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Demand currently greatly outweighs supply in teenage mental health, with statutory services and the third sector struggling to cope with the number of referrals. There is increasing interest in the possibility of using schools to provide mental health interventions. This pilot study looked at the feasibility of developing a version of an existing evidence-based transdiagnostic large-class didactic approach widely used in NHS adult services – ‘Stress Control’ – for use with teenagers as a universal early intervention/prevention approach taught by teachers within the Personal and Social Education (PSE) curriculum in a high school in a highly deprived area. PSE teachers were trained, over five hours, to deliver each of the eight sessions in single weekly periods. Measures of anxiety and depression (RCADS) and wellbeing (WEMBWS) were administered at pre- and post-intervention and at 9-month follow-up. Results suggest that teachers reported few problems in delivering the approach, seen as relevant by pupils and showed significant reduction in anxiety and depression and significant gains in wellbeing at post-intervention. These gains were maintained at 9-month follow-up. There appears to be potential in this model. One of its strengths appears to be the positive collaboration between the psychologist, teachers and pupils, which resulted in changes being made to the original model. Limitations of the study and suggestions for future research are given.
Key learning aims
(1) To learn if an evidence-based adult psychoeducational approach can be adapted to meet the needs of teenage pupils in a school in a deprived neighbourhood.
(2) To learn if teachers, with no training in mental health, can deliver this approach.
(3) To test the viability of the approach with an aim of creating a sustainable intervention.
Unhealthy eating patterns, physical inactivity and alcohol misuse are commonly reported by individuals with severe mental illness (SMI) and significantly contribute to premature mortality. People with SMI could benefit from psychoeducational interventions focused on lifestyle modification.
Aims
To evaluate the effectiveness of the LIFESTYLE programme to improve dietary habits and physical activity levels and reduce alcohol use in individuals with SMI versus controls receiving a less structured psychoeducational programme (Italian Ministry of University and Research, trial registration number: 2015C7374S).
Method
This multicentre randomised controlled trial (RCT) was conducted across six Italian universities and included 401 participants diagnosed with SMI, randomly allocated to either the test group or a comparison group.
Results
At 1-year follow-up, generalised estimating equations showed that the trial intervention boosted the likelihood of higher weekly metabolic equivalents of task (METs) expended on total activity (odds ratio 1.43, 95% CI 1.08–1.89; p < 0.01), on walking (odds ratio 1.50, 95% CI 1.18–1.90; p < 0.001) and on moderate activity (odds ratio 1.85, 95% CI 1.24–2.77; p < 0.01). Improvements in dietary habits included increased intake of fish (odds ratio 1.67, 95% CI 1.45–1.97; p < 0.05), fresh fruit (odds ratio 1.36, 95% CI 1.05–1.76; p < 0.05) and vegetables (odds ratio 1.91, 95% CI 1.56–1.96; p < 0.05), along with reduced junk food consumption (OR = 0.81, 95% CI 0.63–0.99; p < 0.05) and daily alcohol use (odds ratio 0.70, 95% CI 0.52–0.95; p < 0.05).
Conclusions
The LIFESTYLE intervention proved effective in promoting healthier lifestyles among individuals with SMI, with sustained benefits at 1 year. This structured programme could be a valuable addition to routine mental healthcare.
Bipolar disorder often goes unrecognised for several years, leading to delayed treatment and negative outcomes. To help address this, we have developed a novel telehealth-based group psychoeducational and resilience enhancement programme for individuals at high risk for bipolar disorder (PREP-BD), aimed at improving help-seeking among adolescents and young adults at risk of developing bipolar disorder.
Aims
The purpose of the current study was to explore the perspectives of at-risk youth, their families and group facilitators who participated in the feasibility trial of PREP-BD.
Method
Group and individual semi-structured feedback sessions were conducted with the participants (n = 21) of the programme, their family members and the facilitators of PREP-BD. The questions covered their experiences, opinions on the programme’s structure and content and suggestions for improvement. Feedback sessions were transcribed and analysed qualitatively using inductive content analysis.
Results
Overall feedback was positive, with participants and facilitators appreciating the informative and engaging nature of the sessions. Some participants desired more actionable resources and complex content. Family members sought greater involvement and information about the programme. The online format was valued for convenience, but was also viewed as a barrier by some to fostering deeper connections.
