Dr Alastair Dobbin College of Medicine 11/06/13

1. Dr Alastair Dobbin College of Medicine 11/06/13

2. What is Positive Mental Training? • A primary care based intervention • Trained staff supervise modular self help • A DVD and 12 audio tracks on 3 CDs/mp3s • Listen at home x1/day 18 minutes – no reading • No referral required – Simple supervision • Fits into 10 minute appointment • Research in General Practice & Occupational Medicine

3. Timeline • 1960s – 2000 developed with and used for olympic sport and elite performers • 2002 modified for healthcare as resilience building programme • 2003/4 Research in primary care use for depression (Edinburgh University) • 2006 Widespread use by primary care staff leads to research in occupational medicine within NHS services division Scotland (NSS) • 2011 Research with McGill University Montreal in the modification of depressive thinking (DBRCT) by positive emotions. • 2012 Research with Kings College/IOP into cost efficacy • 2012 RCGP accreditation for Workshops • Since 2006 70,000 treated across UK by GPs CPNs OT OH DN Psychiatrists Psychologists etc 850 staff in NHS attended workshops – high level of personal use

4. Positive Mental Training Develops physical & cognitive skills through: • Jacobson Relaxation • Breathing retraining • Visualisation • Changing thinking style – Transformation! • Increasing benefit from positive memories and experiences – increases positive emotions and promotes cognitive benefits, problem solving, empathy, generosity to self and others - Reduces depression anxiety burnout -Very cost effective

5. Transformation! • Fredrickson & Losada 2005 • Dobbin Ross & Philippe 2013 • Critical ratio of positive to negative emotions 3:1 in cognitive benefits • Below : defensive & withdrawn : blocks PA ‘Languishing’ • Above : inclusive & outgoing: generates PA ‘Flourishing’

6. Critical Ratio 3:1 Below 3:1 Above 3:1 Garland, E., Fredrickson, B., Kring, A., Johnson, D., Meyer, P., Penn, D. (2010) Upward spirals of positive emotions counter downward spirals of negativity: Insights from the broaden-and-build theory and affective neuroscience on the treatment of emotion dysfunctions and deficits in psychopathology Clinical Psychology Review 30:849-863

7. Benefits • Used with/ without antidepressants • Immediate psychological treatment choice • No referral/ maximises primary care +ve rapport • Frees up psychology/psychiatry services • De-medicalises patient (and clinician!) distress • Patient & clinician empowerment • Used at home – fits into their life • No reading skills necessary • Non stigmatising, positive focus

8. Limitations • Not face to face therapy • Not drug therapy • Need to make time to listen • Needs motivation to listen every day • Not everyone engages • Not helpful for bipolar/schizophrenia

9. Positive Mental Training Training for Primary Care Staff • Educates - in current theories of mental health and treatment of depression (RCGP accreditation) • Empowers - GPs & others benefit from involvement in mental health treatment • Increases wellbeing of Primary Care Staff – and widespread personal use (particularly GPs) • Training developed and led by GP - 2 x 3½ hour sessions or partially online

10. J. Thomson – Royal Society Occupational Medicine conference 2010 Maslach Exhaustion (ex), Cynicism (cy) and Personal Efficacy (pe) – components of Burnout- in mental health OH referral treated with Positive Mental Training. Changes 0 – 26 weeks p<.05 in all indices note- efficacy increases depersonalisation and exhaustion decrease

11. WEMWBS mean scores pre & post Positive Mental Training workshops for all professions and by individual professions. The difference for each group was statistically significant, p<.001

12. Thank You! • Alastair Dobbin, GP – 07920115647 • alastair@foundationforpositivementalhealth.com • www.foundationforpositivementalhealth.com