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Life with Ease

Life Skills
Facilitation Manual

Jessma Barrani TRS, CTRS

Clara Toronto TRS, CTRS

Table of Contents

Title Program.3
Implementation Description.4
Objective and Performance Measures.6
Content and Process Description..8
Sequence Sheet.....12
Performance Sheet...........13
Progress Notes..........14
Appendix A: Record Review...15

Appendix B: Client Cards...21

Appendix C: Book Mark Template23

Resources..24

Program: Life with Ease

Purpose: To provide clients with skill sets necessary to manage symptoms of depression in their
everyday lives.

Program Goals and Objective:

Goal 1: Clients will learn methods of managing various symptoms of depression.

o Objective 1: Client will journal about skills taught in all group therapy sessions
under the supervision of the RT.
o Objective 2: Client will verbally communicate to the RT three methods of
managing depressive symptoms upon discharge.
Goal 2: Increase ability to actively function within home, work, and social settings.
o Objective 1: Client will identify and share with RT at least three skills that they
will access when they feeling symptoms of depression in a social setting upon
discharge.
o Objective 2: Client will role play using the five decision making steps taught in
group in a realistic situation under observation of RT.

Implementation Description
Population:

This program is designed for adult women (18+) with Depression. Clients must present
five symptoms of depression to attend this program. Clients must be high functioning and
not be AWOL because we will be leaving the facility and using various instruments in
group therapy sessions. Life with Ease is designed for an inpatient setting but can be
implemented in a community or out patient setting.

Special Considerations:

Sharps count
Equipment count
Proper staffing
Transportation
Food allergies and intolerances
Proper staffing ratios.
Adaptations will be pre-planned/prepared for clients individual needs.

Program Length and Duration:

Life with Ease is designed for a span of three weeks. Group will meet two times per week
with each session being 50 minutes long. Session meeting times can be varied but will be
scheduled no less than twice per week with at least one day between each session to
permit clients enough time to finish homework assigned in group session.

Program Context:

This program can be used for this population within any facility or agency, including
either community based or clinical settings.
Six interventions include:
o Whats on the inside
o Decision Making Skills
o Stress Management
o Nature Walk
o Savor the Flavor

Staff Program Responsibilities:

For outside interventions, staff to patient ratio is 1:4.

For indoor interventions/enclosed areas, staff to patient ratio is 1:6.
Ongoing inventory of supplies during interventions.
Observations of behavior and verbalizations of participants.
Ongoing documentation.

Adherence to all professional standards and requirements.

Use BCOM behavior management techniques

Training Requirements for Staff:

State Licensure as a TRS.

Nationally Certified with NCTRC as a CTRS.
CPR/First AID.
Completed facility training on depression.
Attend decision-making, stress management, communication skills, and mindfulness
training.
Be familiar with the concepts of positive psychology.

Facility:

Provide comfortable natural lighting.

Make sure the room is not cluttered and feels open.
White board.
Write the program quote Today is another chance. Make yourself proud on the white
board.

Supplies:

1 bar of high quality dark chocolate

Container of strawberries
6 small bowls
Napkins
Hand sanitizer
2 tables
Table clothes
6-8 exercise balls
6 Savor Every Moment book marks
6 Pens

OBJECTIVE AND PERFORMANCE MEASURES

Objectives and Performance Measures

Program: Life with Ease
Goal: Clients will learn methods of managing various symptoms of depression.
Objective

Performance Measure

1. Client will write in workbook about skills

taught in all group therapy sessions under the
supervision of the RT.

1. RT will review workbooks to see if

objective is being met. Clients will also have
opportunity to share entries from workbook
with group during discussions.

2. Client will verbally communicate to the RT

three methods of managing depressive
symptoms upon discharge.

2. Upon discharge RT will interview client

and ask them to state three methods they have
learned to help manage symptoms of
depression.

Objectives and Performance Measures

Program: Life with Ease
Goal: Increase ability to actively function within home, work, and social settings.

Objective

Performance Measure

1. Client will identify and share with RT at least three

skills that she can access when she is feeling symptoms
of depression during social interactions upon discharge.

1. Client will demonstrate verbally and/or in

workbooks how three skills taught in group relate to
a healthy social relationships.

2. Client will role play using the five decision making

steps taught in group in a realistic situation under
observation of the RT.

2. Client will demonstrate her ability to use the five

steps of decision-making by verbalizing her thinking
process in each step during role playing.

