clinical research

definition of self-management

Self-management of mental health refers to a set of strategies, tools and behaviours that a person can adopt in their daily life to reduce symptoms related to anxiety, depression or bipolarity, prevent relapse, and improve their well-being (Barlow et al., 2002; Omisakin & Ncama, 2011; Villaggi et al., 2015).

This definition is consistent with the one adopted by the Government of Quebec, which prefers the term “self-care” to define anything a person can do on their own to stay healthy and well (Government of Quebec, 2019).

Importantly, self-management skills and strategies have been shown to be enhanced through self-management support interventions (Houle et al., 2013; O’Connell et al., 2018) or what might be called “directed self-care.” According to Mike Slade (2009), an international expert on recovery-based care, supporting self-management skills should in fact be the primary goal of mental health services.

Self-management does not therefore replace the role of professionals—on the contrary. Professionals play a key role in increasing the potential effectiveness of self-management strategies (Gellatly et al., 2007; McCusker et al., 2016) adopted by people living with anxiety, depression or bipolarity.

It is also important to note that self-management support is complementary to psychotherapy and pharmacotherapy and is therefore part of the continuum of mental health services.

 

clinical-research

the importance of self-management support

In recent decades, empirical research has abounded both on the benefits of self-management for people living with anxiety, depression or bipolarity (Coulombe et al. 2015, 2016; van Grieken et al. 2015, 2015; Villaggi et al. 2015) and on the importance of self-management support interventions (Lorig et al. 2014; Ritter et al. 2014; Starnino et al. 2010; see reviews by Barlow et al. 2005, Houle et al. 2013, Lean et al. 2019, and Mueser et al. 2002).

More frequent and daily use of self-management strategies have been shown to be associated with indicators of recovery, both clinically (decreased anxiety and depressive symptoms) and personally (more positive mental health) (Coulombe et al., 2015).

A recent study (Lean et al., 2019) on self-management programs for severe mental disorders—including bipolar disorder and major depressive disorder—also shows the favourable impact of self-management support on symptoms of depression and anxiety, at the end of the intervention and one year later.

Another study (Boyd et al., 2019), involving over 16,000 people in England, shows that even people initially presenting with severe symptoms benefit from starting with a low-intensity intervention (such as self-management support ) before undergoing more intense treatment (such as therapy).

our expertise at Relief

Relief has developed nationally and internationally renowned clinical and scientific expertise in self-management support for people living with anxiety, depression and bipolarity.

Our five self-management workshops were designed according to a rigorous development, content validation and testing process, supervised by Dr. Janie Houle, a psychologist and professor at Université du Québec à Montréal (UQAM). The process took a total of 14,000 hours of work by consultants specializing in psychology and program development and involved 42 mental health experts.

The workshops have now been offered for more than 10 years by Relief and a large network of partners—and constitute one of the few validated self-management support interventions in Canada to have been published in a scholarly journal (Houle et al., 2016).

On average, the study, published in the Canadian Journal of Community Mental Health, showed a significant reduction in the level of depressive symptoms and a significant increase in knowledge about depression and self-management behaviours among the 46 participants who completed the Living with Depression workshop.

Assessment data from the Living with Anxiety workshop (Montiel et al., in press) collected from 70 participants also suggest significant changes between the beginning and the end of the workshop, including lower anxiety and depressive symptoms, as well as an increase in personal recovery (e.g., sense of hope) and in self-management behaviours.

Several other studies are underway, including a randomized clinical trial of the virtual self-management workshops (funding obtained from the Canadian Institutes of Health Research, Pasquale Roberge, Université de Sherbrooke; Janie Houle, UQAM; Jean-Rémy Provost, Relief) and a scientific evaluation of the Achieving Better Balance at Work workshop (Sophie Meunier, UQAM). A partnership research chair project on self-management, mental health and work is also being developed.

Relief would like to thank Simon Coulombe, Professor at Université Laval, for the summary of scientific studies and evidence on self-management support and Relief’s workshops.

references

Barlow, J. H., Ellard, D. R., Hainsworth, J. M., Jones, F. R., & Fisher, A. (2005). A review of self‐management interventions for panic disorders, phobias and obsessive‐compulsive disorders. Acta Psychiatrica Scandinavica, 111(4), 272-285.

Barlow, J., Wright, C., Sheasby, J., Turner, A., & Hainsworth, J. (2002). Self-management approaches for people with chronic conditions: A review. Patient Education and Counseling, 48(2), 177-187.

