Online courses for anxiety and depression PATIENT USER GUIDE. Frequently Asked Questions v2.0

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1 Online courses for anxiety and depression PATIENT USER GUIDE Frequently Asked Questions v2.0 1

2 Contents What are This Way Up courses?... 3 What is CBT?... 3 What is icbt?... 4 Why use THIS WAY UP?... 4 What previous patients have said about our courses What courses do we offer?... 6 Who is suitable for a THIS WAY UP Course?... 7 Course descriptions... 7 How can I study?... 9 How much does it cost?... 9 How do I get started? Does my access expire? How do I complete the lessons and homework? Is there anything else involved? How can I get the most out of a THIS WAY UP Course? What am I likely to experience going through the program? What happens if I don t improve? Where can I get more information?

3 What are This Way Up courses? THIS WAY UP was jointly designed and developed by Professor Gavin Andrews from the University of New South Wales, and his team of psychiatrists and clinical psychologists, at St Vincent s Hospital, Sydney. As a non-profit initiative, THIS WAY UP is sponsored by the Australian Government and the Clinical Research Unit for Anxiety and Depression (CRUfAD) at St Vincent s Hospital, Sydney. THIS WAY UP courses are based on the Cognitive Behavioural Therapy (CBT) model and teach you the core skills needed to manage difficulties with anxiety, and depression. They teach you: About the problem How the problem is maintained (i.e., what keeps it going) Practical skills to manage and reduce difficulties How to prevent symptoms from returning What is CBT? CBT emphasises the relationship between thoughts, feelings and behaviours in creating change. The evidence-based CBT treatment courses that we offer have been developed from a large amount of research, which indicates that CBT is effective in treating difficulties such as your own. You can read more about CBT on our website page about CBT: 3

4 What is icbt? icbt is CBT that is delivered via the internet. It is also known as internet-delivered CBT, online CBT, computerised CBT, CCBT, or ecbt. THIS WAY UP icbt courses have the same content as therapy with a clinician (face-to-face). However, there are some major differences between icbt and its traditional counterpart, including; CBT icbt Face-to-face Online 5-20 sessions on average 4-10 lessons on average Structured around the expectations and needs of the client (low fidelity) Clinically proven structure to optimise treatment (high fidelity) Considerable out of pocket cost Low, fixed cost Ongoing clinical support Option of clinical support, or selfmotivated therapy Limited geographical availability Available in all internet connected areas May require referrals and recommendations Easily prescribed Potential for long waiting times Immediate access Why use THIS WAY UP? If you are experiencing an anxiety or depression disorder, there is a strong chance that you will benefit greatly from undertaking one or more of these courses. Most people get benefit from each lesson they complete. On average, 80% of people who complete all lessons benefit substantially, with 50% to the point of no longer being troubled by anxiety or depression. However, 20% do not benefit and will need to seek further assistance. All courses on offer have been proven to help through clinical trials conducted by our research unit, Virtual Clinic, and the results have been published in leading scientific journals. THIS WAY UP courses are effective, convenient and cost less than seeing a therapist for CBT or visiting a doctor for medication. All THIS WAY UP courses are available in a self-help format, or with supervision from your preferred health care professional, so you can choose how much support you receive. 4

5 What previous patients have said about our courses... The modules are very simple and homework achievable Social phobia patient I'm a believer - this has really helped and I'm able to handle things Depression patient I wish I had discovered this years ago Generalised anxiety disorder patient I see, understand and feel things are much better now Social phobia patient I'm in a much better place now. The last lesson was a timely reminder to keep at it and I will improve Panic patient 5

