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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.
The case of a patient who is receiving mentalization-based treatment (MBT) is described. All of the stages and interventions of MBT, including interventions for suicidality and violence, are illustrated across the patient’s treatment trajectory. The formulation agreed with the patient is the focus for treatment. Clinical examples are presented to illustrate how to implement the phases of MBT using the formulation. The chapter discusses working with the not-knowing stance, the mentalizing process, non-mentalizing modes, affective narratives, and relational mentalizing. Supervision for the clinician is an essential part of MBT, and this is elaborated particularly in relation to its role in supporting the clinician to manage problematic counter-relational responses to the patient.
Hoarding disorder is a surprisingly common problem which impacts on most areas of life. People who hoard typically have multiple agencies involved in their care due to the complex health and safety impact and risks associated with hoarding. ‘Treatment’ involves finding ways of supporting discarding large amounts, typically underpinned by CBT principles. We evaluated the impact and outcomes of a conference designed to boost professionals’ confidence and understanding in working with hoarding problems, both individually and with other agencies with a view to improving inter-agency service provision. Changes in professionals’ confidence and understanding were evaluated immediately before and after the conference. Conference participants’ qualitative responses related to service improvements were analysed using content analysis. People with personal experience of hoarding issues subsequently participated in a focus group where the results of the conference were presented. These data were analysed using thematic analysis. Confidence and understanding in working with hoarding problems substantially increased from pre- to post-conference. Professionals identified a range of possible improvements, most commonly working more closely and improving communication with other agencies. People with personal experience suggested improvements across three over-arching themes: developing an improved understanding of hoarding, the need for improved resources, and improved multi-agency working. A multi-agency conference increased confidence and understanding in professionals working with hoarding problems, and improvements specified by both people with personal experience and professionals provide a useful guide to service improvement. Results provide a framework in which CBT approaches should be embedded.
Key learning aims
(1) To assess the effectiveness of a multi-agency hoarding conference at improving understanding and confidence in working with hoarding problems.
(2) To explore professionals’ perceptions of improvements to multi-agency service provision.
(3) To explore perceptions of improvements that could be made to multi-agency service provision from people with personal experience of hoarding problems.
The recipient interview is primarily psycho-educational in nature. The fertility counselor strives to understand the recipients’ family building goals and help them frame their unique “family story.” Preparation for disclosure to the potential child has become increasingly important, due to the technological and genetic impact on donor anonymity and growing openness. Societal changes have brought about expansion in the types of recipients seeking treatment, as well as greater diversity in the cultural background of both donors and recipients. The recent worldwide pandemic has also caused an increase in virtual counseling.Fertility counselors need to be open and flexible while integrating these changes into our work with recipients. Fertility counselors are essential not only at the outset of the recipient journey, but are increasingly seen as a valuable lifelong resource to be consulted at different stages in the experience of being a donor-conceived family.
Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes regarding bipolar disorder, and improvement in mood symptom scores and health-related quality of life measures compared with treatment as usual (TAU).
Aims
The current protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan. Trial registration: NCT05223959.
Method
A multicentre individual, parallel-arm RCT of CaPE in 300 Pakistani adults with bipolar disorder. Participants over the age of 18, with a diagnosis of bipolar I or II disorder who are currently euthymic, will be recruited from seven sites: Karachi, Lahore, Multan, Rawalpindi, Peshawar, Hyderabad and Quetta. Time to recurrence will be the primary outcome assessed using the Longitudinal Interval Follow-up Evaluation (LIFE). Secondary measures will include mood symptoms, quality of life and functioning, adherence to psychotropic medications, and knowledge and attitudes regarding bipolar disorder.
Results
This trial will assess the effectiveness of the CaPE intervention compared with TAU in reducing the time to recurrence for people with bipolar disorder currently in remission in Pakistan and determine the effect on clinical outcomes, quality of life and functioning.
Conclusions
A successful trial might lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings, including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority group patients with bipolar disorder.
