EFPT Psychotherapy Guidebook chapter on Psychoeducation
Psychoeducation aims to expand patients understanding of their psychiatric disorder, in order to improve coping strategies and to reduce stigma.
By educating people about their psychiatric illness, with regard to their symptoms, course, early signs of relapse, treatments’ effects and rehabilitation Psychoeducation promotes disease’s acceptance, adherence to treatment. Some psychological strategies (like communication skills, relaxation) are also taught, helping patients deal with the problems caused by the disease and improve teir relationships with others like relatives and professionals.
Different programs exist for several disorders and are usually organised by nurses, psychologists, psychiatrists and members of patient associations, involving a multidisciplinary team.
Sessions follow a structured plan with specific objectives. The number of sessions varies across programs. Psychoeducation can be individual or in groups.
It is more than just a lecture, Psychoeducation promotes patients’ empowerment, helping them to be more active in the management of their disorder.
Any chronic disorder could be the target of psychoeducation program. They are mainly developed for bipolar disorders and schizophrenia. The patients need to be previously stabilized. All of them could benefit of this approach, but some studies suggest that younger age, shorter illness period, higher levels of education and less external locus of control are positive predictors of participation and cooperation in the sessions.
There are also some programs that target patients’ family members, especially in case of schizophrenia or ADHD. These programs help the family members to have a better understanding and attitude toward their relative.
Over the years, the investment in psychological interventions for Bipolar Disorder (BD) was scarce. This was due to some factors, mainly, the strong biological component; high heritability of BD; the erroneous idea of the absence of symptoms in the euthymic periods; and the ambivalence of traditional psychoanalytic school regarding the usefulness of psychotherapy in this disease.
Meanwhile, these perspectives began to change. It was accepted that pharmacotherapy is not enough, something that had already been demonstrated in other mental illnesses. It was recognized that not only biological factors but also psychological and social factors are predictors of the disease’s course. The roots of Psychoeducation for BD come from the 1970’s lithium clinics. These were focused in pharmacological treatment monitoring, but also offered some information and mutual support. Afterwards, Psychoeducation groups focused on giving information emerged. In the mid-1990’s, a new model was developed, including not only information but also stressing the empowerment of the patient regarding the treatment and recognition of relapses. This intervention, the Barcelona Psychoeducation Program (BPP), showed efficacy in preventing recurrences and has been replicated several times since it the first published randomized controlled trial, in 2003.
Different Psychoeducation programs have been developed for Bipolar Disorder (BD). The majority found in literature consist in group Psychoeducation directed to BD patients or to families and caregivers. Interest in online Psychoeducation programs has been clearly increasing in the last years. Combined Psychoeducation with other psychosocial interventions has also been common.
The Barcelona Psychoeducation Program (BPP) was proposed by Francesc Colom and Eduard Vieta and consists on 21 weekly group sessions. The authors recommend that the groups should have between 10 to 12 patients, balanced in sex and age. The sessions address awareness of the disorder (definition, causal and predisposing factors, symptoms in different episodes, evolution and prognosis); treatment adherence (mood stabilizers, antimanic drugs, antidepressants, plasma levels of mood stabilizers, pregnancy and genetic counselling, psychosocial therapies, risks associated with treatment dropout); avoiding substance abuse; early detection of new episodes and to what to do if a new phase is detected; regular habits and stress management (lifestyle regularity, stress-control techniques and problem solving strategies). A manual containing all the information needed to implement a group, including a description of every session, procedures, useful tips, patient materials and assignments.
Psychoeducation improved medication adherence, reduced manic symptoms and increased global functioning.
Results are more controversial regarding the reduction of relapse rates: some studies concluded that Psychoeducation reduced both poles relapse rates; other concluded that it had no effect on depressive relapses. In addition, a quite recent meta-analysis concluded that only interventions for family members affected relapse rates.
Overall, Psychoeducation has revealed to be a very useful tool in the treatment of BD, whether it is used in combination with only pharmacotherapy or also in combination with other psychosocial interventions.
I will ask Eduard Vieta or Francesc Colom.
Psychoeducation Manual for Bipolar Disorder; Authors: Francesc Colom and Eduard Vieta, Cambridge University Press, 2006
The Bipolar Disorder Survival Guide – What You and Your Family Need to Know Author: David J. Miklowitz, Guilford Press, 2010
The idea of psychoeducation group for parents of patients with schizophrenia is to increase the knowledge of the carers, improve the communications with their suffering relative and decrease the burden of the family. Carers have a better understanding of the issue associated with the illness (like of motivation, hallucinations, delusions) and more appropriate progressive expectations.
In France, Yann Hodé and Dominique Willard improved and developped the Profamille program from a Canadian program.
Around 12 carers meets during one evening every 2 weeks (14 sessions) during one year and a follow-up the year after 3 sessions.
theoretical knowledge is not the priority. A lot of role-plays are organized to give the carers a training in their communications attitudes with their relatives.
Neurobiology and Neuropsychology of schizophrenia and especially the lack of motivation and insight associated with this disorder
Different kinds of treatments, efficacy and side effects
Early detection of relapse symptomes
Life styles and hygiene to prevent relapse (sport, sleeping routines, relaxation techniques)
Information and destigmatization about the ilness
Decrease emotional burden of the family, how to put limits
How to have a positive approach, how to reinforce a relative, how to be grateful : to be Positive about Precise Small Steps
Motivational communication strategies : open ended questions, avoid to give any not sollicitated advise
Improvement communication in the family and with professionals
How to get help from professional and patients associations
It decreases by two the rehospitalization rate of patients which is as efficient than the neuroleptics.
It decreases diability, improve professional reinsertion. It increases physical and psychologica health of families.
Research in this area is mainly by evaluating patients before and after the group and then in follow-ups. It is important to replicate results but also to consider new areas to include in a Psychoeducation program in order to be more complete and holistic, including life style education (exercise, food) and cognitive remediation, etc. Import work is ongoing about how families cope with the burden of severe mental illnesses. Treatment adherence is very discussed in psychoeducation group and could be increased with such programs.
Other programs exist for ADHD patients (Barkley program).