Psychoeducation Therapy Research Articles

Multi-tiered Group Therapy Model to Identify and Treat the Root Causes of Domestic Violence: A Proposal Integrating Current Social Neuroscience Findings

Domestic violence (DV) is a national public health crisis. The leading treatment model, the Duluth Model, has failed to reduce or prevent DV. New models of treatment for DV are needed. In this paper, an emphasis is placed on an integrated multimodal approach to treating DV, integrating the current psychological science on the neurobiology and brain science of human violence with recent findings in the neurobiology of group relationships to present a treatment program for DV employing a group therapy model. This group therapy treatment approach moves away from the treatment of symptoms to the treatment of the root causes of violence. The two-tier Duluth model (a community teaching model of psychoeducation and court-mandated behavioral therapies for male perpetrators) is expanded to include a third tier. This is a psychological science-driven model that identifies and treats the root causes of DV using a group process and group systems-oriented approach.

Cognitive‐Behavioural Therapies for Young People in Outpatient Treatment for Non‐Opioid Drug Use: A Systematic Review

Youth drug use is a severe problem worldwide. This review focuses on Cognitive-Behavioural Therapy (CBT) as a treatment for young people who misuse non-opioid drugs, such as cannabis, amphetamines, ecstasy and cocaine, which are strongly associated with a range of health and social problems. CBT is an individualized and multicomponent intervention that combines behavioural and cognitive therapy. While behavioural therapy mainly focuses on external settings and observable behaviour, cognitive therapy is concerned with internal cognitive processes. The primary focus of CBT is to reduce usersâ?T positive expectations about drug use, to enhance their self-confidence to resist drugs, and to improve their skills for problem-solving and for coping with daily life stressors. The objective of this review is to assess the effectiveness of CBT for young people (aged 13-21) in outpatient treatment for non-opioid drug use and to explore any factors that may moderate outcomes. The literature search yielded a total of 18,514 references, of which 394 were deemed potentially relevant and retrieved for eligibility determination. Of these, 360 did not fulfil the screening criteria and were excluded. Four records were unobtainable. A total of seven unique studies, reported in 17 papers, were included in the review. Meta-analysis was used to examine the effects of CBT on drug use reduction, social and family functioning, school problems, treatment retention and criminal activity compared to a group of other interventions (Adolescent Community Reinforcement Approach (ACRA), Chestnut Bloomington Outpatient (CBOP) (+Assertive Continuing Care (ACC)), Drugs Harm Psychoeducation curriculum (DHPE), Functional Family Therapy (FFT), Interactional Therapy (IT), Multidimensional Family Therapy (MDFT), and Psychoeducational Therapy (PET)). Our main objective was to evaluate the current evidence on the effect of CBT on abstinence and drug use reduction for young people in outpatient treatment for non-opioid drug use. Seven randomised trials, involving 953 participants, were included in this review. Each of the seven included studies compared CBT to another intervention. We analysed the effects in the short term (from the start of treatment to up to 6 months thereafter), medium term (from 6 months to less than 12 months after the start of treatment), and long term (12 months or more after the start of treatment). We analysed CBT that was delivered with an add-on component such as motivational interviewing (four studies) separately from CBT that was delivered without an add-on component (three studies). Based on meta-analysis of data from the four included studies analysing CBT with an add-on component, there was no evidence of a relative effect of CBT for the reduction of youth drug use frequency compared to other interventions (ACRA, CBOP (+ACC), DHPE, FFT and MDFT). The random effects standardized mean difference was -0.14 (95% CI -0.64, 0.36) for the short term based on four studies, -0.06 (95% CI -0.44, 0.32) for the medium term based on four studies and -0.15 (95% CI -0.36, 0.06) for the long term based on two studies. Based on meta-analysis of data from the four included studies analysing CBT without an add-on component, there was no evidence of a relative effect of CBT for the reduction of youth drug use frequency compared to other interventions (IT, MDFT, and PET ). The random effects standardized mean difference was -0.13 (95% CI -0.68, 0.42) for the short term based on two studies, -0.08 (95% CI -0.48, 0.31) for the medium term based on three studies and 0.02 (95% CI -0.48, 0.52) for the long term based on two studies. Thus, the available data does not support the hypothesis that there is a drug use reduction effect from using CBT with young drug users compared to other interventions (ACRA, CBOP (+ACC), DHPE, FFT, IT, MDFT, and PET ). Statistically significant heterogeneity was present in the short term. In the medium term statistically significant heterogeneity was present between studies analysing CBT with an add-on component. In the analysis of studies without an add-on component there was no statistically significant heterogeneity in the medium term. Due to the low power of detecting heterogeneity with only two studies included in the analysis, this result should be interpreted with caution. There was no heterogeneity between studies in the long term; however, with only two studies included in the analyses the power to detect heterogeneity was low. The primary outcome measured as recovery could only be analysed in the long term. The meta-analysis of CBT with an add-on component was inconclusive as the eight different comparison combinations analysed showed different results. Only one study analysing CBT without an add-on component provided data on recovery status. The reported effect was not statistically significant.

