INTRODUCTION TO PSYCHOEDUCATION

Psycho education- Concept and Definition

According to the American Psychiatric Association (APA), Psycho- education is

defined as "the education of a person with a psychiatric disorder in subject areas that
serve the goals of treatment and rehabilitation."

Beuml defined Psycho-education as, “systematic, structured, didactic information

on the illness and it’s treatment, and includes integrating emotional aspect in order to
enable patient-as well as family members- to cope with illness”.

Psycho-education means imparting information and knowledge to those who are

seeking a better understanding on various subjects. The most common subjects are:
illnesses/disorders (mental-learning disorders, anxiety disorders, schizophrenia and
physical- terminal illnesses), career options etc. It also provides a supportive and
empathetic environment, and teaches its recipients problem solving and
communication skills. It also provides a supportive and empathetic environment,
and teaches its recipients problem solving and communication skills.

It has been termed the combining of “the empowerment of the affected” with
“scientifically-founded treatment expertise” in as efficient a manner as possible
(Bauml, Frobose, Kraemer, Rentrop, & Pitschel-Walz, 2006).

Psycho education is “a simple and illness-focused therapy with prophylactic

efficacy in all major mood disorders” (Colom, 2011)

Historical background

1790's-1800's: Philanthropists like Johann Heinrich Pestalozzi and Dr. Samuel

Gridley Howe used Educative method for providing therapeutic service to physically
and psychologically compromised people.

1911: Psychoeducation concept was first noted in the Journal of Abnormal

Psychology in an article published by John E. Donley.
1941: Brian E. Tomlinson’s “The psychoeducational clinic” was published by
MacMillan.Co

1962: In French, the first instance of the term psycho-education is in the thesis "La
stabilité du comportement"

1980: An American reseracher, CM Anderson popularized and established

Psycho-education as an adjunctive and effective treatment of Schizophrenia

1980’s: Anderson used this as a behavioural therapy which involved 4 concepts:

Briefing the patients about their illness

problem solving training

communication training

self-assertiveness training

1986: McGill and Lee, identifies the underlying elements that support which includes
(1) family involvement and support, (2) an emphasis on adherence, (3) specific
information about illness, (4) strategies for symptom management, (5) involvement
of caregivers in recognition of early signs of decompensation to reduce relapse, (6)
access to crisis intervention, (7) problem solving and stress management strategies, (8)
strategies to build family acceptance, and (9) continuity of services and care

In the last few years, increasingly systematic group programs have been introduced
for cancer, depression, anxiety, serious mental illness like schizophrenia in order to
sensitize patients and their families.

Scope of Psycho-education:

Psychoeducation occurs in a range of contexts and may be conducted by a

variety of professionals

 Covers a vast array of areas - usually associated with severe mental illness such
as psychosis, eating disorders, depressive disorders, anxiety disorders. It also can
be used for physical illnesses such as cancer.
 Proven to reduce drop out rates during treatment in depressive patients in South
Africa. (Seedat, Haskis & Stein, 2008)

 Helps in positive growth in terms of child behaviour, parent-child satisfaction

and child’s knowledge and adherence to medication, when both children with
ADHD and parents are psychoeducated. (Montoya, Colom & Ferrin, 2011)

 Reduction in stress and objective burden of spouses when psychoeducated about

their partner’s health conditions. (Savundranayagam et al, 2011)

 Psychoeducation of families of physically/cognitively impaired older adults led

to increase in life satisfaction.

 It helps in mending ones self image, self-efficacy and self-esteem as it is crucial

for treatment outcomes.

