Online support groups
27/3/09
Online support groups
for mental health problems
“Only connect ...”
Chris Barker and Nancy Pistrang
(E.M. Forster, Howards End)
UCL DClinPsy Conference, March 2009
Face-to-face mutual support groups
Overview
• Group of people sharing a problem
• Face-to-face support groups – meet regularly to exchange information, and to give
and receive psychological support
• Principles and processes
– principally run by members, not professionals
• Online support groups
• Terminology confusing
– UCL online student support group
– self-help, mutual aid, mutual help, support groups
– work in progress: online support for anxiety
and depression • Mental health context:
– often an adjunct to professional services
– high acceptability to service users
– NICE guidelines for depression
Examples of face-to-face Underlying psychological processes
mutual support groups
• Social support (information, emotional support)
• “Experiential knowledge” (Borkman, 1990)
• Alcoholics Anonymous • “Curative factors” in group psychotherapy
• Depression Alliance (Yalom, 1975)
• Hearing Voices – e.g., instillation of hope, universality, modelling,
catharsis
• Contact-a-Family
• “Helper-therapy” principle (Reissman, 1965)
– members benefit from giving as well as receiving
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Online support groups
27/3/09
Community psychology principles
Participation rates
• Public health approach
– aim to reach large proportion of the population • One-year participation rate in mutual
– interventions focus on groups rather than individuals support groups (not necessarily for mental
• Help-seeking rate for professional interventions health problems) is about 7% of the US
in anxiety and depression is about 1 in 4 adult population (Kessler et al., 1997)
(Bebbington et al., 2000; Kessler et al., 1995) • Over 3,000 mental health support groups in
• “Give psychology away” (Miller, 1969) the USA (Goldstrom et al., 2006)
• Build on people’s natural competencies • No comparable UK data
Professionals’ attitudes Are mutual support groups effective?
• Mutual support can complement professional help • Anecdotal literature attesting to benefits
– many professionals make referrals and offer assistance – sense of agency or empowerment
to mutual support groups – sense of community/belonging
• Some professionals, however, are sceptical – self change
– “blind leading the blind” • Some (limited) rigorous outcome research
– potentially harmful (e.g. eating disorders) – review by Pistrang, Barker & Humphreys (2008)
– mixed but largely positive evidence for effectiveness
• More favourable attitudes towards ‘12-step’ for some mental health problems
groups for substance misuse (Chinman et al., 2002) – no evidence of harmfulness
Online support groups Examples of online support groups
• Thousands of online support groups cover the
gamut of physical and psychological problems PsychCentral http://psychcentral.com/ (various)
– also known as “internet support” or “electronic support MentalHelp.Net http://www.mentalhelp.net
groups” (part of the “e-health” movement) (various)
• No geographical limitations (so especially good MDJunction http://www.mdjunction.com (various)
for rare conditions) and available 24/7
Depression Forums
• Participation rate estimated as up to 20% of US http://www.depressionforums.org/
adults with internet access (Pew Research Center,
Bodies under Siege http://buslist.org/phpBB (self-
2005)
harm)
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Online support groups
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Professionals’ attitudes to internet What’s known about effectiveness?
mental health
• Limited outcome research as yet (Eysenbach et
• Pilot study by Louise White al., 2004)
• Small survey of 8 clinical psychologists • Prospective study of 103 participants in online
• Recommended several sites, mostly CCBT support groups for depression (Houston, Cooper
& Ford, 2002)
• Central issues – most users scored in the clinical range on a
– computer literacy depression measure, with low social support
– not suitable for some presenting problems (e.g. scores
paranoia, OCD, health anxiety) – after 12 months, depression had resolved in 43%
of frequent users, compared to 21% of less
– mild to moderate severity; motivated frequent users (but issues in interpreting causality)
– quality of advice may be variable
UCL online student support project Structure of the student support website
• Information pages: information and advice on
• Freeman (2003, DClinPsy project) set up and a range of common student problems:
evaluated a website for UCL students with – academic (e.g., procrastination, exams)
psychological problems – emotional (e.g., depression, homesickness)
– complementary to, and in collaboration with, the • Online support group
UCL Counselling Service – only open to registered UCL students
– bulletin board format
– anonymous postings
(see www.ucl.ac.uk/support-pages for current version)
Research design
Measures
• Recruitment, informed consent, and
• Outcome measures
administration of measures done online
– psychological problems (CORE-OM)
• Design: randomised trial
– satisfaction with life (SWLS)
– Online Support condition: online support group plus
– sense of community (SCI)
information
– Information-Only condition • Process measures
– response modes (Klaw et al., 2000)
• Pre-post outcome measures (10 week interval)
– content categories
• Process and content analysis
– hit counts, showing page by time activity
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Online support groups
27/3/09
Usage: information pages
Participants
• Information pages had 1,204 hits (4.3 per
• 283 students signed up:
participant across both conditions)
– 198 (70%) women and 85 (30%) men
• Most commonly accessed were:
– 202 (71%) white
– support services details (208 hits)
– 137 (48%) in clinical range on the CORE-OM
– procrastination (132)
• For ethical reasons, all participants screened
– work block (100)
(using the CORE-OM) and referred to
– depression (98)
counsellor or family doctor in case of
– concentration (92)
serious problems
Support group process
Support group content
Provide self-disclosure 71%
Study difficulties 29% Provide information/advice 47%
Interpersonal problems 29% Provide emotional support 24%
Depression/sadness 19% Request self-disclosure 15%
Eating concerns 17% Request information/advice 13%
Employment worries 15%
(Note that multiple codings were possible)
(Note that multiple codings were possible) • Very similar to other online support groups
(Klaw et al., 2000)
CORE-OM scores for completers Implications of UCL online support project
Pre Post • Online support groups are a viable method for
M (SD) M (SD) addressing psychological difficulties
• Replication needed with more active group and
longer pre-post interval
Support group 1.13 (.60) .91 (.47)
• Research design issues: are RCTs feasible in this
context?
Information 1.31 (.64) 1.04 (.64)
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Online support groups
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Work in progress (1)
Work in progress (2)
• Predictors of engagement in online support
groups (Louise White’s DClinPsy project) • Process and outcome of an online support group
– NHS patients experiencing depression helped to (Jeremy Dean’s PhD research)
access an existing online support group • Participants recruited online to join an existing
– examine how many engage with the groups, what online support groups for depression or anxiety
their characteristics are, and what is their initial
• Monitor usage rates and types of postings
satisfaction level
– aim to see whether referral to an online support • Monitor psychological status every 3 months
groups would be a useful complement to • Examine predictors of change
psychological therapy
Conclusions
Further information
• Online support groups proliferating, for both
physical and mental health problems
For contact details or further information, see
• Potentially valuable complement to professional the UCL Psychological Helping and
interventions
Support research group site at:
– but some concerns amongst professionals about the
possibility of adverse effects
• Appealing use of new technological means to http://www.psychol.ucl.ac.uk/phas
facilitate the creation of supportive communities
• As yet, little systematic research on their process
or outcome
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