Psychoeducation

by

Ellen Lukens

• LAST REVIEWED: 29 April 2015
• LAST MODIFIED: 29 April 2015
• DOI: 10.1093/obo/9780195389678-0224

Introduction

Psychoeducation (PE) is a flexible strengths-based approach to care that incorporates both educational and therapeutic techniques and can be adapted to serve those with various medical, psychiatric, and other life challenges. The educational component offers key information and care strategies about both general and particular aspects of illness or life challenge, so that recipients have a frame of reference for their experience. The psychotherapeutic component offers safety, structure, feedback, and time for participants to absorb information that may be unfamiliar and challenging and may trigger complex emotions. When implemented by skilled facilitators, the synergy and balance between the two enables participants to increase understanding of and responsibility for monitoring symptoms and triggers, place personal symptoms and response patterns in context, process complex emotions, and build coping and wellness skills that promote hope and that can be applied in everyday circumstances. Psychoeducation can be offered individually, in groups, in multiple family groups, or with individual families, and it is also used to train professional, para-professional, and peer providers. When offered in group settings, the exchange of narratives, information, and social support can enhance the experience. Although definitions vary, the approach rests on principles that include (1) an emphasis on a learning exchange among providers and recipients that recognizes both professional and every day knowledge, (2) a sequenced curriculum that guides facilitators and offers illness-specific information, general information related to stress and coping, and enough flexibility to attend to the needs of a given individual or group, (3) time allotted for processing information and emotions that may be upsetting, mysterious, or difficult to understand, (4) strategies to enhance functioning, quality of life and reduce stigma and burden among participants, and (5) careful attention to adjustment of content, timing, and approach based on cultural context and language. Psychoeducation can be primary or adjunctive to other forms of care, and it is frequently designated as one component of cognitive-behavioral therapy. Interventions implemented in a brief single session or online as exemplified in this article have also been designated as psychoeducational. Much of the work on theory and implementation has focused on those with severe mental illness and their family caregivers. Individual researchers have generally reported reduced burden and stigma and increased understanding and openness to care plans among participants. However, findings from meta-analysis and reviews are equivocal, suggesting inconsistency of design, content, length, and structure as well as varied measures of outcome. Nonetheless, as can be seen from the array of topics in this article, great interest is found in applications designed to prevent and decrease the challenges associated with a range of illnesses or major stressors.

Theory and Principles of Psychoeducation

Several authors contribute foundational theoretical work that together help to clarify the principles and parameters of PE as applied and studied in a range of settings. A relatively early article Anderson, et al. 1980 sets forth the key principles of PE as designed to serve family members of those with schizophrenia. McGill and Lee 1986 traces the evolution of the PE construct as applied to this population and identifies the underlying elements that support it. These include (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. A more recent work Luckstead, et al. 2012 reflects on why this well-tested evidence-based model of care for those with schizophrenia has not been widely implemented in the United States. In another perspective that adds insight to this question, Colom 2011 offers a brief editorial highlighting both the strengths of PE for those with affective disorders and other mental illness and the significant challenges involved in effective implementation. Three additional pieces provide thoughtful theoretical perspectives on the underlying strengths and principles that support PE approaches and the evolution of thinking regarding its potential. Larsen 2007 considers PE in relationship to the anthropological model of “symbolic healing,” noting that efforts to promote healing involve attention to process and to content and structure that reflects cultural context and values. Landsverk and Kane 1998 draws on Antonovsky’s sense of coherence theory to emphasize the importance of carefully integrated curriculum content and sequencing in planning PE approaches to care regardless of target population.

• Anderson, Carol M., Gerard E. Hogarty, and Douglas J. Reiss. 1980. Family treatment of adult schizophrenic patients: A psycho-educational approach. Schizophrenia Bulletin 6.3: 490–505.

  DOI: 10.1093/schbul/6.3.490

  Authors identify the key elements of PE, including an increased knowledge base, reduced family and environmental stress both immediately and over time, and enhanced social supports and network. Subsequent research on PE multiple family groups for persons with schizophrenia evolved from this model.

• Colom, Francesco. 2011. Keeping therapies simple: Psychoeducation in the prevention of relapse in affective disorders. British Journal of Psychiatry 198.5: 338–340.

  DOI: 10.1192/bjp.bp.110.090209

  Three critical aspects of PE are highlighted: (1) open-door policy between psychiatrist and person with illness, in support of proactive self-care, (2) teamwork among professional providers, and (3) recipient-provider relationship that builds on trust and interaction as opposed to authority. Factors that hinder implementation are highlighted.

• Landsverk, Shawn S., and Catherine F. Kane. 1998. Antonovsky’s sense of coherence: Theoretical basis of psychoeducation in schizophrenia. Issues in Mental Health Nursing 19:419–423.

  DOI: 10.1080/016128498248872

  Authors draws on the underlying components of sense of coherence (SOC) theory (i.e., comprehensibility, manageability, and meaningfulness) to identify how the PE process mitigates stress and improves coping for those challenged by the symptoms of schizophrenia. Implications for practice are discussed.

• Larsen, John Aggergaard. 2007. Symbolic healing of early psychosis: Psychoeducation and sociocultural processes of healing. Cultural Medicine and Psychiatry 31.3: 283–306.

  DOI: 10.1007/s11013-007-9055-1

  Reflection piece on core elements of PE and the continuing need for attention to cultural context, the critical nature of the therapeutic relationship in relation to healing procedures and individual experiences, and how relationship building contributes to evolution and change in personal narratives that, in turn, can influence recovery.

• Luckstead, Alicia, William McFarlane, Donna Downing, Lisa Dixon, and Curtis Adams. 2012. Recent developments in family psychoeducation as an evidence-based practice. Journal of Marital and Family Therapy 38.1: 101–121.

  DOI: 10.1111/j.1752-0606.2011.00256.x

  Overview of key issues and challenges relating to implementation of family PE, and why this evidence-based model has not been broadly disseminated the United States. Three core aspects of family PE that contribute to improved outcome are identified, including basic information, strategies for coping and crisis management, and formal (professional) and informal (family/community) support.

• McGill, Christine W., and Evelyn Lee. 1986. Family psychoeducational intervention in the treatment of schizophrenia. Bulletin of the Menninger Clinic 50.3: 269–289.

  Comprehensive introduction to the four distinct approaches labeled as family PE that contributed to the evolution, development, and testing of the evidence-based models for the treatment of schizophrenia. Includes overview of the foundational literature on the impact of schizophrenia on family caregivers.