Content and Process Description of Savor the Flavor:

Goal: Clients will demonstrate the knowledge and use of savoring
Objective:

1: In the presence of an RT, the client will demonstrate the four components of savoring.
2: In the presence of an RT, the client will journal about one positive memory which they
savored in the past.
3: In the presence of an RT, the client will journal about three moments in which they
want to savor in the future.

Content

Process

1. Preparation
Before group begins RTs will:
Set up supplies.
Make sure that any food allergies have been
addressed and accommodated before group.
Make sure room is dimly lit.
Make room open and not cluttered.
Write program quote on board Today is
another chance. Make yourself proud.
Write intervention quote on board plenty of
people miss their share of happiness not
because they never found it but because they
didnt stop to enjoy it-William Feather
Write the rules of group on the white board:
No putdowns
No interrupting
Respect others
Dont judge

1. Preparation

2. Introduction
Review material covered in previous interventions.

2. Introduction
Like the previous interventions start group on the
exercise balls. Remind the clients that the reason for
starting on the ball is a reminder of how physical
movement helps with depressive symptoms and its a
metaphor for treatment, which is bouncing back.
Have clients circle up while sitting on their balls.
Remind clients that this is the last group of the

program, and that group will be starting with a review

of what has been covered.
Ask clients to write in their workbook one
intervention from the program they find helpful in
managing depressive symptoms.
Ask each client to share. The RT should validate
their choice and directly relate it to how it applies to
their personal life and managing depression
symptoms.
Savoring is a concept and technique used to fully
appreciate the moment. It comes from positive
psychology literature. Positive Psychology is the
scientific study of what makes life most worth
living. http://www.psychologytoday.com/blog/thegood-life/200805/what-is-positive-psychology-andwhat-is-it-not

Relate group quote to the hard work they have done.

Then transition into savoring. Explain savoring. Tell
clients that today they will savor food, can be done
anywhere with or without food. Give examples of
other forms of savoring.

3. Start the Activity

3. Start the Activity

Have clients put their balls away and move to the
tables. Before passing out the food, tell the clients
that the group will go through the steps of savoring
together and will eat together. So they have to wait to
eat their food. Have the clients use hand sanitizer
before participating.
Pass out clients chosen foods to savor. Remind the
client that when the RT guides the savoring she may
pose questions. Tell them not to verbally answer, but
to think about the question and answer in their minds.

Guide the clients to the present moment before

savoring.

Guide the clients to the present moment before

savoring.
Ask the clients that if they feel comfortable to
close their eyes. Ask clients to notice their
breath, their posture, their body, and try to let
go of any tension they may be holding. Then
slowly open their eyes if they were closed.

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Guide clients through the steps of savoring.

Guide clients through the steps of savoring.
Have them look at the food they have chosen
to savor. Visually notice the color and shape.
Next, pick up their food. Is it moist or dry? Is
it cold or warm? What is the texture like in
their hands?
Then ask the clients to put the food up to their
nose and smell it. What does it smell like? Is
it familiar?
Next, ask them to place it in their mouths and
take a bite. Let it sit in their mouths for a
moment. Chew it slowly. Feel the texture and
flavorful tones of the food. Is it cool,
comforting, is it fresh or sweet?
Now finish chewing and swallow the bite.
Are there any flavors still left in your mouth
or in the back of your throat? If so, savor the
flavors.
Bring your attention back to the environment,
back to the room. Are there any sounds they
can hear in the background? Any distant
voices or people moving in the hall?
If you feel comfortable, close your eyes.
Think back to the taste, the texture in of the
food in their mouths. The smell and how it
felt in their hands. The way the food looked,
its colors its dimension, its shape.
Give the group members time to savor. Then
gently bring their attention back to your voice,
back to the group, and back to the class.

Next explain the 4 components of savoring the

group just went through:
Focusing on the detail
Being absorbed in the experience
Build memories by creating a mental picture
Pass out book marks
or a souvenir.
Share the experience
Briefly explain the 4 components the group just went
through.
4. Process Savoring
4. Process Savoring
Present discussion questions to clients to tie in
RT will ask discussion questions to stimulate thought
savoring to the management of depressive
processes and help them understand learning
symptoms.
experience.
Possible discussion questions are as follows:
What type of emotions did you experience

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while savoring?
What type of thoughts did you have while
savoring?
Where/when can savoring be used?
How could this help you in managing
depressive symptoms?

