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Supported self-management

Supported self-management (SSM) is also called guided self-help. It helps people with mental health problems to develop the knowledge and skills they need to improve their self-efficacy and better manage their conditions.

The client uses self-directed tools and resources to develop this knowledge and skills. A health care professional works as a coach, guiding the client through the resources and helping to define goals, set priorities and develop plans.

Most of the materials used in SSM are based on cognitive-behavioural principles. Psychodynamic and problem-solvingbased interventions have also been evaluated.

Where is SSM used?

SSM is most often used with people who have mild to moderate depression or anxiety. It is a low-intensity treatment option – step 2 in stepped-care treatment models. SSM is recommended by the U.K. National Institute for Health and Clinical Excellence (NICE) in its clinical guidelines for depression, generalized anxiety disorder and panic disorder, and eating disorders. SSM is also recommended in the Canadian Network for Mood and Anxiety Treatments clinical guidelines for depression.

Implementing SSM

SSM interventions can vary, particularly in terms of duration. The NICE guidelines recommend 6–8 sessions.

Common elements of SSM include:

  • engaging the client
  • identifying key problems and goals
  • identifying appropriate self-help materials
  • supporting the client's change efforts
  • reviewing progress and the need for further help
  • using assessment and outcome measures to monitor and review progress.

Assessment

SSM should be part of an individualized, comprehensive assessment and treatment plan. The clinician and client discuss a range of treatment options.

Before beginning SSM, the clinician:

  • assesses the client's readiness to take on self-management
  • reviews symptom severity
  • discusses the client's needs and preferences.

Introducing SSM and materials

At the outset, the clinician and client discuss:

  • the importance of self-management
  • the clinician's role as coach/facilitator
  • the work the client will do.

Watch a clinician and client discuss SSM for depression.

In SSM sessions, the clinician:

  • helps the client to decide which skills to work on first
  • encourages the client to identify new skills
  • supports the client in reviewing progress and setting new goals.

Good Practice Guidance on the Use of Self-Help Materials within IAPT Services, published in 2010 by the Improving Access to Psychological Treatments program of the National Health Service in the United Kingdom, discusses factors to consider when choosing self-help materials.

Evidence summary

Research evidence suggests that guided self-help (or supported self-management) is more effective than the provision of information alone (see Good Practice Guidance on the Use of Self-Help Materials within IAPT Services for a summary of the evidence).

See also the National Institute for Health and Clinical Excellence (NICE) clinical guidelines for depression, anxiety and eating disorders.

Resources

Supported Self-Management for Depression (PowerPoint presentation), by Dan Bilsker

Vancouver Health Authority. (2009). CBIS: Cognitive Behavioural Interpersonal Skills Manual

Workbooks

Antidepressant Skills Workbook. (2005), by Dan Bilsker and Randy Paterson

Antidepressant Skills at Work: Dealing with Mood Problems in the Workplace. (2007), by Dan Bilsker, Merv Gilbert and Joti Samra

Australian Psychological Society. (2013). Internet Supported Psychological Interventions: A Guide to Navigating the Online World of Psychological Programs

Dealing with Depression: Antidepressant Skills for Teens. (2005), by Dan Bilsker, Merv Gilbert, David Worling and Jane Garland

Web-based programs

Beating the Blues (cost to practitioners for use)

MoodGYM


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