Conclusions
PREP-BD shows promise as a psychoeducational intervention for individuals at high risk for bipolar disorder. To enhance the programme’s effectiveness, future iterations should incorporate more nuanced content, provide additional practical guidance and address the limitations of the virtual setting. Continued evaluation and optimisation are crucial for ensuring the programme’s effectiveness as a tool for early intervention in bipolar disorder.
The chapter will help you to be able to describe the different techniques available in CBT, consider the purpose of any given technique in relation to the maintenance cycles it interrupts, and tailor interventions to individual patients, considering their unique strengths and needs.
To truly understand the efficacy of attention-deficit hyperactivity disorder (ADHD) psychoeducation, we need to know what is commonly included in it. This scoping review aims to describe the content of psychoeducation interventions for ADHD in published research. A literature search was conducted to identify relevant papers. Descriptions of psychoeducation aimed at children, parents/carers, adults and teachers were identified and compared narratively.
Results
After screening, 57 papers were identified for data extraction and coding. Content themes included ‘information about ADHD’; ‘practical advice’; ‘impact of ADHD’; ‘treatment of ADHD’; ‘co-occurrence’; and ‘self-image/self-esteem’. ‘Information about ADHD’ and ‘practical advice’ were the most common themes, with variance on inclusion of other themes. Most of the identified research involved psychoeducation for parents of children with ADHD.
Clinical implications
This review provides greater understanding of the content and delivery of ADHD psychoeducation. Further research could use this understanding to ascertain the efficacy of different content themes in supporting those with ADHD.
Bipolar disorders are a major cause of disability worldwide, with most of the disease burden attributed to those in low- and middle-income countries, including Nigeria. There is limited evidence on culturally appropriate interventions for bipolar disorders in Nigeria.
Aims
The study aims to examine the feasibility, and acceptability of culturally adapted psychoeducation (CaPE) for treating bipolar disorders.
Method
A randomised controlled trial (RCT) compared CaPE plus treatment as usual (TAU) with TAU alone among 34 persons with bipolar disorders in Jos, Nigeria. CaPE comprised 12 group sessions of in-person psychoeducation lasting approximately 90 min each, delivered on a weekly basis by clinical researchers supervised by clinical psychologists and consultant psychiatrists. The primary outcome was feasibility, measured by participants’ recruitment and retention rates. Other outcomes included acceptability as measured by the Service Satisfaction Scale (SSS), Brief Bipolar Disorder Symptom Scale (BBDSS), Patient Health Questionnaire (PHQ-9) and Quality-of-Life scale (EQ5D). Outcomes were assessed at baseline and weeks 12 and 24. Focus group (n = 10) and individual interviews (n = 5) were conducted with the CaPE + TAU group, recorded, transcribed verbatim and analysed using interpretative phenomenological analysis.
Results
The CaPE+TAU group (n = 17) recorded a high participant recruitment and retention rate of 86% across 12 sessions, and also recorded a higher level of satisfaction with SSS compared with the TAU alone group; 87.5% indicated very satisfied compared with 66.7% indicated not sure in the TAU group. In terms of clinical outcomes, for PHQ-9 scores the intervention group showed a reduction from baseline to end of intervention (EOI) and follow-up, with differences of −12.01 and −7.39, respectively (both P < 0.001). The EQ5D index showed a notable improvement in the intervention group at both EOI and follow-up (P < 0.001). Lastly, BBDS scores decreased significantly in the CaPE+TAU group at both EOI and follow-up, with differences of −21.45 and −15.76 (both P < 0.001).
Conclusions
The RCT of CaPE is a feasible, acceptable and culturally appropriate treatment option for bipolar disorders in Nigeria. Further adequately powered RCTs evaluating the intervention’s clinical and cost-effectiveness are warranted.
High rates of trauma exposure among patients with severe mental illness (SMI) in Botswana highlight the need for appropriate interventions. Culturally adapted interventions have been reported to be more acceptable, effective and feasible. This study aimed to culturally adapt the Brief Relaxation, Education and Trauma Healing (BREATHE), a brief psychological intervention to treat post-traumatic stress disorder (PTSD) among people with SMI in Botswana. The cultural adaptation process followed the steps outlined by previous research. They included a community assessment to identify needs, selecting an appropriate intervention and consultations with experts and stakeholders. Individual interviews and focus groups were conducted with patients living with SMI and mental health professionals, respectively, to inform domains of the intervention to be adapted. BREATHE was adapted to be culturally congruent to Botswana by following the ecological validity model framework and using data from the interviews. Examples of the adaptation include language that was translated to Setswana, and spoken English and the content that was revised to reflect the traumatic experiences and demographics of the Botswana population. The study underscores the utility of using evidence-based frameworks to culturally adapt interventions. The adaptation process resulted in a culturally relevant BREATHE for patients with comorbid PTSD and SMI in Botswana.
