Family Members In Treatment Research Articles

The 5-Step family intervention in primary care: II. The views of primary healthcare professionals

Background: This is the second of two papers using qualitative methods from a study of an intervention for family members affected by close relatives’ substance misuse problems.Participants: 168 primary healthcare professionals (PHCPs: GPs, practice nurses and health visitors) working in general practices in two areas of England, and who took part in the study.Data sources: Recruitment and post-session forms completed by PHCPs; telephone interviews with each PHCP 12 weeks after recruitment of a family member; interviews with PHCPs at the end of the study.Results: At the end of the project PHCPs were overwhelmingly positive about the family member intervention and about primary care as the appropriate site. Difficulties were encountered, however, in identifying and engaging affected family members, who were often excluded on grounds of the complexity of their problems or the level of their distress. Shortage of PHCP time and other practice-related factors added to the difficulty. Active work by a PHCP was often necessary in order to make the link between presenting symptoms of physical or mental ill-health and the existence of a family substance misuse problem. When family members were identified and recruited, PHCPs were usually positive about what was achieved. Nearly all were in favour of an approach that combined giving a self-help manual with some follow-up contact with a family member as needed.Conclusions: Taken in conjunction with statistical outcome findings of significant reductions in symptoms and changes in ways of coping, plus qualitative analysis of the views of family members, the present results encourage the view that a flexible form of this intervention should be developed for use in primary healthcare, and that further work should build on existing strengths and attempt to overcome weaknesses identified.

A Survey of Neurologists on Self‐treatment and Treatment of Their Families

Although neurologists commonly self-treat for migraine and other conditions, little is known about the patterns of self-treatment by physicians in the United States. The aim was to obtain information about neurologist's self-treatment and treatment of family members and their attitudes about self-treatment by other physicians. A survey was performed among neurologists attending the Texas Neurological Society's Winter Conference using a questionnaire about self-treatment and treatment of family members during the prior 12 months and attitudes about self-treatment by other physicians. Among 186 physicians invited to participate, the response rate was 48%. Although 76% reported having primary care physicians, neurologists reported the following behaviors: 38% self-diagnosed or self-treated medical conditions including migraine in 25%; 56% started themselves on prescription medications including 21% who used triptans and 15% who used migraine preventive medications; 33% ordered blood tests on themselves; and 20% ordered imaging studies on themselves. Sixty percent reported missing no work due to illness, 87% missed 2 days or less, and 99% reported missing 1 week or less. Eighty percent reported treating their family members for acute minor illnesses and 33% for chronic conditions. The following percentage of participants reported that they would be likely to self-diagnose and self-treat the following hypothetical illnesses: 70%, migraines which were not severe; 19%, new onset frequent headaches; and 48%, chronic daily headaches. The following percentage of participants agreed or strongly agreed that the following behaviors were acceptable for physicians: 94%, self-treat acute minor illnesses; 37%, self-treat chronic conditions; 42%, order blood test for diagnostic purposes; 40%, order imaging studies for diagnostic purposes; 87%, treat family members for acute minor conditions; and 36%, treat family members for chronic conditions. Neurologists commonly treat themselves and family members.