Boyd, L., Baker, E., & Reilly, J. (2019). Impact of a progressive stepped care approach in an improving access to psychological therapies service: An observational study. Plos One, 14(4), e0214715.

Coulombe, S., Radziszewski, S., Meunier, S., Provencher, H., Hudon, C., Roberge, P., ... & Houle, J. (2016). Profiles of Recovery from Mood and Anxiety Disorders: A person-centered exploration of people’s engagement in self-management. Frontiers in Psychology, 7, 584.

Coulombe, S., Radziszewski, S., Trépanier, S. G., Provencher, H., Roberge, P., Hudon, C., … & Houle, J. (2015). Mental health self-management questionnaire: Development and psychometric properties. Journal of Affective Disorders, 181, 41-49. doi: 10.1016/j.jad.2015.04.007

Gellatly, J., Bower, P., Hennessy, S., Richards, D., Gilbody, S., & Lovell, K. (2007). What makes self-help interventions effective in the management of depressive symptoms? Meta-analysis and meta-regression. Psychological Medicine, 37(9), 1217-1228.

Gouvernement du Québec. (2019). Programme québécois pour les troubles mentaux : des autosoins à la psychothérapie (PQPTM). Consulté au : https://www.quebec.ca/sante/conseils-et-prevention/sante-mentale/programme-quebecois-de-psychotherapie-pour-les-troubles-mentaux-pqptm/

Houle, J., Gascon-Depatie, M., Bélanger-Dumontier, G., & Cardinal, C. (2013). Depression self-management support: A systematic review. Patient Education and Counseling, 91(3), 271-279.

Houle, J., Gauvin, G., Collard, B., Meunier, S., Frasure-Smith, N., Lespérance, F., ... & Lambert, J. (2016). Empowering adults in recovery from depression: A community-based self-management group program. Canadian Journal of Community Mental Health, 35(2), 55-68.

Lean, M., Fornells-Ambrojo, M., Milton, A., Lloyd-Evans, B., Harrison-Stewart, B., Yesufu-Udechuku, A., ... & Johnson, S. (2019). Self-management interventions for people with severe mental illness: systematic review and meta-analysis. British Journal of Psychiatry, 214(5), 260-268.

Lorig, K. R., Ritter, P. L., Pifer, C., & Werner, P. (2014). Effectiveness of the chronic disease self-management program for persons with a serious mental illness: A translation study. Community Mental Health Journal, 50(1), 96-103. doi: 10.1007/s10597-013-9615-5

McCusker, J., Lambert, S. D., Cole, M. G., Ciampi, A., Strumpf, E., Freeman, E. E., & Belzile, E. (2016). Activation and self-efficacy in a randomized trial of a depression self-care intervention. Health Education & Behavior, 43(6), 716-725.

Mueser, K. T., Corrigan, P. W., Hilton, D. W., Tanzman, B., Schaub, A., Gingerich, S., ... & Herz, M. I. (2002). Illness management and recovery: A review of the research. Psychiatric Services, 53(10), 1272-1284. doi: 10.1176/appi.ps.53.10.1272

Omisakin, F. D., & Ncama, B. P. (2011). Self, self-care and self-management concepts: Implications for self-management education. Educational Research, 2(12), 1733-1737.

O’Connell, S., Mc Carthy, V. J., & Savage, E. (2018). Frameworks for self-management support for chronic disease: a cross-country comparative document analysis. BMC Health Services Research, 18(1), 583.

Ritter, P. L., Ory, M. G., Laurent, D. D., & Lorig, K. (2014). Effects of chronic disease self-management programs for participants with higher depression scores: Secondary analyses of an on-line and a small-group program. Translational Behavioral Medicine, 4(4), 398-406. doi: 10.1007/s13142-014-0277-9.

Slade, M. (2009). Personal recovery and mental illness: A guide for mental health professionals. Cambridge, UK: Cambridge University Press.

Starnino, V. R., Mariscal, S., Holter, M. C., Davidson, L. J., Cook, K. S., Fukui, S., & Rapp, C. A. (2010). Outcomes of an illness self-management group using wellness recovery action planning. Psychiatric Rehabilitation Journal, 34(1), 57-60.

Villaggi, B., Provencher, H., Coulombe, S., Meunier, S., Radziszewski, S., Hudon, C., ... & Houle, J. (2015). Self-Management strategies in recovery from mood and anxiety disorders. Global Qualitative Nursing Research, 2