6 What courses do we offer? THIS WAY UP offers the following courses: Sadness (Depression) Worry (Generalised Anxiety Disorder) Worry and sadness (Mixed Depression and Anxiety) Obsessions and Compulsions (Obsessive Compulsive Disorder) Panic (Panic/Agoraphobia) Shyness (Social Phobia) Posttraumatic Stress Disorder (PTSD) Worry and sadness (Mindfulness-Based Course for Mixed Depression and Anxiety) Fear of Illness (Health Anxiety) Each course follows the story of a fictional character (or characters) who experiences symptoms of anxiety and/or depression. Throughout the course, the stories will help you learn about your own symptoms and steps required to help you recover. THIS WAY UP courses involve: 6 lessons in an easy-to-read comic-based story format Homework exercises to complete after every lesson Extra Resources and descriptions of other peoples experiences Online questionnaires before each lesson Each lesson takes about 20 minutes to read and you will generally need 3-4 hours in between lessons to complete the suggested homework activities. The courses are self-paced, but designed to be completed within 3 months, at most. It is best to do one lesson every week or two to allow time to practice between lessons. The system won t allow less than 5 or more than 25 days between lessons. Most people take weeks to complete the course. Initially you will be granted 90 days access, and upon completion of the course, you will be granted an extra 90 days access for practice purposes. 6

7 Who Is Suitable For A THIS WAY UP Course? Patients who have moderate to severe anxiety and depressive disorder are suitable for a THIS WAY UP course. Please note that THIS WAY UP will not accept clinical responsibility for individuals who: Have been diagnosed with schizophrenia, bipolar disorder, or drug or alcohol dependence Are suicidal Are taking benzodiazepines and/or atypical antipsychotics. Please note that This Way Up is not a crisis service. In the event of emergency or mental health crisis we advise that you phone the emergency services (Police or Ambulance) on 000, or Lifeline on , or if available, contact your GP. Course Descriptions Depression Depression is a condition in which individuals experience persistent sadness and/or loss of interest in activities. Other symptoms include inability to concentrate, feelings of worthlessness, as well as thoughts of suicide. In this course, you meet Jess, a woman who has recently experienced a Major Depressive Episode. You follow her story as you learn to overcome your depression through changes to your thinking patterns and behaviours. Generalised Anxiety Disorder Generalised Anxiety Disorder or GAD is a condition where individuals experience months of uncontrollable and excessive worry about a number of areas in their life. In this course, you meet Liz, who is a chronic worrier. You follow her story as you learn how to manage your worry through changes to unhelpful thinking patterns and skills aimed at dealing with uncertainty. Mixed Depression and Anxiety This course was introduced because we find that our patients often experience both anxiety and depression. Therefore, this new program is designed to treat symptoms of depression and anxiety. In this course, you meet two characters Liz, who struggles with generalised anxiety and depression, and Rob, who experiences panic attacks and social anxiety. You follow their stories as you learn practical skills for tackling these difficulties and improving your overall emotional wellbeing. 7

8 Worry and Sadness (Mindfulness-Based Course for Mixed Depression and Anxiety) This program is based on the Mixed Anxiety and Depression Course the course that primary care clinicians generally find most useful for their patients and it incorporates principles of both Cognitive Behavioural Therapy and Mindfulness Training. CBT and mindfulness have both proven to be helpful in treating anxiety and depression. Obsessive Compulsive Disorder People with Obsessive Compulsive Disorder (OCD) experience intrusive and distressing thoughts, images and/or urges. They may engage in a variety of repetitive activities to reduce uncomfortable feelings. In this course, you will meet Bella, a woman who experiences OCD. Bella learns about what OCD is and how she can use cognitive behaviour therapy (CBT) to manage it. Panic Disorder Panic Disorder is a condition where people experience frequent panic attacks, in which they experience intense fear as well as physical symptoms such as heart palpitations and shortness of breath. Individuals with this disorder worry about having panic attacks and tend to avoid situations in which they fear they may experience a panic attack. In this course, you meet Penny, who develops panic attacks and begins to avoid situations for fear of experiencing panic. You follow her story as you learn how to challenge unhelpful thoughts and confront feared situations. Social Phobia Social Phobia or Social Anxiety is condition where patients experience overwhelming fear of negative evaluation from others. Individuals with social phobia avoid social and/or performance situations in which they may be judged by others. In this course, you meet John, a student who has extreme anxiety in social situations. You follow his story as you learn how to manage your social anxiety through challenging unhelpful thoughts and confronting feared situations. Posttraumatic Stress Disorder (PTSD) Posttraumatic Stress Disorder (PTSD) can occur after a traumatic event. People with this condition are troubled by distressing memories or thoughts about the trauma, avoid memories and other reminders about what happened, and experience intense anxiety, sadness, or anger. This course has been developed for people who have PTSD, and teaches people practical skills to help them recover. Fear of Illness (Health Anxiety) Health anxiety is typified by feeling overly anxious about having or developing serious illnesses or diseases, and is also known as illness anxiety disorder. Health anxiety is treatable. This program is designed for people who are excessively worried that they might either have or will develop a serious disease. 8