Let clients know that thoughts and comments are

encouraged and appreciated.
Ask clients to journal about one positive memory
they have savored in the past.

Ask clients to journal about three positive moments

they wish to savor in the future.

5. Closure
Ask a group member to volunteer to read closing
savoring quote on the bookmark.

After discussion session is completed, have group

journal about one positive memory they have from
the past and ask them if anyone would like to share
that moment with the rest of the group.
Possible discussion question:

How does that memory make you feel?

After first journaling, ask clients to journal three

things they would like to savor within a month of
discharge. Ask each member to share with the group
one of the experiences they wrote down.
5. Closure
RT will ask a group member to volunteer to read the
savoring quote which is found on the back of the
bookmark.
Ask them what the quote means to them personally.
Explain to the group that the bookmark is a souvenir
of their time spent here and the progress that they
have made and will make in the future.
Thank them for their cooperation and participation in
group.

6. After Intervention
RT will chart on group session and verify that goals
were met be each individual client.

6. After Intervention

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SEQUENCING SHEET
Life with Ease: Savor the Flavor
Goal

Objective

2&3

Description

Session

Time
(min)

Preparation
Organize supplies
Set up room
Prepare food
Write quotes/rules on white board

10 min

Introduction
Review past interventions
Clients share what they remember from past
interventions
Introduce savoring

10 min

Start Activity
Pass out food
RT guides the savoring process
Pass out bookmark
RT discusses four components of savoring

10 min

Process Savoring
Ask discussion questions
Facilitate first journal entry
Ask them to share
Facilitate second journal question
Ask them each to share one

20 min

Closure
Read intervention quote
Connect savoring to managing depression
Wrap up group

10 min

Each
Session

10 min

After Intervention
Chart

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PERFORMANCE SHEET

Program: Life with Ease

Client

Kadie
Hilary
Danielle
Jackque
Jessica
Whitney

Goal 1

Obj. 1

Obj. 2 Goal 2 Obj. 1 Obj. 2 Personal

.
Goals

Personal
Goal
Score

Staff Date
Initials

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Staff:________________________________
Date:______________________

5-Goal/Objective Exceeded
4-Goal/Objective Accomplished
3-Goal/Objective Somewhat Accomplished
2-Goal/Objective Was Not Accomplished
1-No Participation

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Appendix A:

Record Reviews:

Danielle MDD
Danielle is a 25 year old married woman who is LDS and a mother of 3 children. She has had
postpartum depression for 6 months, which was immediately after the birth of her last child. She
has been ignoring the care of her children since the birth of the last. Her children are 6 months, 2
years, and 6 years old with one miscarriage between the 6 and 2 year old. Her husbands mother
moved in shortly after the birth of the last child to help take care of them and Danielle. She was
admits to an overdose in an attempt to commit suicide. She has been addicted to pain killers for
the last 3 years and Ambien since she was 14 years old. When she overdosed on hydrocodone
and was taken to the ER by her husband. He insisted that she go to a psychiatric hospital to
receive the proper care. In her assessment Danielle reported that she used to like to hike with her
family, run and read in her free time.
Allergies:

Bananas

Behaviors:

Persistent irritability
Fatigue
Anhedonia (lack of interest in activities they once enjoyed)
Persistent sadness
Hypersomnia
Suicide risk
Self harm

Goal: Client will demonstrate the knowledge and use of savoring.

Objective: Client will demonstrate the four components of savoring in the presence of the RT.
Group History: This is the sixth and last intervention of the program.
Interventions already completed are:
1.
2.
3.
4.
5.

Nature Walk
Whats on the inside? (Emotional Expression)
Interpersonal skills
Stress management
Decision making skills

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Group Dynamic: sense of friendship and group support.

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Hilary Bipolar
Hilary is a 54 year woman who has been divorced for seven years. She is from Newark, New
Jersey. She has two college aged children who are studying on the east coast. She came to Salt
Lake City after her youngest a year ago to take care of her ill mother, who died four months ago.
She currently does not practice any religion but has a Roman Catholic background. She was
diagnosed with Bipolar disorder when she was studying Engineering at MIT (over 20 years ago)
and has been very consistent with her medication up until her mothers passing. After her
mothers death Hilary experienced a serve depressive episode, saiding I have never felt this low
before. She admitted to BCOM psychiatric hospital. She worked for Arsenal Inc. for 15 years
as an engineer and quit due to problems with management. In her free time she enjoyed playing
soccer, biking, swimming and crocheting.
Allergies:

NONE

Behaviors:

unable to relax
Perfectionist
Tendency for mood swings
Low self worth
Persistent sadness
Low energy
Anhedonia

Goal: Client will demonstrate ability for positive thinking.

