Stress Control's Origins

Background

Stress Control at Home, our online programme, is our most recent development. I developed Stress Control as a community class in 1986 as part of my NHS duties. I designed it as a way to allow many more people to access good CBT help – the largest class I know of was 450 people who attended a course in Malahide, Ireland. At that time, working in this way in the NHS was regarded as an odd way to offer help for problems like anxiety and depression. However, because we carefully evaluated it, wrote research papers that were published in peer-reviewed journals and wrote books, Stress Control became well-known across Britain, Ireland and in a few countries where people championed the approach. Belgium is a good example of this. It was not only efficient, i.e., allowed a lot of people to attend but also effective, i.e., it also worked well for each individual who attended a course.

By 2020, Stress Control was well-established in the NHS across the UK. It was rolled out across Ireland and Northern Ireland and we were making it available to more and more NHS services in England, Scotland and Wales. Continental, the German multi-national company offered it to all their employees across the world. However, we hadn’t really considered adapting it as an online approach. Then covid hit…

Covid lockdown

…and everything came to a standstill. Services, unable to run classes in the community or offer individual therapy, contacted us to see if we could offer any help. Knowing it would take the NHS in the UK and the HSE in Ireland some time to get services online, we decided to ‘do our bit’ by quickly developing an online version of Stress control and offering it, free-of-charge, to our national health services in order to provide help to those who were suffering from the common mental health problems but who were unable to access their usual care. We also thought it would be useful for the many people who were feeling highly stressed simply due to the worrying times we were living in, especially in the Spring and Summer of 2020 when the most stringent lockdowns were in place. We believed that if we could offer an evidence-based intervention ‘upstream’, it may help nip problems in the bud, avoiding the need, at a later date, for people to access services further ‘downstream’.

Developing ‘Stress Control online’

We turned to an old friend, Matt Harvey at Maybank Studios in Glasgow to help us film the course and create the YouTube channel where it would be streamed. We worked to an extremely tight timetable – we filmed on the 2^nd and 3^rd April. Editing and website creation took place right up to the day of the first session - 13^th April. The YouTube sessions allowed participants to live chat to each other, which seemed to create the feeling of people gathering as they would gather for a community-based Stress Control class, perhaps particularly helpful while people were feeling isolated due to lockdown.

Advertising the course

We relied on NHS and HSE partners to advertise in their own areas. Simple one-page adverts were offered as templates that could be developed by these services. Health services in Northern Ireland and Ireland were particularly good at getting information out to their populations. Local newspapers ran articles, Dr Hilary Jones retweeted our messages, The Late, Late Show of RTE mentioned the course, some football teams, e.g., Glasgow Rangers retweeted which resulted in supporters’ clubs and pubs getting the message out to normally hard-to-reach groups, e.g., working-class men.

Outcomes

According to YouTube analytics, around 7,000 people completed the course. Due to the very positive feedback we received (see below), we decided to run the course again in May. This time, just under 10,000 took part. Approximately double the number of people watched the afternoon session compared to the evening session, perhaps reflecting the number of people locked down at home during the day. ‘Likes’ for each session ranged from 97 to 100%.

The greatest numbers who took part were from Northern Ireland and Ireland, probably reflecting both that the Stress Control community class was already well-known in those places and also how well their communications teams advertised the course to individuals and organisations.

Live chat

Hundreds of participants used this and there was a strong community feel. We were impressed with how empathic and helpful live chatters were to one another, offering hope and advice to those who were struggling. People left many positive comments about the course and there was a strong sense of gratitude towards us and the course in general. Many people commented that they had felt ‘in the same boat’ as the other participants, especially welcome at a time when they felt isolated at home.

Evaluation

We asked participants to complete an evaluation form. Overwhelmingly, people said they were not stressed by covid but had had anxiety and depression problems for many years and this was an opportunity to learn more about these problems and ways to deal with them.

99% ‘agreed’ or ‘strongly agreed’ that the course had been of great benefit to them.
100% reported that the booklets and relaxation were ‘helpful’ or ‘very helpful’.
98% would recommend the course to a friend.

When asked for their preferences:

46% would prefer to attend the online course.
8% would choose the community class.
27% would attend either.
19% would like to attend both.

In addition, many clinicians and GPs got in touch to say how valuable the course had been and hoped it could continue. Northern Ireland and Ireland continued to run monthly courses – by summer 2023, over 100,000 people had taken part.

Conclusions

We showed that an online course could be set-up and that those who took part would find it beneficial. Our course was rough around the edges – no wonder, it was filmed in two hectic days and the website was put together in a week. Everything was rough-and-ready yet it clearly benefited people. We began to realise that this was not just something that could help until our community classes started up again and that doing it ‘properly’ would allow us to unleash its full potential.

So, Stress Control at Home was born. Sessions were better designed. We decided on 12 shorter sessions to allow people to better concentrate on them. Given the luxury of time, the videos contain more comprehensive information and look a lot better. We were able to introduce genuine choice – short or long booklets, a much wider range of relaxation and mindfulness, either narrated by a male (Jim White) or female (Dr Ruth Jamieson), music or no-music background options. We developed a range of interactive features into the programme to better allow participants to ‘become their own therapist’ – a critical aspect of the community class version too. And by allowing participants access to all the resources, people can now work at their own pace, in their own time instead of having to follow the previous live-steamed format.

Covid was a terrible time for so many people but it did allow many people involved in mental health to think differently about how best to help others. ‘Stress Control at Home’ was one such innovation.