9 How can I study? You can choose to enrol into the course as self-guided or supervised by your clinician. To find out more information about each course you can visit our website: If you d like to be supervised by your clinician (GP, Medical Specialist, Psychologist or any other Allied Health Professional), they will need to register on our website as clinicians and can then you a prescription to a course. Your clinician will be able to help you with anything that comes up as you do the course. If you elect to do a self-help course you are agreeing to do it without supervision, on your own responsibility, and therefore there is no clinician who is responsible for you. Our courses are available as self-help in Australia only. Our research consistently shows that people do better when they are taught how to manage their difficulties themselves. The focus of this program is to provide you with skills and to encourage you to practise them repeatedly until they become ingrained. This approach leads to the best long-term benefit. How much does it cost? Each course in THIS WAY UP will cost AUD$59 for 90 days. You will be asked for payment after you complete the registration process. 9

10 How do I get started? Firstly, you need to register. Below are step-by-step instructions for registering with THIS WAY UP. 1. Go to thiswayup.org.au 2. Click and Courses and choose the course you would like to do 3. Choose the option for the platform of the course (supervised, self-help web, phone app) and sign-up 4. If you have a prescription or a referral code, enter your prescription code OR continue registration to enrol into a course as self-help 5. Read and agree to the terms and conditions, select the payment option to pay AUD$59 to enrol and commence your course. Now you are ready to commence your course! Please note, we will use your address to communicate with you. 10

11 Does my access expire? Yes, your access expires 90 days after the day you register for the course. You have 13 weeks to complete the program from the day you register for the course. However, we recommend you complete lessons 1 and 2 in the first 30 days after you register. We recommend that you complete one lesson per week in order to benefit from the THIS WAY UP courses. After completing the course, you will have access to the materials for a further 90 days. This allows you to revise the course material and continue working on applying the skills from the course. IMPORTANT If you do not log in and complete your final lesson within the 13 week period (90 days), you will be withdrawn from the program. This does not mean that you have failed; just that internet treatment is probably not the best treatment for you. You will be contacted by your clinician to arrange an appointment for a review and to discuss other treatment options. How do I complete the lessons and homework? After you ve reviewed the slides, it is vital you download and complete your homework. Your homework assignments are compulsory, because they help you manage your symptoms. The THIS WAY UP team does not review your homework and it is for your records only, however if you have any concerns or would like to discuss the content, please contact your clinician. The THIS WAY UP system will only register that you have completed your lesson after you have downloaded your homework. If you do not download your homework we will assume that you are not ready to move onto your next lesson. The next lesson will become available 5 days after the last lesson is complete and the homework is downloaded. Please note that the homework is an editable PDF form but you can download, print and fill out the homework by hand. 11

12 Is there anything else involved? Another important part of THIS WAY UP programs are the assessment questionnaires that you usually complete before, during, and at the end of treatment. Our online questionnaires help to establish how you are feeling. Results from the questionnaires are then relayed back to your clinician after each lesson. If you are undertaking a self-guided course, you will be notified by THIS WAY UP if your scores are above the normal range. We have a responsibility to ensure that these courses work properly and so we keep track, for quality assurance purposes, of the proportion of people who complete the course and the average level of benefit they gain. This performance data is published on the website to inform users and is periodically published in scientific articles to inform the professionals who refer people to the courses. No information that would allow your identification is ever published. Do not participate in a course if you do not want your progress to be pooled with others as part of this routine quality assurance exercise. 12