Cultural Beliefs Can Be Harnessed To Aid Outcome

Back to table of contents Previous article Next article Clinical & Research NewsFull AccessCultural Beliefs Can Be Harnessed To Aid OutcomeJoan Arehart-TreichelJoan Arehart-TreichelSearch for more papers by this authorPublished Online:7 Jul 2006https://doi.org/10.1176/pn.41.13.0019b Not long ago, David Henderson, M.D., an associate professor of psychiatry at Harvard University, treated a Japanese student from the Massachusetts Institute of Technology (MIT) for depression.Shamsah Sonawalla M.D., chaired the symposium on ethnic and cultural aspects of mood and anxiety disorders.Joan Arehart-TreichelYet after he gave the student a prescription for an antidepressant, the student did not return for a follow-up visit. Concerned about the student, Henderson contacted the dean at MIT. The reason the student failed to come for the follow-up, it turned out, was that he had decided that he was not very depressed because he had been given only one prescription, not multiple ones, which would have been the case in Japan.In other words, no matter how much psychiatrists know about cultural differences among patients, there is still more to learn, Henderson indicated in a symposium at APA's 2006 annual meeting in Toronto in May.“It makes our lives as clinicians challenging, that's for sure,” symposium discussant Gregory Fricchione, M.D., declared. Fricchione is director of the Division of International Psychiatry at Massachusetts General Hospital.To speed psychiatrists on their journey of learning more about cultural differences among patients, speakers presented some valuable insights gleaned either from their personal experiences or from studies that they had conducted. For example:Keeping appointments. Patients from a Hispanic background may arrive early or late for appointments because Hispanics sometimes have a different conception of time than many non-Hispanic Americans do, David Mischoulon, M.D., Ph.D., reported. Mischoulon, an assistant professor of psychiatry at Harvard University, is originally from Argentina.Depression. When depressed Chinese-American patients visit clinicians, they tend to talk about physical symptoms, not their depression, Albert yeung, M.D., Sc.D., an assistant professor of psychiatry at Harvard University, noted. The reason, he said, is that they do not seem to realize what the illness of depression is, but if you ask them directly whether they are sad, they will acknowledge it.Culture-bound syndromes. Indian men sometimes believe that they are losing semen in urine, but actually they are anxious and depressed, said Rajesh Parikh, M.D. Parikh is a consultant neuropsychiatrist at the Jaslok Hospital and Research Center in Bombay. Hispanic patients sometimes experience an “attack of nerves,” Mischoulon noted. It is similar to a panic attack, but often involves fainting or shouting. Some two-thirds of individuals who experience this syndrome are anxious or depressed, studies have shown.Psychotic symptoms. Psychotic symptoms expressed by Hispanic patients may differ from those often seen in Americans patients of other ethnic backgrounds, Mischoulon said. For example, their auditory hallucinations may consist of hearing a knocking at the door, a doorbell ringing, or children's voices calling one's name. visual hallucinations might consist of “black” thoughts flying across one's vision.The symposium speakers also suggested ways of deploying patients' cultural beliefs and expectations to bolster the therapeutic process. Among them:Involving the family. With patients from India, it is crucial to involve family members in treatment, Parikh asserted, because family in their culture is very important. The same is the case with Hispanic patients, Mischoulon stressed. Also, bringing in family members can give a clinician more perspective on a patient's issues, he said.Relaxing boundaries. Many Hispanic patients expect clinicians to divulge a lot of personal information about themselves, which American psychiatrists usually do not do, said Mischoulon. Thus, providing a little personal information might further therapy with Hispanic patients.Countering fatalistic beliefs. When Hispanic patients resist treatment because they hold fatalistic beliefs such as “the good Lord willing” or “Que sera, sera” (what will be, will be), Mischoulon might admonish them to “do the necessary leg-work to help God.”Enlisting native healers. For some Hispanic patients, for example, it may help to enlist the assistance of traditional healers, Mischoulon asserted. The reason is that patients may respect the psychiatrist for being open to their ways.These “practical tips for harnessing an individual's cultural beliefs, support systems, et cetera, toward treatment” were some of the symposium highlights, co-chair Shamsah Sonawalla, M.D., an assistant professor of psychiatry at Harvard University, told Psychiatric News.“The most impressive notion [of the symposium],” Fricchione believes, “was that modern psychiatry in the United States must become more sophisticated in its evaluation and management of diverse populations that increasingly seek treatment in our centers. This is because, while there are certainly psychiatric conditions that all groups share, with common symptom clusters and treatment responses, there are also important differences that will impact on patient access, compliance, and response to treatment.” ▪ ISSUES NewArchived

Involving Family Members in the Treatment of OCD

This review focuses on previous research with families of adults and children with obsessive‐compulsive disorder (OCD). Three primary areas of research are covered: (i) characteristics of family members and the family environment; (ii) the prediction of treatment response based on family variables; and (iii) the inclusion of family members in treatment. Much of the research supports a hypothesized model of family response to symptoms of OCD that ranges on a continuum from overly accommodating to overly antagonistic. Further research indicates that responses at either extreme of this continuum are associated with poorer response to both exposure and response prevention (ERP) and pharmacotherapy. Finally, results of preliminary treatment outcome studies suggest that family‐based interventions aimed at reducing such responses and/or including family members in ERP as coaches or co‐therapists may enhance patients' response to treatment. Based on current theory and research, suggestions for future research and general recommendations for involving family members in treatment are made.

