Psychoeducation
- 1. Psychoeducation Presenter: Ashfaq Ahmad M.Phil Psychiatric Social Work Department of Psychiatry Government Medical College and Hospital Chandigarh
- 2. Contents Introduction Historical background Definition Elements of psychoeducation Goals of psychoeducation Models of psychoeducation Benefits of psychoeducation Types of psychoeducation Outcomes
- 3. Introduction Anderson et al. used the term for the first time in 1980 for the family treatment of patients with schizophrenia. Psychoeducation is an important component of any psychotherapy program. Psychoeducation, as the name suggests, is education about a certain situation or condition that causes psychological stress. This is not necessarily psychotherapy as it does not exclusively deal with psychological or mental illness but rather any condition you are experiencing.
- 4. Cont… Frequently psychoeducational training involves individuals with schizophrenia clinical depression, anxiety disorders psychotic illnesses, eating disorders and personality disorders as well as patient training courses in context of the treatment of the physical illnesses. Psychoeducation has its roots in the “Mental Hygiene Movement” of the early 20th century and “Deinstitutionalization Movement” of the 1950s and 1960s. Subsequently, studies on the role of “Expressed Emotions” in schizophrenia provided further impetus to the growth of psychoeducation. The basic aim is to provide the patient and families knowledge about various facets of the illness and its treatment so that they can work together with mental health professionals for a better overall outcome.
- 5. Definitions Psychoeducation has been defined as “the education of a person with a psychiatric disorder in subject areas that serve the goals of treatment and rehabilitation ( according to the American psychiatric association APA) Barker, in the Social Work Dictionary, defined psychoeducation as the “process of teaching clients with mental illness and their family members about the nature of the illness, including its etiology, progression, consequences, prognosis, treatment, and alternatives.” Psychoeducation includes cognitive behavioral and supportive therapeutic elements. Psychoeducation is usually implemented by psychologist or anybody who is an expert in the specific condition the individual is experiencing and who has experience in psychotherapies such as nurses psychiatric social workers occupational therapists ,
- 6. Elements of psychoeducation Briefing the patients about their illness Problem-solving training Communication training Self-assertiveness training
- 7. Essential components of psychoeducation sessions Etiological factors Common signs and symptoms Awareness regarding the early signs of relapse/recurrence How to cope with the situation Various treatment options available When and how to seek treatment Need for adherence to treatment as per the guidance of treating team Long-term course and outcome Dos and don’ts for family members while dealing with the patient Clearing myths and misconceptions about the illness and dispelling stigma
- 8. Goals of psychoeducation Improving insight into illness and improvement of compliance Promoting relapse prevention Engage in crises management and suicide prevention Supporting heathy components Enhancing informational and educational activities
- 9. Cont… Enhance family coping skills Improve communication skills and problem solving skills Deepening the patients role as an expert Co therapists _ strengthen the role of relatives Optimal combination of professional therapeutic methods and empowerment
- 10. Effective psychoeducation Education is interactive Use of multiple teaching aids Connote consumer as an “expert” Elicit relatives experience and understanding Avoid conflict and confrontation Education is long term process Evaluating understanding Review material as often as possible
- 11. Models of psychoeducation Information model The focus is on providing families knowledge about psychiatric illness and their management. Skill training model The skill training model focusses on developing certain skills so that the family members can manage the illness more effectively. Supportive model The supportive model mainly involves taking help of support groups for engaging the family members of the patients in sharing their feelings. Comprehensive model The comprehensive model uses a combination of the previous three models
- 12. Cont… The Multiple Family Group Therapy Model (The MGFT Model) by William McFarlane: This model seeks to assist the patient and family in accommodating the disease while developing social support systems for the reduction of confusing, anxiety, and exhaustion in the patient’s family, while they learn adaptive strategies. The Behavioural Family Management Model: This model of family intervention gives maximum importance to family and views family as the most effective and efficient resource for community rehabilitation of severely ill mental patients. As per this model healthy functioning of the mentally ill individual can be achieved through instilling positive coping mechanism in family.
- 13. Cont… Family Focused Treatment (FFT): This approach of psychoeducation is primarily developed for the treatment of bipolar patients. This approach also aims to instill problem- solving and coping skills of the caregivers of these patients This model has three modules: In first we told about the symptoms, nature, causes, and treatment of bipolar disorder. The second module (seven to 10 sessions), aims to help patients and caregivers to learn communication skills for dealing with interfamilial stress In the third module (four to five sessions), participants are given a framework for defining problems and how to develop as well as implement effective solutions to those problems.
- 14. Various types of psychoeducation According to the target population, psychoeducation can be individual, family, group, or community based. According to the predominant focus of psychoeducation, it can be compliance/adherence focused, illness focused, treatment focused, and rehabilitation focused Active psychoeducation involves the active involvement of the therapist with the patient/family during the process, leading to interaction and clarification In passive psychoeducation, materials are provided to patients/family members in the form of pamphlets, audio/video material that they are supposed to read and assimilate on their own
- 15. Group psychoeducation This usually comprises patients having similar kinds of illness. Thus, groups may consist of patients with bipolar disorder, schizophrenia, substance abuse, etc. Groups usually have 4–12 members, with the optimum number being 8. The number of sessions usually varies from 5 to 24, with the optimum number of sessions being determined by research and practice The sessions usually last 40–60 min and are mostly held at weekly intervals People feel that they have the support of of the group as the feeling that they are not alone which decreases the amount of stress in the situation Majority of common questions will be dealt with predominantly through discussion
- 16. Cont… In group situation experiences are shared with each other. This way everyone gains a perspective of how other people deal with their situations which adds to overall learning experience. Group psychoeducation can also be implemented in schools as preventative measure Some of the issues discussed in classroom or small group sessions are . Teen age pregnancy , eating disorder, body image and healthy eating. Anger management and bulling
- 17. Individual psychoeducation Individual psychoeducation can be more specific and focused and can cover information and content that is more relevant for an individual situation. In group situation tends to make patient or family feel anxious and threatened then individual psychotherapy with safety and confidentiality of a one on one interaction with a therapist pr doctor mat be more suitable.