A midwifery-led care pathway for women requesting caesarean sections

The caesarean section rate in the UK has increased dramatically in the last 20 years. Subsequently, there has been a rise in caesarean sections for maternal request (CSMR) without medical indications. In 2011, the National Institute for Health and Care Excellence (NICE) added to their guidance, that if after discussion and support, a vaginal birth is not acceptable, elective caesarean should be offered. This article proposes the implementation of a midwifery-led care pathway for women requesting caesarean section without medical indication. The care pathway includes group psychoeducational therapy which has been found to reduce CSMR, emergency caesarean sections and negative birth experiences. The challenges and barriers that may be faced when leading developments in maternity services are discussed, with reference to political, economic, social and technological factors.

Pain in primary Sjögren’s syndrome: the role of catastrophizing and negative illness perceptions

Objectives: Pain is a major factor in health quality in Sjögren’s syndrome (SS), but little is known about the factors that contribute to pain severity. Because pain perception has been linked to catastrophizing in other diseases, we assessed subjects with primary SS (pSS) to explore a possible link between pain, illness appraisal, and catastrophizing.Method: A total of 92 subjects who met American–European consensus criteria for the diagnosis of pSS completed a questionnaire that included health history, medication use, illness perceptions, pain severity, mood, fatigue, pain anxiety, and pain catastrophizing. Linear regression was used to test the effect of each variable on pain severity. Multivariate models were constructed using backwards elimination to assess the significant predictors of pain severity.Results: From linear regression analysis, catastrophizing was more strongly predictive of pain severity than age, fatigue, depression, or anxiety in both seropositive and seronegative pSS patients. In the multivariate model identified using backwards selection, four variables (pain catastrophizing, fibromyalgia status, serological status, and the conviction that illness would have severe consequences) predicted 55% of the variance in pain severity.Conclusions: Pain catastrophizing was a significant predictor of pain severity in both seropositive and seronegative pSS patients. This study suggests that behavioural interventions designed to reduce pain catastrophizing and negative appraisal of illness could be of benefit in pSS patients. Research is needed to test the effect of psycho-educational therapies on key patient-reported outcomes, particularly pain, depression, and fatigue, in pSS.

Modulation of fronto-limbic activity by the psychoeducation in euthymic bipolar patients. A functional MRI study

Bipolar disorders (BD) are mainly characterized by emotional and cognitive processing impairment. The cerebral substrate explaining BD impairment and the action mechanisms of therapies are not completely understood, especially for psychosocial interventions. This fMRI study aims at assessing cerebral correlates of euthymic bipolar patients (EBP) before and after psychoeducation therapy. Sixteen EBP and 16 matched healthy subjects (HS) performed a word-face emotional Stroop task in two separate fMRI sessions at 3-month interval. Between fMRI sessions, EBP underwent psychoeducation. Before psychoeducation, the comparison of EBP vs. HS in fMRI data revealed (a) significant decreased activity of cognitive control regions such as bilateral inferior and left superior frontal gyri, right insula, right fusiform gyrus and bilateral occipital gyri and (b) significant increased activity of emotion-related processing regions such as bilateral hippocampus, parahippocampal gyri and the left middle temporal gyrus. After psychoeducation, EBP showed significant clinical improvement, increased activity of inferior frontal gyri and a tendency toward decreased activity of right hippocampus and parahippocampal gyrus. These results suggest that the imbalance between cognitive control and emotion processing systems characterizing BD acute episodes may persist during euthymic periods. Moreover, this imbalance may be improved by psychoeducation, which enhances the cognitive control and modulates emotional fluctuations in EBP.