Hope and coping in family members of patients with obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) affects approximately 2–4% of the adult population. Despite the practical and emotional demands of having a family member with OCD, few systematic attempts have been made to assess the coping strategies used by relatives of individuals with such diagnoses. In this study we examined the relationships between hope, coping strategies, and depressive symptoms in a heterogeneous sample of 67 spouses/primary caregivers of individuals with a history of OCD. In support of our hypotheses, hope was negatively related to depressive symptoms, symptom severity, and denial disengagement coping strategies, and positively related to active reframing and social support coping strategies. Active, Reframing, Social Support, and Religiosity were negatively related to depressive symptoms. Denial/Disengagement was positively associated with depressive symptoms. Coping mediated the relationship between hope and depressive symptoms. Given the importance of family members in treatment, clinical implications of these findings are discussed.

Striving for effectiveness in the treatment of adolescent depression: Cognitive behavior therapy for multisite community intervention

The Treatment for Adolescents With Depression Study (TADS) was designed to compare the relative and combined effectiveness of cognitive behavior therapy (CBT) and fluoxetine, each of which had demonstrated efficacy in carefully controlled single-site studies. Models of CBT from these efficacy studies served as the foundation for the TADS psychosocial intervention. When interpreting the acute and long-term outcomes of TADS treatment in the context of other studies of CBT for major depression, it is critical to understand the process and the decision making that formed the TADS CBT intervention. The TADS CBT Committee reviewed meta-analyses of child and adolescent psychotherapy as well as studies of CBT for childhood and adolescent depression, relied on expert consultants, and evaluated the treatment process in a feasibility study to derive the essential components of TADS CBT. In this article we describe the rationale for the TADS CBT, the process of treatment design, and the immediate sources of the TADS treatment. Key decisions were made involving the degree of treatment structure, therapist flexibility versus cross-site consistency, duration and intensity of treatment, the involvement of family members in treatment, and core versus optional elements of the intervention.

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Case 6.4: Treatment of Family Members and Significant Others—All in the Family

Families in Transition: Victims of Alcoholism and New Challenges Ahead

In the societal structure, the family is undergoing a transition and the most noticeable consequence of this transition happens to be a marked increase in the number of people addicted to alcohol. Alcoholism creates a major stress on individual family members and the family system. Drinking behaviour may interrupt normal family tasks, cause conflict and demand adjustive and adaptive responses from family members who do not know how to appropriately respond. In brief, alcoholism creates a series of escalating crises in family structure and function, which may bring the family to a system crisis. As a result, the members develop dysfunctional coping behaviour called ‘Codependency’. Therefore, it is imperative to involve family members in treatment. Family therapy is designed with the end in mind and it is specific, with attainable therapeutic goals. There are certain special population who need a lot of support in the form of family therapy. Children of alcoholics are one of the largest, most explosive and most remedial population who need help. Secondly, the number of women alcoholics is on the rise. Their addiction leads to neglect of children, and parenting responsibilities are compromised. In the future, drug related education needs to be viewed as a people rather than a chemical problem aimed directly at parents and families. Education efforts should revolve around family life, with emphasis on positive ways to deal with the issue of addiction, and treatment needs to shift from individual oriented to family system approach.

