The emphasis is on helping clients to deal with impulsive behaviours such as self harm, avoidance, withdrawal and isolation, aggression, substance misuse and binge eating. These behaviours are often associated with anxiety, depression, anger, addictions, eating disorders and personality disorders and can have devastating consequences.The Decider summarises thirty-two cognitive behavioural therapy (CBT) and dialectical behavioural therapy (DBT) informed skills under four core skill sets; the acceptance skills of distress tolerance and mindfulness and the change skills of emotion regulation and interpersonal effectiveness. The manual provides a client handout and a detailed explanation for the clinician for each skill. The Decider has the potential to be adapted for a range of service settings; adult mental health, child and adolescent, learning disability, substance misuse, prisons.
In February 2018, The Decider was incorporated as The Decider Limited in the Guernsey Registry, company number 64654More about The Decider: A Skills Manual
The Full Story
Michelle Ayres and Carol Vivyan are mental health nurses and Cognitive Behavioural Psychotherapists from Guernsey in the Channel Islands.
Back in the late 1990s and early 2000s, mental health nurses Michelle and Carol were working together in the acute mental health service in Guernsey, their home island. After progressing into management, they decided to change tack and study Cognitive Behaviour Therapy to enable them to become therapists. Guernsey didn’t have any CBT therapists at that time. In 2006, they travelled each week to Manchester and gained a Certificate in CBT, then in 2007-2008, they changed their weekly commute across the water to Southampton to complete a post-graduate Diploma in Cognitive Behaviour Therapy for severe mental health problems.
They started working within the new psychological therapy service, the two of them sharing an office and ideas. One of the local consultant psychiatrists gave them the task of developing a group-based intervention for long term service users who might otherwise have been sent off-island for longer term residential placements, and for those returning from such placements.
They started with their own ideas, based on their knowledge and clinical experience of CBT and DBT (dialectical behaviour therapy), and their many years of mental health nursing experience. They put together a skills training group, teaching 32 CBT/DBT based skills over 14 weeks. The pilot group consisted of 7 long term service users. That first group was challenging, but so valuable. The service users gave honest feedback which was incredibly positive, together with further ideas and suggestions for improvement.
They chose the name “The Decider” skills as it became apparent that learning the skills was empowering the service users to “decide” for themselves how to react in difficult circumstances.
Winning a local health bursary scheme in 2010, helped them develop their work into a manual so that others could run their own skills training groups. All Guernsey’s mental health workers were trained by Michelle and Carol, and some helped co-facilitate the groups, alongside service user “graduates”.
One of the most noticeable benefits of so many service users learning the skills was that it became a “common language”. Previously, service users spoke of receiving different advice from every professional they saw. With most staff and service users learning The Decider Skills, they started receiving the same reinforcing advice, such as “Do you know The Decider Skills? What skill can you use right now?”
With each group they ran, the delivery of the skills evolved into fun sketches for each skill. “The fun makes the difference!” Previously, service users had tried most interventions on offer, which were all problem focused. The Decider Skills were different – solution focused, entertaining, fun, memorable and effective.
The Decider Skills can and have been adapted to many different settings and are used in primary and secondary care mental health, substance misuse, prisons, learning disability services, social services, child and adolescent services, physical health services, dentistry and dietetics services etc.
In every group Michelle and Carol ran, at least one service user said: “I wish I’d learned these skills when I was young. Maybe I wouldn’t have gone on to have these problems now”.
That was transformative for Michelle and Carol, as they realised they had spent years working at fixing problems for people who had been suffering for years. What if they could work proactively? Teaching these skills to people, including children, BEFORE they need them?
Proactive mental health!
They then spoke with child and adolescent mental health professionals, teachers, children and young people, to find out which of the 32 skills would be most useful as proactive mental health.
So The Decider Life Skills were developed in during 2012. Not just for proactive mental health, they are also used in mental health services, but proactively, they are taught in schools, prisons, businesses, charitable organisations, and youth groups.
In 2018, with their passion for promoting mental health in children and young people, Michelle and Carol have devoted their time to developing The Decider Life Skills Good2Go, which will reduce teacher time and costs, with videos using child actors to teach and demonstrate The Decider Life Skills for schools.
Michelle and Carol believe that mental health education and awareness should be treated just like fire drill: taught and refreshed every year, in all settings.
The greatest gift we can give children and young people is the skills to manage their own emotions and mental health. Ayres & Vivyan 2017