Clinical practice guidelines identify several efficacious treatments for posttraumatic stress disorder, including prolonged exposure therapy, cognitive processing therapy, and trauma-focused cognitive-behavioral therapy. Credible components of treatment include psychoeducation, homework, exposure therapy, and cognitive techniques. A sidebar discusses how different categories of traumatic events can influence treatment choices. Another sidebar reviews the controversy over eye movement desensitization and reprocessing.
The most efficacious treatments for bipolar disorder include cognitive-behavioral therapy, family-focused therapy, and systemic care. Credible components of treatment include psychoeducation, cognitive restructuring, social support, and relapse prevention. The chapter also include a sidebar on research therapists and another on overcoming challenges to learning and implementing therapy.
ADHD is a highly prevalent, genetic, brain-based disorder associated with important impairments in academics, socio-emotional, family, and physical aspects of a person´s life. It has been described many years ago, generally starts in childhood, and in 50% of cases persists into adulthood. It has a well-documented safe and effective treatment that includes a multimodal combination on psychoeducation, parent training in behavioral management, academic support, and medication (stimulants or nonstimulants). Early and sustained treatment reduces symptoms, impairment, and negative consequences of complicated ADHD, such as poor academic outcomes, depression and other psychiatric complications, and accidents/injuries.
Family members of people experiencing a first-episode psychosis (FEP) can experience high levels of carer burden, stigma, emotional challenges, and uncertainty. This indicates the need for support and psychoeducation. To address these needs during the COVID-19 pandemic, we developed a multidisciplinary, blended, telehealth intervention, incorporating psychoeducation and peer support, for family members of FEP service users: PERCEPTION (PsychoEducation for Relatives of people Currently Experiencing Psychosis using Telehealth, an In-person meeting, and ONline peer support). The aim of the study was to explore the acceptability of PERCEPTION for family members of people who have experienced an FEP.
Methods:
Ten semi-structured interviews were conducted online via Zoom and audio recorded. Maximum variation sampling was used to recruit a sample balanced across age, gender, relatives’ prior mental health service use experience, and participants’ relationship with the family member experiencing psychosis. Data were analysed by hand using reflexive thematic analysis.
Results:
Four themes were produced: ‘Developing confidence in understanding and responding to psychosis’; ‘Navigating the small challenges of a broadly acceptable and desirable intervention’; ‘Timely support enriches the intervention’s meaning’; and ‘Dealing with the realities of carer burden’.
Conclusions:
Broadly speaking, PERCEPTION was experienced as acceptable, with the convenient, safe, and supportive environment, and challenges in engagement being highlighted by participants. Data point to a gap in service provision for long-term self-care support for relatives to reduce carer burden. Providing both in-person and online interventions, depending on individuals’ preference and needs, may help remove barriers for family members accessing help.
Psychoeducational interventions are a critical aspect of supporting adults with attention-deficit hyperactivity disorder (ADHD). The Understanding and Managing Adult ADHD Programme (UMAAP) is a six-session, group-based webinar intervention that incorporates psychoeducation with acceptance and commitment therapy. UMAAP relies on self-referrals and is facilitated by a charity, to promote accessibility.
Aims
The present study aimed to evaluate the feasibility of UMAAP and explore preliminary effectiveness.
Method
Adults with formally diagnosed or self-identified ADHD (n = 257) participated in an uncontrolled pre–post design. Feasibility was indicated by attendance, confidence in completing the home practice and satisfaction. Quality of life, psychological flexibility, self-acceptance and knowledge of ADHD were assessed at baseline, 1 week post-intervention and 3 months later, to explore preliminary effectiveness.
Results
Feasibility was demonstrated by the high attendance ratings and satisfaction with the intervention, although there was only moderate confidence in the ability to complete the home practices. Quality of life (mean increase 9.69, 95% CI 7.57–11.80), self-acceptance (mean increase 0.19, 95% CI 0.10–0.28) and knowledge of ADHD (mean increase 1.55, 95% CI 1.23–1.82) were significantly improved post-intervention. The effects were maintained at the 3-month follow-up. Psychological flexibility did not significantly change immediately post-intervention, but increased significantly at the 3-month follow-up (mean increase 0.42, 95% CI 0.26–0.58).