Objective: Client will verbally express two positive emotions or feelings in relation to the
savoring intervention.
Group History: This is the sixth and last intervention of the program.
Interventions already completed are:
1.
2.
3.
4.
5.

Nature Walk
Whats on the inside? (Emotional Expression)
Interpersonal skills
Stress management
Decision making skills

Group Dynamic: sense of friendship and group support.

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Kadie MDD
Kadie is a 37 year old woman who is from the Nez Perce Reservation in Lapaway, Idaho. She
has diabetes and lower back pain. She has an 18 year old daughter who is currently pregnant. She
has a history of alcohol abuse and has struggled with sobriety for the past four months. Her
brother passed away six months ago. She has gained about 25 pound in the last two months.
These events spiked her depressive episode. Her boyfriend, who she lives with, cant handle her
in her current condition and told her you go get help or get the hell out of here so she admitted
herself to the hospital to seek help. She enjoys going out with her friends, watching TV, and
drawing.
Allergies:

NONE

Behaviors:

Headaches
No energy
Sleeps too much
Low self esteem
Feelings of worthlessness and shame
Persistent feelings of saddness

Goal: Client will demonstrate the practical use of the four savoring techniques.
Objective: Client will journal three moments that she wants to savor within the next one month
after discharge and share one of them with the group.
Group History: This is the sixth and last intervention of the program.
Interventions already completed are:
1.
2.
3.
4.
5.

Nature Walk
Whats on the inside? (Emotional Expression)
Interpersonal skills
Stress management
Decision making skills

Group Dynamic: sense of friendship and group support.

Whitney: MDD

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Whitney is a 42 year-old Hispanic woman who was presented to the hospital with symptoms of
difficulty concentrating, problems sleeping, and complains of having a "jumpy" feeling all the
time. Whitney works as an accountant and states that she is seeking help, because these
symptoms are interfering with her ability to perform her work. She has difficulty sleeping, is
experiencing a loss of cognitive abilities, and shows agitated behaviors. Whitney also has
experienced a loss of appetite, weight change with no intentional change in diet, and a loss of
interest in activities she used to enjoy. Whitney states that this is the first time she has ever felt
this "bad," and it is a "constant struggle" to do daily activities like getting out of bed, bathing,
and eating. When asked how her culture has impacted her life, Whitney explains that her culture
and religious beliefs do not allow for suicide, and that she would never think of taking her own
life. Whitney appears very motivated to get well, stating that she will "do whatever it takes to
feel good again." Whitney is experiencing a first, single major depressive episode. Whitney
reported to have enjoyed dancing, making ceramics, and meditating.
Allergies:

None

Behaviors:

Agitated behaviors
Anxiety- Jumpy
Difficulty concentrating
Anhedonia
Crying
Persistent feelings of saddness

Goal: Client will demonstrate to RT an understanding of how to use 4 components of savoring to

regulate depressive episodes.
Objective: Client will journal about three moments she wants to savor within one month of
discharge and share one with the group.
Group History: This is the sixth and last intervention of the program.
Interventions already completed are:
1.
2.
3.
4.
5.

Nature Walk
Whats on the inside? (Emotional Expression)
Interpersonal skills
Stress management
Decision making skills

Group Dynamic: sense of friendship and group support.

References: http://www.examiner.com/article/major-depressive-disorder-analysis-a-case-study

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Jessica MDD
Jessica is a 20 year old college student who was admitted because of active suicidal ideations.
She has no substance abuse history. Jessica reported depression for the past 2 years and an
obsession with death since 8th grade. She is an obese female who appears sad, makes poor eye
contact and demonstrates poor social skills. Jessica reported difficulty sleeping, decreased
energy, irritable mood and trouble with her appetite. She also reported significant feelings of
worthlessness and hopelessness. Jessica reported that she enjoys cooking, bird watching, and
watching Netflix.
Allergies:

Chocolate

Behaviors:

Obsessed with death

Flat affect
Apathetic
Low energy
Irritable mood
Avoids eye contact

Goal: Client will demonstrate ability to experience positive emotions.