Family Responses and Multifamily Behavioral Treatment for Obsessive‐Compulsive Disorder

Family responses to obsessive-compulsive disorder (OCD) that have relevance to behavioral treatments for adults with this disorder include family accommodation, family members’ expression of emotion (EE) toward patients, and the effects of including family members in treatment. Family accommodation to OCD symptoms has been linked to greater severity of symptoms and poorer family mental health. Components of EE, including hostility and perceived criticism, have proved predictive of poorer outcome following behavioral treatment, but nonhostile criticism appears to improve outcomes. A model of multifamily behavioral treatment, in which relatives and patients are trained in exposure and blocking of rituals, as well as behavioral contracting to improve communication, is presented and illustrated in case examples. [Brief Treatment and Crisis Intervention 3:231–247 (2003)]

All in the family

The questions in the panel, and similar requests, present no obvious ethical concerns in the context of daily medical practice, unless we add that each is voiced by a physician's relation. Even so, it may not be obvious why such routine matters pose problems. But closer consideration reveals many levels at which treatment of family members may compromise professional judgment and threaten familial bonds. Since it is obvious how this could occur when treating one's own children or spouse, assume that these requests came from a cousin, aunt, or sibling. Panel ▪“My plane leaves in 6 hours and I forgot to renew my prescription. Can you write one for me?” ▪“Mom has not had a physical in years, and you are the only person she trusts. Can I bring her in?” ▪“I think the baby has a fever. Could you see him this afternoon?” ▪“My plane leaves in 6 hours and I forgot to renew my prescription. Can you write one for me?” ▪“Mom has not had a physical in years, and you are the only person she trusts. Can I bring her in?” ▪“I think the baby has a fever. Could you see him this afternoon?”

Patterns of Confiding and Factors Influencing Mental Health Service Use in Older Adults

The present study was designed to examine factors that might influence older adults to seek out professional counseling and to ascertain differences in confidant preferences by gender and nature of confidence. Analyses were conducted on 206 community-dwelling older adults ranging in age from 57-98. While men were more likely to confide in a spouse, women chose friends and children, usually daughters, as their confidants. Serious illness of self and serious illness of spouse emerged as sensitive subject matter regarding nature of confidence as evidenced by analyses run on large numbers of missing data for these items. Only 8.3% of the sample reported having received professional counseling, although familiarity with mental health services surfaced as the variable most likely to influence the possibility of consultation. Older adults with either previous exposure to outpatient psychological treatment or who had friends or family members receiving treatment reported being familiar with mental health services. Elders perceived the experiences of friends or family members in treatment to be positive experiences, although the majority of older adults did not perceive their problems as serious enough to warrant professional intervention.

Interventions for Family Members Caring for an Elder with Dementia

This chapter reviews 73 published and unpublished research reports of interventions for family members caring for an elder with dementia by nurse researchers and researchers from other disciplines. Reports were identified through searches of MEDLINE, CINAHL, Social Science Index, PsycINFO, ERIC, Social Work Abstracts, American Association of Retired Persons database, CRISP index of the National Institutes of Health, Cochrane Center database, and Dissertation Abstracts using the following search terms: caregiver, caregiving, dementia, Alzheimer's, intervention study, evaluation study, experimental, and quasi-experimental design. Additional keywords were used to narrow or expand the search as necessary. All nursing research was included in the review and nonnursing research was included if published between 1991 and 2001. Studies were included if they used a design that included a treatment and control group or a one-group, pretest-posttest design (ex post facto designs were included if they used a comparison group). Key findings show that approximately 32% of the study outcomes (e.g., burden, depression, knowledge) were changed after intervention in the desired direction. In addition, several problematic issues were identified including small, diverse samples; lack of intervention specificity; diversity in the length, duration, and intensity of the intervention strategies; and problematic outcome measures.