Conclusions
Overall, UMAAP is a feasible intervention for adults with ADHD. Findings highlighted the feasibility of delivering psychological interventions online in group settings, to increase access to support for adults with ADHD.
Edited by
David Kingdon, University of Southampton,Paul Rowlands, Derbyshire Healthcare NHS foundation Trust,George Stein, Emeritus of the Princess Royal University Hospital
This chapter gives an overview and update on functional neurological disorder (FND), also known as dissociative neurological symptom disorder and previously known as conversion disorder. FND is the presence of neurological symptoms that are not explained or explainable by a neurological disorder. FND has been assumed to be a purely stress-related psychiatric disorder, but over the recent decades, this simplistic conception has been supplanted by more nuanced models of symptom generation. FND is no longer a diagnosis of exclusion. Instead, wherever possible, it is ruled-in by distinct features of history and examination, the latter known as positive clinical signs. There have been concurrent advances in the biological understanding of FND, exemplified by functional neuroimaging studies that have indicated that FND can be distinguished from, for example, feigned symptoms mimicking the disorder. FND encompasses multiple subtypes, from seizures to motor disorders to sensory abnormalities. Symptoms often co-occur, sometimes in a striking fashion.
Current treatment options for FND are limited, and many patients have severe long-term symptoms despite best-available treatment including psychological therapies and medication. Nevertheless, there are simple, and sometimes effective, steps that clinicians can take to manage and treat patients.
Once a defendant is deemed incompetent to stand trial (IST), the evaluator must indicate whether restoration can occur within the foreseeable future. This restoration must occur in a “reasonable” – but undefined – period. If restorable and the defendant is in the community, an outpatient restoration program might be utilized but only if the defendant does not constitute a physical threat to the community. If the defendant is incarcerated, the restoration process will likely occur in a secure hospital setting or a jail setting. Unfortunately, not every jurisdiction has an outpatient restoration program or a jail restoration program. The nature of the crime often creates what I call a “justice” bias toward competency or the restoration process. The more heinous the crime the more likely the defendant is to be competent or IST but restorable.
Psychological treatments for eating disorders (EDs) and obsessive-compulsive disorder (OCD) have been shown to be effective in many studies. The specific mechanisms of change in treatments for EDs are not entirely clear, but it is suggested that psychoeducation, collaboration, exposure-based interventions, cognitive therapy, interpersonal effectiveness, and value-based interventions may be active treatment ingredients. Psychoeducation and collaboration between patient and therapist are essential to provide information about the disorder and its causes, challenge negative appraisals and self-criticism, and foster a collaborative environment. Exposure and behavioral experiments are often used in the treatment of both disorders. The goals of exposure include reducing anxiety by repeated contact with a feared stimulus and eliminating avoidance, safety, or escape behaviors, as well as increasing distress tolerance and extinction learning. Cognitive therapy, interpersonal effectiveness, and value-based interventions in ED treatment aim to increase self-efficacy and self-esteem through decreasing interpersonal problems and shifting values that are based on appearance.
Some components of commonly used, empirically supported eating disorder treatments (CBT-E and FBT) may not be suitable for patients who also have OCD. These include aspects of parental control in FBT, collaborative weighing, self-monitoring and eating schedules/meal plans, and psychoeducation about food and weight. Achieving weight gain is particularly difficult in anorexia nervosa due to fear and preoccupation with weight, eating and “becoming fat.” Low body weight and malnourishment tends to increase anxiety and obsessionality, so weight gain early on is paramount, especially for individuals with this co-occurring presentation. Through clinical observations, patients have reported that FBT may aggravate OCD symptoms, such as preoccupation with numbers and exactness, and expanding obsessionality to concerns about exercise/movement and other topics within the morality domain of OCD. The lack of control and greater uncertainty that an adolescent experiences while completing FBT may be related to increased OCD symptomatology and poor treatment outcomes.
Psychoeducation is a common element in psychological interventions for youth depression and anxiety, but evidence about its use with youth perinatally is limited.
Aims
This review aims to understand outcomes and mechanisms of psychoeducation for the indicated prevention and treatment of perinatal depression and anxiety in youth.
Method
For this review, we synthesised published quantitative and qualitative evidence. Seven databases (ASSIA, Medline, PubMed, PsycINFO, PsycArticles, Scopus and Web of Science) were searched for studies published before 10 August 2021. We also had consultations with a youth advisory group (N = 12).
