Eliminating Waiting Lists

1. Eliminating Waiting Lists Short-Term Prevention Groups for College Students

2. Program Authors – Campus Mental Health Services • Shane Owens, Ph.D., ABPP, Assistant Director • Andrew Berger, Ph.D., ABPP, Director • Jill Bandura, Ph.D., Staff Psychologist • Christopher Browne, Ph.D., Staff Psychologist • 2012-2013 Psychology Externs: • Meredith McWillams, MS • Kristin Lopez, MS • Jameela Youssef, MS

3. Introduction

4. Campus Mental Health Services • Four Full Time Staff • Three Licensed • One License-Eligible • Two Board Certified in Cognitive Behavioral Psychology by ABPP • Three Part-Time Psychology Externs • Master’s Level • In pursuit of Doctoral Degree

5. Campus Mental Health Services • All staff are on call 24 hours per day, 365 days per year • Services • Individual, couples, and group psychotherapy • Consultation and liaison services • Education and outreach • Works on an outpatient treatment facility model • Multisymptomatic outpatient population

6. Statement of the Problem • 29% of college counseling centers place limits on sessions • 48% promote themselves as short-term services • Average number of sessions is 6.2 • 88% of directors report an increase in the number of students on campus with severe psychological problems • 92% of directors report an increase in the number of students seeking services Source: National Survey of College Counseling, Gallagher, 2012

7. Statement of the Problem (ctd.) • More than half of schools that responded place limits on number of sessions (as low as 5 sessions) • Survey respondents are seeing an average of 223 new cases per semester • Survey respondents indicated truncated hours based on budget and placing services when most needed Source: Unpublished SUNY CCD survey results, Owens & Berger, 2012

8. Statement of the Problem (ctd.) • At Farmingdale, we do not, nor have we in the last 30 years, had a waiting list • New patients are offered an appointment within 48 hours of calling or visiting the office • ALL crisis cases are seen immediately (some after-hours cases are dealt with by phone with the assistance of University Police and Residence Life staff) • University police attend the State Police Academy • Not campus security • Well-trained (most are EMTs) Source: Internal Data from FSC CMHS File Review

9. Statement of the Problem (ctd.) • No session limits • Average number of sessions at CMHS: 5.95 • Modal number of sessions at CMHS: 1 • Median number of sessions at CMHS: 2 (heavy positive skew) Source: Internal Data from FSC CMHS File Review

10. Program Description

11. Program Overview • 4 Sessions • Delivered in groups of 4 to 8 students • Content: • Psychoeducation • Training in specific cognitive-behavioral technique for stress management • Highlighting other ways to manage stress

12. Session 1: Icebreaker and Intro to Group Work • Set goals • Set rules for the group • Ice breaker • Initial measurement of symptoms

13. Session 2: Introduction of Stress Management Techniques • Stress reaction • Symptoms of stress • Long-term effects of stress • Sources of stress • Some coping mechanisms • Discussion of rational and irrational thought patterns • Assign REBT homework

14. REBT Primer “people are not disturbed by things, but by the view they take of them” – Epictetus – Greek Stoic philosopher

15. REBT • A form of CBT created and developed by Albert Ellis (1913-2007) • Both a system of psychotherapy and a philosophy • Largely based on the writings of Greek Stoic philosophers

16. REBT • Fundamental premise: we cause/increase emotional disturbance by the way in which we view events • Through the language we use, our beliefs, attitudes, and the meaning we give to events, others, and ourselves, we create/increase emotional disturbance. • Typically, people blame their emotional disturbance on events or on people ‘doing things’ to them (‘he/she makes me so angry!’) – REBT sees our beliefs, and specifically, the meaning we give those events, as the cause of those disturbances.

17. A-B-C Model of Emotional Disturbance • A: Activating event – can be external or internal • B: Beliefs – include meanings, assumptions, attributions, desires, demands, etc. • C: (emotional/behavioral) Consequence • To the extent that one’s beliefs are rigid, absolute, and dogmatic, REBT predicts that individual will experience emotional and behavioral consequences that are frequently negative and self-defeating.

18. Ellis: Three Core Irrational Beliefs – the ‘3 Musts’ • I must do well and win the approval of others or I’m no good • Other people must treat me fairly and well 100% of the time, in exactly the way I want them to treat me, and if they don’t I’m no good and they deserve to be condemned • I must get exactly what I want, when I want it, and I must never get what I don’t want. It’s terrible if I don’t’ get what I want, and I can’t stand it

19. Secondary IB’s • Demands: musts/shoulds/oughts • Awfulizing/Catastrophizing: it’s awful, terrible, horrible • Low Frustration Tolerance: I can’t stand it! • Self/Other/Life Ratings: I’m bad/worthless; life is not worthwhile; he/she is bad/worthless

20. Example Intervention: Identifying IB’s, Disputing them, and Substituting RB’s • A) Final exams, Final projects • B) ‘it’s unfair! This professor expects too much from us’ - unrealistic demand ‘I can’t stand it! There’s no way I can do this’ - low frustration tolerance ‘I’m going to fail out of school!’ - catastrophizing C) Emotional: Anxiety, anger, frustration; Self- defeating Behavior (procrastination, avoidance)

21. Session 3: Reinforcing Thought-Changing Techniques • Review REBT homework • Extend awareness of IBs and RBs to working toward change • Assign homework

22. Session 4: Extending Techniques to the Rest of YourLife • Review homework • Discuss any difficulty that participants had with homework • Elicit future problems and strategies for dealing with them utilizing REBT principles • Elicit feedback • Encourage future help-seeking • Administer post measures

23. Results and Discussion

24. Measures Used • Beck Depression Inventory-Second Edition (BDI-2) • Beck Anxiety Inventory (BAI) • Beck Hopelessness Scale (BHS) • Patient Health Questionnaire-9 (PHQ-9)

25. Pre to Post Changes

26. Pre to Post Changes

27. Discussion • This was in 2, imagine if we’d been able to do 4. • Program is easy to administer and repeatable. • Program can be extended in length and altered to fit specific diagnoses. • Program is efficient. • A more desirable alternative to waiting list or referral to outside providers. • May be used in conjunction with traditional approaches (e.g., individual therapy). • Not for those with serious psychopathology.

28. Questions