Involvement of Family Members in Treatment of Depressed Individuals

Sir: The negative impact depression has on family relations is mentioned several times by Pincus and Pettit in their recent Editor's Choice supplement article on chronic major depression.1 However, nowhere in the discussion of treatment in the articles that follow in that special supplement on depression is it pointed out that it is vitally important to involve family members, employers, and others who have frequent contact with the depressed person in the treatment plan. Since the Companion addresses family physicians, emphasis needs to be placed on the preventive work a family doctor can perform for the relatives of depressed patients. Chronic depressive illness can be classified as contagious in that family members as well as coworkers frequently will become depressed secondary to the stress of living and working with a depressed person. On reviewing the symptoms of chronic depression—anhedonia, insomnia, irritability—it becomes clear how difficult it would be to live with someone thus afflicted. Talking to the family of any depressed person and explaining—demystifying—the illness, illustrating how the disease affects those involved with the patient and why the patient acts the way he or she does, always lifts guilt, decreases anger, and facilitates coping with the difficulties chronic depression presents every day. Families need to understand the etiology, signs and symptoms, treatment, and prognosis of this illness, as well as the effect depression has on relationships. The primary doctor is the logical person to dispense this information. When given simple examples of how each of the symptoms of major depression can result in rejection, anger, frustration, and hopelessness, family members will display a smile of recognition. The explanation will elicit responses such as this one from a wife and mother: “I found a new recipe and used it to bake him a beautiful birthday cake. He pushed it away and said: ‘You know I don't like chocolate!' He has always eaten chocolate cake! My feelings were hurt, and I was angry. He didn't even say thank you. He had been really down and I was trying to cheer him up.” The teenager in the family chimes in, “He always sleeps till noon, his business is slipping because he never gets to work till after lunch. If I sleep in on Saturdays he wakes me up, even if I don't have anywhere to go. If I ask him to help me with my math homework, he doesn't concentrate and gets me all mixed up. He used to be good at math.” The younger brother of this teenager states, “He never plays ball with me anymore, he always says he is tired. He can't decide anything, not even what to wear. He is no fun to be around.” The family eventually loses patience and rejects the depressed person, who then becomes more depressed because he thinks that nobody cares about him or loves him—a vicious circle! Each one of these family members is suffering. They question themselves: What have I done or not done to contribute to the withdrawal, the unhappiness of the person I love? How can I help that person? The lack of success in healing the depression leads to burdens of guilt, rejection, and anger, and eventually depression. The joy and energy most of us feel every day is at risk and has to be defended when living with chronic pessimism. A family physician can help families understand and accept chronic depression as an incurable illness, which they did not cause and cannot improve. This preventive work may decrease the number of secondary depressions among those close to the chronically depressed individual and make it possible for family members to live with and come to terms with a tragic situation.

The cultural context of interventions for family members with a seriously mentally ill relative.

This chapter provides an overview of interventions for relatives of severely mentally ill individuals. The author discusses the design and use of these interventions in the context of the cultural characteristics of families and providers, as well as the culture of the interventions themselves.

Understanding AIDS-Risk Behavior Among Adolescents in Psychiatric Care: Links to Psychopathology and Peer Relationships

Severely mentally ill youths are at elevated risk for human immunodeficiency virus infection, but little is known about acquired immunodeficiency syndrome (AIDS) risk behavior in adolescents who seek outpatient mental health services or about the links between psychiatric problems and particular high-risk behaviors. This pilot study used structural equation modeling to conduct a path analysis to explore the direct and indirect effects of adolescent psychopathology on risky sex, drug/alcohol use, and needle use. Ethnically diverse youths (N = 86) and their caregivers who sought outpatient psychiatric services in Chicago completed questionnaires of adolescent psychopathology. Youths reported their relationship attitudes, peer influence, sexual behavior, and drug/alcohol use. Different AIDS-risk behaviors were associated with distinct forms of adolescent psychopathology (e.g., delinquency was linked to drug/alcohol use, whereas aggression was related to risky sexual behavior), and peer influence mediated these linkages. Some patterns were similar for caregiver- and adolescent-reported problems (e.g., peer influence mediated the relation between delinquency and drug/alcohol use), but others were different (e.g., caregiver-reported delinquency was associated with risky sex, whereas adolescent-reported delinquency was not). Findings underscore the complexity of factors (types of informants and dimensions of psychopathology) that underlie AIDS risk in troubled youths, and they offer specific directions for designing and implementing uniquely tailored AIDS prevention programs, for example, by targeting delinquent behavior and including high-risk peers and important family members in interventions.

The cultural context of interventions for family members with a seriously mentally ill relative.

This chapter provides an overview of interventions for relatives of severely mentally ill individuals. The author discusses the design and use of these interventions in the context of the cultural characteristics of families and providers, as well as the culture of the interventions themselves.