The effects of group psychoeducational programme on family burden in caregivers ofIranian patients with schizophrenia

This study was aimed at assessing the impact of group psychoeducation therapy on family burden in caregivers of Iranian patients with schizophrenia during the acute phase of the disease. Using a randomized-controlled trial design, 71 caregivers of patients with schizophrenia were randomly assigned to either a 4-week group psychoeducational programme (n = 36) or the control group (n = 35). Family burden was assessed by Family Burden Index Schedule (FBIS) at the beginning, and after a month of psychoeducation therapy as a follow-up. FBIS assesses family burden in six different dimensions with score ranging from 0 to 48, higher scores indicating higher burdens. At baseline mean, FBIS score was not significantly different between the cases and the controls. After the intervention, the mean total FBIS score was significantly lower in the case group compared with the control group (P < 0.001). In the intervention group, FBIS score change was significant through the study in all dimensions as well as the total score (P < 0.001). A significant reduction in family burden has been achieved by implementing group psychoeducational programmes for inpatients with acute phase schizophrenia in Iranian population.

Effects of group songwriting on depression and quality of life in acute psychiatric inpatients: A randomized three group effectiveness study

The purpose of this study was to determine the immediate effects of group psychoeducational songwriting on quality of life, depression, and treatment perceptions in acute psychiatric inpatients during a randomized three group design. Participants were randomly assigned by cluster to one of three conditions: Group songwriting (n = 33), psychoeducation (n = 32), or recreational music therapy (n = 40). Quality of life and depression were measured via established psychometric instruments and treatment perceptions were measured via Likert-type scales at immediate posttest. Results indicated no significant between-group differences in quality of life or depression measures. However, participants in the songwriting condition tended to have the highest mean quality of life and lowest mean depression scores. Participants in the psychoeducation condition tended to have the lowest mean quality of life and highest mean depression scores. Although not significant, participants in both music therapy conditions tended to have slightly higher mean ratings of helpfulness and comfort than participants in the psychoeducation condition. From the results of this study, it seems that psychoeducational group songwriting can be utilized to immediately increase aspects of wellbeing in acute psychiatric inpatients. Limitations of the study, implications for clinical practice, and suggestions for future research are provided.

Terapia familiar en los trastornos de personalidad [Family therapy in personality disorders

Mental illness affects not only the patient but also their families, it can difficult interpersonal communication, can cause additional pathologies inside the family and all this can worsen the evolution of the disorder. Psychoeducational therapies with families improve the prognosis of the disease and furthermore prevent the occurrence of other disorders in relatives. The most important elements of these therapies are: psychoeducation of the disorder, re establishment of a healthy relationship between patient and family, establishment of limits, improvement of family communication, and the establishment of relations with extensive social network to avoid the isolation both family and patient. Mixed therapeutic interventions, individual and family, have shown to be very useful in personality disorders, especially in borderline personality disorder.

Maturity fears in anorexia nervosa

Maturity fears (MF) is a relevant feature of patients suffering from anorexia nervosa (AN). The presence of MF and its implications in the outcome of AN is described. A review of specialized textbooks and the available literature in PubMed was made. Bruch (1974) and Crisp (1997) models have related the psychosexual immaturity to the regression to a prepubescent body as a maladaptative mechanism to confront the bio-psycho-social changes due to the transition to adulthood; as well as the individual vulnerability, family dynamics and deficits in mother/daughter bond. These findings show that MF are significantly correlated to an early onset of the disorder, primary amenorrhea, restrictive subtype of AN, feminine gender role, asceticism, self-discipline, hypercontrol, self-injury behaviors, treatment drop out, and negative outcome. There was a significant improvement of MF in anorexic adolescents included in a psycho educational programme and family therapy. One of the core characteristics of the AN is the MF underlined in classical paradigms and based on the current scientific evidence. MF should be considered a central therapeutic aspect and a prognostic index in AN.

2222 – Comprehensive therapeuric rehabilitation

Addressing the psychosocial rehabilitation of mental health patients, can be approached in various ways. In this case illustrates how a multidisciplinary approach so early impact on rehabilitation os psychiatric illness. Patient is a woman of 45 years, starting in mental health in 1989 and with five entries in the inpatient psychiatric unit between 2006–2011, with a diagnosis of bipolar disorder. During this period has come to irregularly shaped mental health unit, with poor adherence therapeutics and instability in their symtoms, without being able to normalize their mood. Has presented several manic episodes with psychotic symptoms and depressive episodes. Treatment begins with a comprehensive approach: psychiatry, psychology, social work, and assistant nursing. Treatment objectives were: raise awareness of disease, adherence and development and expansion of social skills in order to reduce the number of admissions and achieve clinical stabilization. Included in the treatment psychoeducational group therapy, activities and social skills workshops and home visits. Therefore, we emphasize the importance of integrative treatment in the rehabilitation of this patient and the approach of this type of intervention to detect these cases.