Objective: Client will verbally express with RT two positive feelings or emotions that she
experienced during the savoring intervention.

Group History: This is the sixth and last intervention of the program.
Interventions already completed are:
1.
2.
3.
4.
5.

Nature Walk
Whats on the inside? (Emotional Expression)
Interpersonal skills
Stress management
Decision making skills

Group Dynamic: sense of friendship and group support.

eferences www.brown.edu Courses BI... Deepa 2 Sekhar.doc

Jackque MDD

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Jackque is a 40-year-old woman. She is married for 15 years and has one child. She has been a
stay at home mother since the birth of her child. She has a 20-year history of recurrent MDD.
Her first episode began when she was 20 years old. Three years ago her depressive symptoms
began to aggravate slowly, characterized by depressed mood, irritability, diminished interest in
her usual activities, loss of appetite, weight loss, lack of energy, poor concentration, insomnia,
and recurrent thoughts of death, such as It would be nice not being alive. These symptoms led
to impaired work and social functioning. Her mother had a history of chronic depressive mood
disorder. Jackque has taken medication for her depression but as soon as she starts to feel better,
she stops taking it. Jackque told RT upon admission that she enjoyed walking every morning,
making and decorating cakes, putting together outfits, and talking with her neighbors.
Allergies:

None

Behaviors:

Irritability
Anhedonia
Isolation
Vocalizing thoughts of death
Low Self Worth
Suicidal risk and Self harm

Goal: Client will demonstrate an understanding of the four components of savoring.

Objective: Client will journal about one positive memory of the past and one positive moment
that she would like to experience within a month of discharge.

Group History: This is the sixth and last intervention of the program.
Interventions already completed are:
1.
2.
3.
4.
5.

Nature Walk
Whats on the inside?
Interpersonal skills
Manage Your Stress
Decision Making Skills

Group Dynamic: sense of friendship and group support.

References: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3304678/

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Appendix B:
Client Cards- Review Prompt Cards:

Danielle

Whitney

I liked what I learned in the

Interpersonal skills thing a lot
because I learned how to
communicate my feelings
better so my husband wont
get so sad with me.

Everything that weve learned

so far has helped me feel good
again. Especially the Nature
walk because it got me outside
of myself while we were
outside noticing the small
beauties around us.

Jessica

Jackque

Exercising can help me feel

better about who I am and
help me feel less frustrated
with myself.

The stress management group

has helped me recognize my
stressors and see that I can
avoid them and control my
reactions to them when they
get to me. IM NOT A VICTIM
TO MY STRESS!

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Hilary

Kadie

I learned that if I can just

properly manage my stress, I
dont get so mad when other
people dont do things as well
as I think should.

Doing the collages was helpful

for me in seeing how I see
myself on the inside and what I
really like about me.

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Appendix C:

Book Mark

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Resources:
a. American Psychiatric Association (2013). Diagnostic and Statistical Manual of
Mental Disorders (5th ed.)
b. V. Mark Durand & David H. Barlow. Essentials of Abnormal Psychology
c. Marry Ellen Ellis, (May 30, 2013). Affective Disorders, (Mood Disorders).
Retrieved from http://www.healthline.com/health/affective-disorders
d. American Psychiatric Association, (2013). Highlights of Changes from the DSMIV-TR to DSM-5. Retrieved from
http://www.dsm5.org/Documents/changes%20from%20dsm-iv-tr%20to%20dsm5.pdf
e. John Grohol, (May 18, 2013). DSM-5 Changes: Depression & Depressive
Disorders. Retrieved from http://pro.psychcentral.com/2013/dsm-5-changesdepression-depressive-disorders/004259.html
f. Anxiety and Depression Association of America, (2013). DSM-5: Changes to the
Diagnostic and Statistical Manual of Mental Disorders. Retrieved from
http://www.adaa.org/understanding-anxiety/DSM-5-changes
g. National Alliance on Mental Illness (2013). What is Depression? Retrieved from
http://www.nami.org/Template.cfm?Section=depression
h. Psychology Today (2013). Diagnosis Dictionary: Depressive Disorders.
Retrieved fromhttp://www.psychologytoday.com/conditions/depressive-disorders
i. http://www.gapsychology.org/displaycommon.cfm?an=1&subarticlenbr=219

J. Barrani TRS, CTRS and Clara Toronto TRS, CTRs