Brief-UP pilot study plucks UCalgary students from stressful experiences

First-year University of Calgary student Jenin Ahmad describes her introduction to post-secondary life in 2020 as “simultaneously so much… and incredibly uneventful.”

It’s a description sure to resonate with those in her peer group who, like Ahmad, finished high school during COVID’s first wave and began university without stepping foot on campus, enduring long stretches of isolation and tedium accentuated by bouts of uncertainty and anxiety. For Ahmad, who has a history of mental health struggles, this new academic reality eventually became too much for her to bear alone. Thankfully, she didn’t have to.

Ahmad joined 46 other UCalgary students in a pilot program led by Dr. Gina Dimitropoulos, PhD, associate professor in the Faculty of Social Work, member of The Mathison Centre for Mental Health Research and Education, and member of the Alberta Children's Hospital Research Institute. Dimitropoulos and her team truncated what is usually a 15-week treatment into five weeks.

The treatment is known internationally as the Unified Protocol (UP), a form of cognitive-behavioural therapy for individuals diagnosed with anxiety, depression and related disorders. Hence, the shortened UCalgary project’s designation as a “Brief-UP.”

During the five-week program offered through Student Wellness, participants engaged in group sessions over Zoom where they were introduced to techniques that address a spectrum of mental health issues caused or exacerbated by the pandemic.

For her part, Ahmad says being able to directly engage with her peers alone was worth it: “Honestly, I think the best part about it was that it was always with the same participants — getting to know these people and hearing the perspectives of everyone else.”

The study reveals that that much-needed human connection was commonly cited as being of major benefit. The data also showed that the students’ anxiety levels, and their effect on day-to-day functionality, significantly decreased following the program, and that their individual symptoms — from obsessive compulsive behaviour to fears about illness — also demonstrated sustained improvement.

“It's so helpful,” says Ahmad of one coping technique she learned as a study participant and which she continues to use in her daily life. “Oftentimes it can pluck you out of the stressful situation.”

The success of the program led to Dimitropoulos’s selection as a Peak Scholar in COVID-19 Innovation Excellence. She spoke to UCalgary News about the project

Q: At what point did it become first apparent that the university needed to develop remote pathways to resources in response to this new reality?

A: Early in the pandemic, many of us who were doing research in Unified Protocol at various organizations thought, ‘There's no way that we're going to be able to continue to do this in person, so we need to pivot quickly and figure out how we can deliver this virtually to students.’ We also had to consider how to do this in a way that would reach the widest number of young people, young adults, who were struggling with anxiety due to COVID-19 and the uncertainty that comes with the pandemic.

So, a group of international researchers rapidly — within weeks — took the Unified Protocol for adolescents and condensed it into a five-week group intervention, which was a real feat. We had to think, ‘What are the core strategies and tools that we can provide youth to help them cope with anxiety and uncertainty related to COVID?’

That happened very quickly, and I think it's because we knew we had to — we had to figure out how to adapt. We wanted to be responsive and reach a wide range of students where it didn't matter what type of mental health problem they were struggling with, and it didn't matter how much experience they had in therapy or treatment. We wanted to just offer generic tools that could be applicable to a wide range of students struggling with mental health concerns, academic stressors and social isolation.

Q: Which is where Unified Protocol comes in. Or in this case, Brief-UP. Could you explain what it is and how it works?

A: It’s a Cognitive Behavioural Therapy approach. What's happened in the field in the last decade is that there's been a proliferation of manualized CBT approaches for different diseases and disorders. What I really like about the Unified Protocol is that it takes everything that works in CBT, regardless of the disease or disorder, and kind of whittles it down. To describe it in a straightforward way, the UP approach is about helping people to learn how to identify their emotions: what contributes to them responding in certain ways to experiences that might be frightening or threatening — like the pandemic.

The first session focuses very much on helping people to identify the three components of an emotion: being able to identify thoughts, identify what’s happening physiologically, and how that drives your behavioural response.

I think what is invaluable is that it helps you to look at how your response in the short run might alleviate anxiety, but in the long run may perpetuate the feelings you are trying to avoid. Brief UP is not prescriptive: it provides people with a range of tools that may be helpful.

Q: What does the recognition of the Peak Scholar program mean for this type of research?

A: It's just a real acknowledgement of the incredible amount of work that we've done as a team to develop an intervention where we can support people who are struggling with stress related to the pandemic or stress related to other natural disasters.

We're so proud to have received this and we’re continuing to plow ahead and think about other ways of advancing this research. I think the next step is to think about how to test this out with other student populations, like international students. We’re thinking a little bit about, ‘Are there some sub-groups within campus that we need to be thinking about who may experience additional problems/challenges accessing mental health services?’

Where we’re moving forward now is thinking about how to add an app as an adjunct to the intervention. We're hoping to work with students across campus to help us co-design it within the context of this brief intervention.

We will be seeking involvement from students from across campus interested in co-designing an app to augment that virtual Brief-UP for Student Wellness.