P.2.e.025 A randomized controlled trial of psychoeducation or cognitive-behavioural therapy in bipolar disorder: a CANMAT study

P.2.e.025 A randomized controlled trial of psychoeducation or cognitive-behavioural therapy in bipolar disorder: a CANMAT study

Quit Now! A Psychoeducational Expressive Therapy Group Work Approach for At-Risk and Delinquent Adolescent Smokers in Singapore

In this article, we review the risk and protective factors for adolescent smoking, as well as current research on evidence-based practices. The relevance of structured expressive therapy in meeting the maturational and emotional needs of at-risk and delinquent adolescents, and the multicultural context of adolescents in Singapore's Asian society are also explored. We present a framework for an evidence-based psychoeducational structured expressive therapy group work model which was pioneered in Singapore residential rehabilitation programs and high schools under the auspices of CARE Singapore.

PROTOCOL: Cognitive‐Behavioural Therapies for Young People in Outpatient Treatment for Non‐Opioid Drug Use

PROTOCOL: Cognitive‐Behavioural Therapies for Young People in Outpatient Treatment for Non‐Opioid Drug Use

Expanding the Application of Group Interventions: Emergence of Groups in Health Care Settings

Changes in the health care arena and within the specialty of group work are contributing to the increased utilization of groups in health care settings. Psychoeducational, theme, and interpersonal therapy groups are highlighted for their contributions to treating challenging health conditions. An understanding of the evolution of these group modalities, distinguishing their core features, and applying the fundamentals of group development assist in the development of group interventions to treat a wide range of conditions. Theme groups appear to be emerging as a more prominent group modality across a variety of health care settings to address challenging health conditions.

Working in the Conflict-Free Sphere: Adaptation Group in Methadone Maintenance Treatment

Many studies have been published on various types of psychoeducational group therapy in methadone maintenance treatment (MMT), but none has ever addressed the issue of group therapy for new beginners, despite the fact that the initial period following the cessation of drug abuse holds promise for many significant changes in an individual's lifestyle and behavior. This article presents an integrative group model for patients newly enrolled in MMT based on a psychoanalytic conceptualization of Hartman's ideas on adaptation and on Winnicott's contributions about transitional phenomena. The adaptation group includes 10 sessions that relate to significant issues in patients’ lives during the recovery process, among them medical information about methadone and addiction-related diseases, prevention of relapse, and anger management. The special characteristics of this group are discussed in the context of specific issues concerning the treatment of MMT patients.

P02-332 - Neurocognitive predictors of functional outcome in patients with bipolar disorder

IntroductionNeurocognitive deficits are known as a core feature in bipolar disorder (BPD). Persisting neurocognitive impairment is associated with low self-reported quality of life and low psychosocial functioning. Current findings indicate the importance of adjunctive psychosocial interventions in the treatment of BPD patients to enhance symptomatic and functional outcome.ObjectivesTo assess whether functional outcome in patients with BPD is affected by cognitive psychoeducational therapy, clinical parameters and cognitive impairment.AimsTo identify potential predictors of functional outcome, global clinical impression and early recurrence in patients with BPD.MethodsUsing a neurocognitive test battery 43 patients with BPD in euthymic state were compared to 40 healthy controls. Patients were assigned to two treatment Conditions cognitive psychoeducational therapy over 14 weeks (n = 19, 12 female, age) and treatment-as-usual (n = 24, 14 female). Predictors for functional disability, global clinical impression and early recurrence including clinical and cognitive variables as well as treatment conditions were examined using logistic regression.ResultsCompared to healthy controls patients with BPD showed lower performance in executive function (p &lt; 0.01) and sustained attention (p &lt; 0.001). Cognitive psychoeducation (p &lt; 0.05) and subthreshold depressive symptoms (p &lt; 0.05) were predictors for occupational functioning. Age (p &lt; 0.05), delayed verbal memory (p &lt; 0.05) and word fluency (p &lt; 0.05) predicted global clinical impression. Recurrence in the follow-up period of 12 months was predicted by delayed verbal memory (p &lt; 0.05).ConclusionsPatients with BPD seem to benefit from cognitive psychoeducational training mainly in areas of working life. The extent of cognitive impairment appears to impact clinical outcome and recurrence rate.