13 How can I get the most out of a THIS WAY UP Course? From research, we know that the more time you spend on a course, the more you are going to improve. This is what we recommend: We expect that over the next 8-10 weeks, you will need to spend at least 3 hours per week working on the lessons and homework assignments. The homework assignments are compulsory, because just reading about helpful techniques for managing your symptoms won t fix the problem. We know from our research that to get the most benefit from your course, it s important to complete all of the lessons. Some tips to finish the course: Setting a date that you ll complete the next lesson by Rewarding yourself when you complete each lesson We ll help out by sending reminder and progress s to facilitate you along the way so that you can monitor your own progress. Also, please tell us how you re going in our feedback section. Your experiences help us improve the program. It is important to have realistic expectations about what you will achieve from a course. It will take patience and effort to take control over your symptoms. It is important that you keep on practising the techniques even after the course has finished. Each course involves perseverance, determination, and courage to start making changes. 13

14 What am I likely to experience going through the program? Each person s experience in the course will be different. Most people report that they get a lot out of our courses. However, as you go through the course, there may be some challenges on the way to getting better. Below is a list of some thoughts and feelings that you may experience during the course. STAGE 1 Most people are excited about starting the course and feel optimistic that change is possible. However, some people may feel apprehensive about commencing treatment over the internet rather than face-to-face. If you have any concerns, please discuss them with a clinician. Most people find the characters in the courses to be useful examples and helpful in terms of understanding the course content. Of course, not everyone will relate to the characters used in the program. The characters merely represent the typical age and gender of individuals with the particular disorder. It is important that you remember that identifying with the characters is not important for creating lasting change. They are simply used as a guide to illustrate the core skills needed to recover. The skills in this program can be used for a wide variety of problems, not just the ones that the characters describe. o If you are having trouble applying the core skills from the homework tasks to your personal life situations, please contact the clinician and let them know that you would like some help in matching the lesson content to your personal situation. Reducing avoidance of feared situations is a core component of change. This is an indication that you are on track as it shows that you are no longer avoiding what you used to. Although this may feel uncomfortable at times, there is no need to worry; it means you are getting better. This program is designed so that people are likely to succeed. Some people report that they have tried these strategies in the past without success. The difference is that this program encourages you to take the necessary steps to manage your anxiety and/or depression in a structured way with valuable tips to help you succeed. 14

15 STAGE 2 Hopefully by the middle of your course, you will have a better understanding of your symptoms and the steps needed to reduce your distress. However, this may also be a time where obstacles can begin to arise and the initial excitement of starting something new subsides. Remember that it is normal to be reluctant to change. The best way to counter this is to think about your reasons for change and then to continue practicing the recommended steps. STAGE 3 By the end of the program, you will likely begin to see some of the results of your efforts and start to feel differently about yourself and your future. It is very important to realize that ongoing use of the skills you have learned is essential for making the changes last. This program will point you in the right direction so if you want to maintain your growth, please make sure that using the skills is a regular part of your daily life. Those people who actively commit to practicing the skills regularly, report much better outcomes at the end of the program and are also doing better when we check back in several months later. At any stage in the course, if you need any guidance, talk to a clinician. What happens if I don t improve? The strategies included in your THIS WAY UP program are strategies that have been tested in research studies and we know they work. Remember, the brain is a lot like your body and strengthening it is like going to the gym the first time you go, it s tough; but it gets easier. The more you practise, the stronger you become. The good news is that the skills we suggest aren t complicated. Though you may find some of the steps challenging, if you follow them and practise them repeatedly, you will get better. If you ve completed the full program and there is no improvement in your symptoms, we suggest that you discuss other treatment options with your clinician (GP or a mental health professional). 15

16 Where can I get more information? To understand more about THIS WAY UP, please read through our website: thiswayup.org.au or call our clinic on Good luck! The team from THIS WAY UP Website: thiswayup.org.au contact@thiswayupclinic.org St Vincent s Hospital, Sydney, Australia 16