Cognitive Behavioural Therapy Skills Training Spread Initiative

The Shared Care Committee, a partnership between Doctors of BC and the BC government, has partnered with UBC Continuing Professional Development and Mind Space to deliver a Cognitive Behavioural Therapy (CBT) Skills program for physicians and for primary care patients experiencing mild to moderate anxiety and depression. The flagship program introduces concepts of CBT, mindfulness, emotion regulation and Acceptance and Commitment Therapy over an 8-week series.

The provincial initiative has 3 components:

The Primary Care Patient Program’s target population is adult primary care patients from all BC communities who are experiencing mild to moderate anxiety and depression. Over 16,000 patients have participated to date. The purpose is to provide high-quality education and evidence-based skills training to support mental wellbeing, with a priority on accessibility and equitability. The structure of this program is an 8-week group series delivered in-person or virtually by a specially trained physician facilitator who is funded through the Medical Services Plan.

The Physician Wellness Training’s target population is practicing BC physicians seeking mental health training and continuing education. Over 700 physicians have participated to date. The purpose is to provide education and training to support the physicians’ own mental wellbeing through evidence-based self-management strategies, to increase awareness of CBT and its clinical applications and to equip physicians to better support their patients with mental health conditions. The structure is an 8-week virtual group series that is accredited, with no cost to participants.

Select physicians also complete Advanced Facilitator Training. The target population for this is up to 100 family physicians from across the province who want to offer groups within the Primary Care Patient Program. The purpose is to train family physicians in facilitation skills and CBT foundations so that they can deliver groups, wherein patients are supported with education and skills training for symptom management. Once trained, facilitators provide this service to both their own patient panels and to the referred patients of their colleagues. Family physicians become trained facilitators through completing the Physician Wellness course and then eight cohorts of 8-week virtual groups, beginning with co-facilitation and progressing to solo facilitation. One of the physicians involved in Advanced Facilitator Training shared, “This program is amazing, it really helps counter burnout both by giving me skills to teach patients, as well as the benefit to my own well-being from continuing reflecting on the application of CBT.”

This program aims to make a difference in mental health care by providing a publicly funded mental health program for participants, utilizing the group medical visit fee code to compensate facilitators. The program provides services to patients with mild to moderate symptoms before they escalate in severity and require higher levels of intervention. It is also a resource to patients stepping down from higher acuity services who wish for support to prevent relapse. The group format allows patients to get as much as nine times the amount of interaction time with a physician than they would through individual consults. Virtual groups open up access to patients from across the province. Since its inception, the model has also been extended to provide other mental health services, with the recent addition of programs such as Skills for Success: ADHD Strategies for Adults, Raising Resilient Kids Parenting and CBT Skills for Insomnia. An Indigenous-designed program is also in development.

“One of the major benefits that I found from the CBT Skills Group was the availability and the affordability. It helped me in the time that I was waiting to seek other forms of support for my mental health and it really helped fill that gap that I was experiencing…I’m able to deal with life a lot better and I feel stronger, more empowered with dealing with my emotions than I [have] ever felt in the past,” commented a CBT Skills Foundation participant.

The physician training program has also cultivated change, fostering a culture where physicians have become more comfortable seeking and offering help. “If you’re not talking about [challenges and stressors] at work, you don’t realize everybody else is actually thinking and feeling the same way. Even just getting together in a small group on Zoom, a lot of the same themes start coming out. It’s helpful to know you have that shared human experience,” – Physician Wellness participant.