 For family members of patients with serious mental illnesses, perceived self
efficacy showed an increase with psychoeducation. (Solomon et al, 1996)

 In patients with bipolar disorder, the domains of general satisfaction and physical
functioning showed a significant increase with psychoeducation as compared to
the control group. (Michalak et al, 2005)

 Psychoeducation is also useful in increasing medical compliance in patients with

bipolar disorder. (Javadpour et al, 2013)

Goals and Importance of Psycho-education:

The goal of the Psycho-education program is not to completely alleviate the

condition to the point where it is no longer a factor, but rather to give the person
suffering from the psychological condition a better road map towards functioning in
an optimal way, without being too impeded by their condition.

Another goal of psychoeducation is to educate people living with illness to

become better at symptom management and increase awareness of the process of
their own illness.

To help people better understand and become accustomed to living with mental
health conditions. One study showed psycho-education, when administered to those
with schizophrenia, helped to both reduce hospitalization rates and reduced number
of days spending in hospital.

Psychoeducation occurs in range of contexts and may be conducted by a variety

of professionals, each with a differing emphasis.

1. Information transfer as when clients and their families learn about symptoms,
causes and treatment. It helps to evaluate a person’s intellectual and
social-emotional development as well as his/her academic progress and
adjustment.

2. Emotional discharge is a goal served as the client or family ventilates frustrations

during the sessions. Families helps individuals suffering from mental illness to
stay courageous in the face of seemingly insurmountable challenges

3. Support a medication or other treatment, as cooperation grows between

professional and client and adherence and compliance issues diminish. They also
provide information designed to have a direct application on clients’ lives in
order to to instill self-awareness, suggest opinions for growth and change,
identify community resources that can assist clients in recovery.

4. Assistance toward self-help is training in aspects such as prompt recognition of

crisis situations and knowledge of what steps should be taken, etc. Helps
individuals to solve personal problems, change behaviors, cope with stress, and
improve quality of life. It helps clients to be more assertive in communicating
with professionals. Focuses on educating clients about their disorders and ways
of coping.

5. Condition Management training: One thing you need to understand is how to

manage your condition. As mentioned before, you need to learn what symptoms
to report and whether those symptoms signal an urgent or emergency situation

6. Problem solving training: It`s easy to leave problems of mental health to

professionals and through psycho-education client can narrate problems clearly.
Models of Psycho-education:

Several psychoeducation models were developed according to the needs of persons

with mental illness and their caregivers. They are classified in two ways:

 Based on Target Population

 Based on Methodology

Based on Target Group

a) Individual Psycho-eduaction:

 It is more specific and focus on and can cover information and content that is
more relevant for an individual situation.

 It provides more safety and confidentiality in comparison with Group

psychoeducation

 A one to one interaction with the therapist/doctor is more suitable and

comfortable

b) Group Psycho-eduaction:

 It is a form of therapy in which people share therapeutic experiences under

the guidance of a therapist.

 It helps people learn to improve their inter-personal relationships

 People in group have the support of the other members of the group and as
well as feel that they are 'not alone'

 Through discussions issues and common questions are addressed

 It is also implemented in schools as a preventive measure. issues such as

Teenage Pregnancy, Body Image, Anger management, Bullying, etc.

c) Family Psycho-eduaction:
  Therapeutic program for the family members of the client, which helps in
mental health awareness, coping skills, preventing relapse, psycho-social
support, etc.

 Effective in schizophrenia, bipolar affective disorder, OCD, Eating disorder

and Borderline personality disorder

 Different models: Single family, mixed family and multiple family

psychoeducation groups

d) Community Psycho-eduaction:

 Information imparted to larger mass of population which may be non

homogenous, irrespective of illness

 Media has greater role in facilitating

 Video conferencing, debate and teleshow helps in the process

BASED ON METHODOLOGY

1) Information model- Focuses on providing families with the knowledge about

psychiatric illness and its management. The aim of this approach is to improve
the families’ awareness about the illness and contribution to the management of
the patient.

2) The Skill Training model- Directed at systematically developing specific

behaviors to enhance family members capability to assist the ill relatives and
manage the illness more effectively.