- 18. Family psychoeducation Family psychoeducation can be carried in the setting of single families or in a group with more than one family having similar kinds of illness in their patients (multifamily groups). Education about the condition is relevant not only to the individual with the problem, but also the people who share their life. Therefore psychoeducation programs for the whole family are commonly used; this can reduce stress at home and encourage better relationships at between the family members. Psychoeducation can be implemented for number of families at same time.
- 19. Cont… It is also helpful to make them aware of early signs of relapse so that they can identify and seek help accordingly. The number and frequency of sessions are variable, though the average number is between 6 and 12 sessions held at weekly intervals. Follow-up sessions may be conducted at monthly intervals following the discharge of the patient.
- 20. Psychoeducation for friends and care takers For many people with mental illness, especially adults ,there is no family around to support them. Therefore psychoeducation programs for friends and caretakers have also been developed. Social psychoeducation The influence of social stigma as well as social support and the importance of recording the social support you have, this is called social psychoeducation. When people have there support of the community they are more likely to manage the distress associated with their condition more effectively.
- 21. Psychoeducation in various psychiatric disorders Psychoeducation for schizophrenia Initial discussions should start by encouraging the patients to come out with their understanding of the disorder. The basic message should be that schizophrenia is caused by biological factors in combination with psychological stress. Hence, both medications and psychosocial interventions are essential for management.
- 22. Cont… Meaning of the term “Schizophrenia” Positive and negative symptoms Neurobiological origin of symptoms Stress‐vulnerability‐coping model Various medicines and their side effects Psychosocial measures Psychotherapeutic interventions and suicide prevention Early warning signs and relapse prevention Long‐term course and outcome, including remission and recovery.
- 23. Psychoeducation for bipolar disorder If the patient does not gain insight into his condition, he would be unlikely to take interest in the subsequent sessions of psychoeducation. Emphasizing the medical model of the illness helps in reducing stigma related to the illness. The issues addressed cover the following areas: 1. Introduction 2. What is Bipolar Disorder 3.Etiologies and triggering factors 4.Symptoms of mania and hypomania 5. Symptoms of depression and mixed episode 6. Course and outcome of bipolar disorder.
- 24. Cont… The areas that need to be covered while targeting better treatment adherence are as follows: Mood stabilizers Antimanic agents Antidepressants Serum levels of lithium, carbamazepine, and valproate Pregnancy and genetic counseling Psychopharmacology versus alternative therapies Risks associated with treatment withdrawal.
- 25. Psychoeducation for anxiety and depressive disorders After the diagnosis of anxiety and depressive disorder and performing necessary assessments, the mental health professionals should provide detailed information to the patient regarding the symptoms, causes, various treatment options, side effects of medications, need for adherence, and overall course and outcome of the disorder. Apart from medications, the role of nonpharmacological measures such as activity scheduling and regular physical exercise is emphasized Passive psychoeducation is very popular in patients with anxiety disorders.
- 26. Psychoeducation for substance use disorder Group psychoeducation is one of the cornerstones of psychosocial management of patients with substance use disorder. Psychoeducation for substance abuse must highlight certain points Medical complications Family issues Social and professional aspects Treatment process and recovery Craving and relapse Utilizing free time Adaptation to a new life
- 27. Psychoeducation for dual diagnosis Dual diagnosis refers to patients having a psychiatric disorder along with comorbid substance abuse or dependence. The dominant models of care for these groups of patients include parallel and sequential models. In the sequential model, the primary condition is treated first followed by the comorbid condition.
- 28. Psychoeducation programs for dual diagnosis patients must highlight Stages of motivation and how to overcome the barriers to change Various aspects of substance misuse and its effects on mood and behavior How substance abuse adversely affects mental health and negatively alters the course and outcome of mental disorders Techniques of relapse prevention and skills training Ways to cope with emotional problems and symptoms of mental illness Skills training and lifestyle change
- 29. Outcomes of psychoeducation Information transfer (symptomology of disturbance, cause treatment, concepts etc.) Emotional discharge (understanding to promote, exchange of experiences with others concerning, contacts) Support of medication or psychotherapeutic treatment as cooperation is promoted between the mental health professional and patient (compliance and adherence) Assistance to self help (e.g. training as crisis management situation are promptly recognised and what steps should be taken to be able to help the patient)
- 30. References Sarkhel S, Singh OP, Arora M. Clinical practice guidelines for psychoeducation in psychiatric disorders general principles of psychoeducation. Indian J Psychiatry 2020;62:S319-23. Bhattacharjee D, Rai R K, Singh NK, Kumar P, Munda S K, Das B. Psychoeducation: A Measure to Strengthen Psychiatric Treatment. Del psy journal 2011;14(1)33-39 Bäuml J, Froböse T, Kraemer S, Rentrop M, Pitschel‐Walz G. Psychoeducation: A basic psychotherapeutic intervention for patients with schizophrenia and their families. Schizophr Bull 2006;32 Suppl 1:S1-9.