The effect of a psycho-educational program on CARS scores and short sensory profile in autistic children

There is great demand for effective management of children with Autistic Spectrum Disorders (ASD). This study aimed to investigate the effect of an individually tailored psycho-educational program for autistic children on the scores of the Childhood Autism Rating Scale (CARS) and the Short Sensory Profile (SSP). Methods Forty children (36 males) were enrolled into an intervention program which consisted of occupational therapy including sensory integration techniques, speech therapy, social skills therapy and parent-directed approaches. Autism severity was assessed using CARS; sensory response capability with the SSP pre- and post-treatment. Results Eight children were intellectually normal; 12 borderline and 20 of low intelligence. Pre-treatment CARS showed that 8 were mildly autistic, 32 moderately–severely autistic. Post-treatment, 24 children changed category; 11 were no longer autistic. The percentage of children performing in the definitive difference region, according to total SSP score, changed slightly (45% vs 32.5%). Comparison of the pre- and post-treatment values revealed that CARS decreased significantly ( p < 0.001), whereas total SSP did not ( p = 0.294). Tactile sensitivity and low energy/weakness sections, though, were significantly different pre- and post-treatment. Longitudinal analysis, taking into account other confounding factors besides time, further revealed a significant decrement for CARS score with time but not for SSP score ( p < 0.001 and p = 0.288, respectively). Similarly, intelligence levels affected CARS but not SSP values ( p < 0.001 and p = 0.813, respectively). Conclusion Individually tailored psycho-educational therapy had a significant effect on autism severity according to CARS. Changes in the SSP scores were not significant.

Vascular depression: where do we go from here?

Vascular depression has been the topic of many studies since its revival at the end of the last century. Several important conclusions can be drawn from this research. First, from a conceptual point of view, it is a potentially valuable eiotological based new entity. Second, vascular depression encompasses not only depression with small vessel disease of the brain, but also poststroke depression, and depression related to myocardial infarction should be placed in this same category of vascular depression. Third, the treatment outcome and natural course of vascular depression have been much worse than that of the nonvascular depression. Fourth, more research on vascular depression is needed, especially on interventions. Poststroke antidepressant and psychoeducation therapy and vascular preventive interventions can probably improve outcome.

Web-based psychoeducational intervention for persons with schizophrenia and their supporters: one-year outcomes.

This study examined the use of a uniquely designed Web site and home computers to deliver online multifamily psychoeducational therapy to persons with schizophrenia and their informal supports (family and friends). Web site usage and outcome benefits are reported. Thirty-one persons with schizophrenia or schizoaffective disorder and 24 support persons were randomly assigned to the online intervention (telehealth) or treatment as usual (usual care) condition. At three, six, and 12 months, interviewer-administered assessments were conducted with participants. Intention-to-treat analyses compared persons with schizophrenia in the two study conditions on severity of positive symptoms and knowledge of schizophrenia. Support persons in the two study conditions were compared on knowledge of schizophrenia. Each participant's usage of the Web site was logged. Persons with schizophrenia in the telehealth condition had a large and significant reduction in positive symptoms (p=.042, d=-.88) and a large and significant increase in knowledge of schizophrenia compared with their counterparts in the usual care condition. Support persons in the telehealth condition showed a large and significant increase in knowledge about prognosis compared with those in the usual care condition (p=.036, d=1.94). Persons with schizophrenia used the Web site to a much greater extent (pages viewed and time spent) than support persons. These findings suggest that online delivery of psychotherapeutic treatment and educational resources to consumers' homes has considerable potential to improve consumer well-being and offers several advantages over standard clinic-based delivery models.

Preventie van depressie: een overzicht

Prevention of depression Depressive disorders are highly prevalent and are associated with a huge disease burden, a considerable loss in quality of life and enormous economic costs. Current treatments can reduce the disease burden with about one third. Prevention of depression is very important and may be helpful in the further reduction of the disease burden of depression. A considerable body of research in the past 15 years has shown that preventive interventions are likely to be effective and can reduce the incidence with about 22%. In this paper, we show that traditional epidemiological research can not identify the best target groups for prevention. However, relatively simple statistics, such as the exposure rate, the population attributable fraction, and the numbers-needed-to-be-treated can be used to select those high-risk groups which are as small as possible, but can account for most of the new cases. Psycho-educational cognitive behaviour therapy is the most used preventive intervention for depression and it has been implemented in many countries. Over the next few years, the internet will probably give rise to new opportunities for broad-scale implementation of preventive interventions, because access is very scalable, economically affordable and effective. Another important development is that of stepped-care interventions. It is expected that this type of intervention will be able to reduce the incidence of depression further.