The Covid-19 pandemic profoundly affected delivery and accessibility of mental health care services at a time when most needed. The OPTIMA Mood Disorder Service, a specialist bipolar disorder service, adapted group psychoeducation programme for delivery on-line.
Objectives
We report the feasibility of creating a digital psychoeducation programme.
Methods
The OPTIMA ten session group psychoeducation programme was converted into a ‘Digital’ intervention using video-conferencing. Sessions offered a range of key topics, derived from the initial Barcelona Group Psychoeducation Programme. At the time of writing, OPTIMA had fully completed two 10 session digital courses.
Results
A total of 12 people (6 in each group) consented to be part of a service evaluation of the digital groups. Just over half of the participants were women (7/12; 58.3%) and one identified as being non-binary (8.3); remaining participants were men. Age of participants ranged from 25 years to 65 years (Mean=42.3; SD=13.1). Data showed a high level of engagement (77%) All participants reported some improvement with a mean Bipolar Self-Efficacy scale (BPSES) post-group score of 105.6 (SD=14.8). At group level, this change was not statistically significant (F (1, 15) = 0.71, p=0.41). At an individual level, two out of five showed a reliable change index >1.96.
Conclusions
Delivering a ‘digital’ group psychoeducation programme was possible due to careful planning and programme development. There was good uptake from service users suggesting it is a feasible approach with preliminary evidence of clinical benefit.
The family of a child with a mental illness is a significant source for his support in harmonizing his development and achieving successful socialization.
Objectives
The objective of the survey is to develop a psychoeducational program for parents.
Methods
Questionnaire “Parental attitude to children’s illnesses” (V.E. Kagan, I.P. Zhuravleva) Parents of 39 (22 mothers and 17 fathers) children aged from 3 to 6 with ASD - autism spectrum disorders (F84.01; F84.02; F84.11).
Results
Parents of children with ASD often do not realize the morbid nature of changes in the children`s behavior and interpret them as spontaneity, pamperedness or even giftedness. Most parents underestimated the doctor’s recommendations for compliance with the treatment regime. Taking into account the parents` complaints and the difficulties of understanding the child`s problems, a psychoeducational course was developed, including 7 sessions: 1. acquaintance; 2. the concept of ASD, etiological factors, features of manifestation; 3. the role of the family in the treatment and rehabilitation process; 4. development of mental functions in children with ASD; 5. emotional development of children with ASD; formation of communication skills and social adaptation; 6. training organization and correctional and developmental classes for children with ASD; 7. summing up. The psychoeducational course is carried out in the form of group thematic seminars 7 meetings once a week for 1.5-2 hours. After completing the course, some families remain on individual psychological follow-up.
Conclusions
Completing a psychoeducational course makes it possible to fill the lack of information regarding the disease and treatment tactics, increases compliance and harmonizes parent-child relationships.
The number of children with developmental language delay is growing. But the isolated use of speech therapy doesn’t always help to improve the long-term prognosis. It was found that developmental language delay is almost never the only violation of a child.
Objectives
To develop the prevention program of emotional and behavioral disorders in children with developmental language delay.
Methods
100 children with developmental language delay (70 boys; Mage= 26.9 months, SD = 5.5) and 50 children with typical language development were studied by clinical follow-up method. The clinical method was supplemented by the Bayley Scale, the Language Development Survey and the Child Behavior Checklist 1½ -5.
Results
A comprehensive children examination revealed developmental language delay risk factors, the psychomotor profile of the children, and the types of emotional and behavioral impairments, which were determined by us as: emotionally labile, emotionally detached and oppositional. The presence of subclinical disorders symptoms in children makes it necessary to carry out preventive measures. The primary prevention consists of pregnancy planning, effective care in pregnancy and childbirth. The secondary prevention aims to early diagnosis of developmental language delay, risk factors assessment of emotional and behavioral disorders and effective methods application of language and psychomotor development correction. Tertiary prevention have to individualized solves the children problems in accordance with revealed types of emotional and behavioral impairments. But the most important part is psychoeducation (special courses for parents and children with developmental language delay).
Conclusions
The prevention program was developed to prevent numerous psychiatric problems in childhood and adolescence.