Results
In total, 20 studies met the inclusion criteria. Seven quantitative studies examined multicomponent interventions that included psychoeducation, and one study evaluated psychoeducation as a standalone intervention for postnatal depression. Multicomponent interventions showed significant effects on postnatal depression in two out of six studies, as well as being effective at reducing prenatal anxiety in one study. Standalone psychoeducation for postnatal depression was also effective in one study. Evidence from 12 qualitative studies, corroborated by commentaries from the youth advisory group, suggested that psychoeducation could increase knowledge about symptoms, generate awareness of relevant services and enhance coping.
Conclusions
Psychoeducation may be an important foundational ingredient of interventions for perinatal depression and, potentially, anxiety in adolescents and young adults through stimulating help-seeking and self-care.
Despite the importance of assessing the quality with which low-intensity (LI) group psychoeducational interventions are delivered, no measure of treatment integrity (TI) has been developed.
Aims:
To develop a psychometrically robust TI measure for LI psychoeducational group interventions.
Method:
This study had two phases. Firstly, the group psychoeducation treatment integrity measure-expert rater (GPTIM-ER) and a detailed scoring manual were developed. This was piloted by n=5 expert raters rating the same LI group session; n=6 expert raters then assessed content validity. Secondly, 10 group psychoeducational sessions drawn from routine practice were then rated by n=8 expert raters using the GPTIM-ER; n=9 patients also rated the quality of the group sessions using a sister version (i.e. GPTIM-P) and clinical and service outcome data were drawn from the LI groups assessed.
Results:
The GPTIM-ER had excellent internal reliability, good test–retest reliability, but poor inter-rater reliability. The GPTIM-ER had excellent content validity, construct validity, formed a single factor scale and had reasonable predictive validity.
Conclusions:
The GPTIM-ER has promising, but not complete, psychometric properties. The low inter-rater reliability scores between expert raters are the main ongoing concern and so further development and testing is required in future well-constructed studies.
This study confirms the effectiveness of pretreatment video-based psychoeducation on stress management and relaxation in reducing depression, anxiety, and uncertainty among patients with breast cancer.
Methods
We conducted a nonrandomized trial with 86 pretreatment patients with breast cancer who were divided equally into intervention and control groups, and stratified according to cancer stages and patient ages. Omitting the excluded participants, 35 intervention group and 36 control group participants were asked to complete the Hospital Anxiety and Depression Scale and Universal Uncertainty in Illness Scale (UUIS) before the psychoeducational intervention (baseline, hereafter “BL “) as well as 1 and 3 months later. Then, a 2 group (intervention and control groups) × 3 time points (BL and 1 and 3 months post-intervention) mixed models repeated measures (MMRM) analysis was implemented.
Results
Analysis confirmed interaction between 2 group × 3 time points for depression, anxiety, and UUIS. Multiple comparisons revealed that each score in the intervention group was significantly lower 1 and 3 months post-intervention compared to BL. Meanwhile, in the control group, the depression score was significantly higher at 3 months post-intervention compared to pre-intervention. The anxiety scores and UUIS of the same group were not significantly different between 1 and 3 months post-intervention. The effect size values 3 months post-intervention were −0.57 for depression, −0.25 for anxiety, and 0.05 for uncertainty.
Significance of results
Pretreatment psychoeducation reduced depression, anxiety, and uncertainty in the intervention group of patients with breast cancer compared to the control group. The effect sizes at 3 months post-intervention were moderate for depression and small for anxiety. These results suggest the effectiveness of psychoeducation for patients with breast cancer, using videos on stress management and relaxation, early at the pretreatment stage.
Antisocial personality disorder (ASPD) and violence result from a loss of mentalizing. Mentalization-based treatment for antisocial personality disorder (MBT-ASPD) is delivered primarily as a group intervention. Individuals with ASPD are more likely to learn from those whom they consider to be similar to themselves, so the task of the MBT clinician is to generate constructive group interactions during which learning can take place. Common mentalizing profiles of people with ASPD are outlined and examples of the formulation that can be used are given. The chapter discusses how to engage patients in treatment using the formulation, and it provides examples of how to prevent dropout by creating an atmosphere of equality within the group. A range of clinical problems that are commonly encountered when running groups for people with ASPD are outlined, and suggestions on how to intervene in these scenarios are given.