Stress Management Groups: A Method for Reaching More Patients and Resident Education Rebekah Pershing, Psy.D. Theresa Lengerich, Psy.D. Angela N. Fellner, Ph.D.Emily Sander, M.A. Susan Kissel, M.A.David Bull, M.A. The 31st Forum for Behavioral Science in Family Medicine September 24, 2010

Introduction Problem Statement 60 – 70% of visits to Primary Care are prompted by stress related concerns 1 (Kroenke & Mangelsdorf, 1989) Due to brief medical visits, Physicians have little time to address physical and mental health needs Medical Residents have little formal education on brief counseling skills to assist their patients with stress related concerns Patients have limited access to mental health services due to various barriers (finances, availability, transportation, stigma, etc.) 2

Introduction Proposed Solution Weekly Skills-Based Stress Management Groups Free of Charge 1 Hour each week – 30 minutes Skill Building – 30 minutes Open Discussion & Support Open Group (No Appointment Necessary & Open to all Adult Patients of the Medical Practice) New topic each week (relating to stress management) Group led by 2 behavioral health therapists – Later Groups Co-Facilitated by Medical Resident on Behavioral Health Rotation (every other week) 3

Methods Advertised Groups Flyers posted in Waiting Room & Exam Rooms Discussed during Staff Meetings & Lectures Face-to-face Physician Referral Face-to-face & phone Behavioral Health Referral Invitation Sent to 14 patients identified by the Medical Resident assisting with group that month

Weekly Topics Relaxation Mindfulness Communication Problem Solving Distress Tolerance Breaking Bad Habits Improving Sleep Understanding Emotions Aches & Pains

Measures 1. Coping Skills Inventory 2 (Pre & Post) 14 questions (4-point Likert scale) Each question assesses a different coping skill Yielded an overall coping skills score for analysis 2. Perceived Stress Scale 3 (Pre & Post) 10 questions (5-point Likert scale) Questions assess patient’s level of perceived stress and confidence in dealing with stressors Yielded an overall perceived stress score for analysis 3. Group Satisfaction Survey (Post only) 3 satisfaction questions (5-point Likert scale) 1 Open Ended question re: desired future group topics Open Comment Area

Group Schedule

Results - Participants 12 Participants attended Group 2 Eliminated from Data Collection 1 due to exclusion criteria 1 due to no post test data (left group early) 6 attended 1 session 4 attended 2 or more sessions Demographics (of those analyzed) Ethnicity: 6 Caucasian, 3 African American, 1 Other Gender: 8 Female, 2 Male Distance Traveled to Attend Group: 7 participants traveled 0 – 4 miles 3 Traveled over 5 miles

Results- Satisfaction Survey Neither Strongly Agree nor Strongly AgreeAgree Disagree Disagree Disagree Response Mean 1. I feel this session was beneficial I would come back for another session like this I would recommend this session to a friend Total Mean Satisfaction Score = 4.78 (out of 5)

Results – T-Tests Coping Skills Scores No statistically significant differences were found between pre- and post-test data Perceived Stress Scores No statistically significant differences were found between pre- and post-test data

Results - Correlations No significant association between coping skills and perceived stress at pre-test (p >.05)  Post-test coping skills were statistically significantly negatively correlated with perceived stress, r = -.635, p =.049 As coping skills increased, perceived stress decreased

Discussion – Issues Recruitment Stigma Learned Helplessness Uncomfortable in Groups “Stress” is an Abstract Concept Physician referral did not typically result in attendance Attendance Open (No set Appointment) Busy/ Chaotic Lives (Transportation, Forgetfulness, Conflicts)

Discussion – What Went Well 1 Topic per Session Flexible, tailor topics to attendees if necessary or possible Use real examples from group members’ lives Having hand-outs (simple, no more than 2 per group) At least 2 facilitators present Helped with time keeping, managing issues, keeping session interesting/ conversational Leaving time at end for open discussion

Questions & Comments

References 1. Kroenke, K. & Mangelsdorf, A. D. (1989). Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. American Journal of Medicine, 86, Coping Skills Inventory –Adapted from Carver, C. S. (1997). You want to measure coping but your protocol’s too long: Consider the Brief COPE. International Journal of Behavioral Medicine, 4(1), Perceived Stress Scale –Cohen, S., Kamarck, T., & Mermerstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24,