentive to encourage full attendance, as motivational problems can be a symptom.

Counselling Fees are GST free and health insurance rebates apply (with private cover).

Health-Care Card Holders receive a discount, as do “Beating Depression” Course Participants.

Because mental health services are usually provided by government subsidized providers, people seem reluctant to outlay for private mental health services. But the costs of getting the computer, car or washing machine serviced privately is seen as normal and an acceptable and necessary expense.

Many depressed people have financial difficulties, and the cost of meeting their mental health needs rates low in the budget. Also it can be seen as self-indulgent. When a person is depressed it can be hard to see the logic that increased wellbeing is an investment that pays off many times over, and assists the quality of life of close others as well as oneself.

Look at the costs of “Beating Depression” in comparative terms. The course provides 17.5 therapeutic hours, so the cost per hour is $8.45 (day course), $12.85 (evening course) and $16.85 (weekend course). Compare that with any other service and it is an inexpensive, cost effective, excellent investment with far reaching benefits.

The courses are not subsidized, and fees have been kept to a minimum. The day course fee is already discounted to encourage people on low fixed incomes, however it is still difficult to afford for some, particularly for those who are unemployed. However, it is important that people are reminded that Depression comes at a high personal cost – and staying depressed costs even more.

Depression moreover costs the community, dollar-wise, far and above the material costs for the individual. These costs include the subsidized fees of medical practitioners, and for some, hospital services, as well as the subsidized cost of anti-depressant medications. The direct and indirect overall social costs of depressive illness to families and the community are enormous.

The cost of the course to organizations who wish to provide this opportunity to their community members or employees is $1225 (day course). This means that costs are reduced substantially per individual for organizations that are in a position to gather a client group. (However - the course is only available to attendees who either are currently, or have formerly been depressed).

Individuals who wish to re-take the course may do so for half fee (the full Registration Bond is still required). Individuals who fail to demonstrate in their self-reported symptom assessment measure a positive shift of at least 10 % are invited to re-take the course free-of-charge (Registration Bond still required).

Ongoing Support

The support group is an informal time of sharing mutual support through processes based on the “Beating Depression” tool-kit and strategies. The common feedback from courses was a need for more discussion time and more opportunity for talking with others. As participants are all aware, the course material is tight and allows only minimal opportunity for this, although the need is acknowledged. Also, many course participants have called for some sort of ongoing support afterward to keep up the good work and the motivation to keep developing their tools for resilience.

The evening support group starts at 7.30 PM, with a formal finishing time of 9.00 pm, however with an open-ended informal finishing time (to 10.00 pm), as needed, which would allow for ongoing discussions for those who would like to, or need to stay on longer (or adjourn to the pub/café). The day group starts at 10.00 am, formally finishing at 11.30, but open-ended also, as needed.

The support groups run on the basis of a “subscription” payment for nine sessions, over ten available sessions per term (one session is free). This means an initial up-front cost, to establish the “go-ahead” of a particular group. Also, the subscription is at a discounted rate. Once a group has the “go-ahead”, then “drop-in” participants who wish to attend on a flexible, session-by-session basis can do so, paying a sessional rate on the night. A support group is limited to twelve participants, and requires six subscribing members to go ahead.

This arrangement ensures a core group of attendees, and the cohesion that this provides to make the group supportive, and as well, it provides the flexibility to allow participants to take nights off when needed. Each group decides on a structure and format that meets their needs, which Jonathan Daw facilitates. Support groups can run on Monday and Thursday nights, also on Mondays and on Fridays. The support group would start the week commencing each school term.

Support Group Fees: The Subscription cost is: Evening $148.00 ($16.50 per session), Concession $135 ($15.00 per session); Day $135, or on a drop-in basis, $18 (Day) $20 (evening) per session.

People who respond early with their subscription (“early-bird” – 2 weeks prior to commencement date) can join for the concession rate, or, for the day group $125.

Course venue:
The courses run at the premises of The Well Being Project, at Unit 3, “Woolloongabba Gardens” 9 Hubert Street, Woolloongabba. There is plenty of parking on the premises. Hubert Street is one-way into Stanley Street so must be accessed via Hawthorne Street.