This locally based group started in response to demand, the nearest Anxiety Management clinic having closed. I looked at programmes colleagues were running in other health services but, decided to do my own thing. The basics were pretty standard for a rural practice: six sessions, advertise in the local paper, grab a co-leader, and map out a programme starting with easy entry ‘getting to know you’ and ending with closing exercises. We evaluated with pre-test and post test anxiety scales, plus qualitative feedback. Nothing special there.
We had decided against pre-group interviews, with both myself and my colleague working part time we chose to talk with people by phone, largely to determine if anyone wasn’t going to be able to function in a group setting, if so, we offered them one-to-one sessions.
The empowerment orientation was there from the start but has grown with the implementation of an action-reflection improvement cycle. Being social workers, and middle age-ish, we had people sitting in a circle of chairs in the early groups. Through feedback and attrition we eventually learned that was too confronting for many of our participants and we have better retention now sitting around a table. I also now see this as more respectful. Treating people as colleagues in a learning and sharing environment rather than as ‘clients’, is less pathologising.
From the start we used the narrative therapy gambit of externalising the anxiety, so no ‘anxious people’, just ‘people affected by anxiety symptoms’. Yes it’s a bit Michael White/post modernist and wordy, but it matters. It matters how a person affected by anxiety thinks of themself; as a pathology, or as a person with a challenge to manage. So that is an empowerment element.
Another empowerment feature is the lack of a clinical pathway into the group. No labelling by a GP or psychiatrist. If you feel you’re affected by anxiety, you phone in. Yes, we assess informally during our phone interview, but there’s still not that medical diagnosis. Some people have had a formal medical, mental health experience and others haven’t. In the group we are all in the same room.
We work on building a convivial environment; welcoming people warmly, providing smart folders and pens, having a nice morning tea, being good hosts. We make it more like a study group or community meeting in some ways. We do our best to avoid a hierarchical leader/group member separation. We seat ourselves around the table amongst the other participants and if we want to write on the whiteboard we get up and walk to the board.
We call the people who come to the group’ people’, or participants.
In the first session we have the participants ‘map the influence’ of the anxiety on them and their lives. Another borrowing from narrative therapy. We have them identify what the anxiety does to them. So, we use ‘self -diagnosis’ not expert labelling. It is the beginning of a process of determining which non-medical management techniques are going to work for you. Each participant maintains a notebook through the sessions tracking their experiences and practice with the various evidence based techniques that are introduced over the six, two hour meetings.
At the end they have the benefit of the bonding that is the beauty of group work – they’ve come to know 6-8 other great people who are having the same challenge. They no longer feel alone and inadequate, and they have strategies that have improved their self-management.
After six series and 32 people completing at least 4 sessions, the pre-post test improvements are significant on a two tailed t test. The decrease in anxiety as captured by the Mind Over Mood Anxiety Inventory (Greenberger and Padesky 1995) was from a group mean of 31.31 to a group mean of 22.09, so a difference of 9.22.
Not having set out to do research, simply evaluation, this result is encouraging but hardly gold standard. Our next challenge will be to drill a bit further into the relative efficacy of this approach compared to a standard CBT group. To do this however means more measuring and, inherently more measuring of the problem. This produces a values conflict between being strengths and empowerment focused, and being accountable within the medical model. So, more adventures ahead.