3) Supportive model- It is an approach which generally utilizes support groups

designed to engage the families of patient in sharing their feelings and
experiences. The main goal is to enhance and improve the emotional capacities
of the families to cope with the burden of caring for their ill relatives.

4) Comprehensive model- Also called combination approach because it consists of

information , skill training and supportive model. In the initial phase of this
 approach members are given lectures about the illness. They are to take part in
multi-family support group. In the final phase they have to participate
particularly as a member of individual sessions with a mental health professional.

5) The Multi Family Group Therapy model- Developed by William McFarlane.

Aims at engaging families in rehabilitation and after care programme of severe
psychiatric illness like schizophrenia. 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.

6) The Behavioral Family Management model- As per this model healthy

functioning of the mentally ill individual can be achieved through instilling
positive coping mechanisms that may buffer the vulnerable family member from
the negative effects of environmental stresses and also family members can be
provided knowledge about how to plan and implement of various tasks essential
for rehabilitation and aftercare of patient.

7) Peer-to-Peer Psycho-education Approach: Rummel et al, clinically applied this

appraoch. In this programme mentally ill persons are given the access to mix
with the people who had the same problem earlier but the recuperated from that
problem. These people can motivate the patients up to considerable extent and
provide them a new way of hope.

8) Family Focussed Treatment (FFT): David J. Miklowitz and MJ Goldstein

developed this approach for treatment of Bipolar patients initially. This model
has 3 modules in which psycho-education is provided in seven or more sessions.
The clinicians during the sessions would educate the targeted people about the
biological and genetic underpinnings of bipolar from a vulnerability–stress
diathesis perspective.

Techniques used in Psycho-education:

1. Brochures: Group and brochure psychoeducation included CETA program was

effective for improving antidepressant adherence. It can be applied by psychiatry
 nurses to outpatients who received diagnosis of depression for the first time were
also considered as cost-effective methods. (Günaydın and Barlas)

2. Role Plays- Act out or perform the part of the person or character specific to the
training module.

3. Presentations and Seminars- Share ideas or discoveries in a way that gives

participants an opportunity for discussion.

4. Team Building activities- Various types of activities used to enhance social

relations and define roles within a team.

5. One-to-one interactions and group interactions- one to one interviews and

focused group interviews can be conducted.

6. Demonstrations (Eg: Hygiene)- A practical exhibitions and explanation of how

something works or is performed.

7. Self-regulation training- A system of conscious personal management that

involves one’s thoughts behaviour and feelings to reach goals.

8. Relaxation Techniques (Eg: In case of Stress management)- Variety of methods

used to reduce stress, muscle tension and anxiety in the body.

Effectiveness of Psycho-education:

 Improved knowledge about a problem allows clients to better utilize methods of

reacting to it. This leads to a decrease in the stress, conflict, or impairment
caused by the problem.

 Studies show psychoeducation leads to significant reduction in pain and

dependency, improved physical functioning, mental health, and increased life
satisfaction and self efficacy (LeFort, Gray-Donald, Rowat, and Jeans (1998).

 A study examining psychoeducation effects on obesity showed

that psychoeducational subjects showed significantly increased self-esteem, body
satisfaction, and more restrained eating patterns compared with control
participants (Ciliska, 1998)
 An Indian study on parents of disabled children showed that psychoeducation
significantly improved parental attitude regarding child rearing and management
of the disability (Russell, al John, and Lakshmanan (1999).

 It creates an awareness of the situation to the families. Teaches the families of

the different ways in which the patients need to taken care off.

 It creates a conducive environment for the patients. It helps in accepting the

diagnosis.

 Helps to get rid of the stigma associated.

Limitations of Psycho-education:

 Not all psycho education programs are received well.

 Language used in the presentation.

 Some families do not feel the need to be educated.

 It’s time consuming- multiple sessions are required to understand the intricacies
of the issue.

 Not all programs give the desired results.

 Blind beliefs can seldom be challenged/ removed.