Research on the Effectiveness of Psychoeducation

"In one study 121 bipolar I and bipolar II outpatients, who had been in remission for at least six months, were given either 21 sessions of group psychoeducation or 21 sessions of nonstructured group meetings in addition to their normal medication and treatment. They were assessed during the study and for the following two years.

The results showed that group psychoeducation significantly reduced the number of relapsed patients and the number of recurrences per patient, and increased the time to depressive, manic, hypomanic, and mixed recurrences. The number and length of hospitalizations per patient were also lower in patients who received psychoeducation. For example, after two years, 87% of the control group experienced recurrence against 63% for the group that received the education."

Colom F,et al. "A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission." Arch Gen Psychiatry. Apr. 2003, 60(4):402-7.

In another study 69 patients with bipolar disorder who had had a relapse in the previous 12 months were either given 7 to 12 individual treatment sessions from a research psychologist [teaching them to recognize early warning signs] plus routine care or routine care alone. They were assessed every six months for 18 months.

The results showed that the time to the first manic relapse in the experimental group was 65 weeks compared with 17 weeks in the control group. Significant reductions in the number of manic relapses over the 18 month period were also observed. The experimental treatment had no effect on time to first relapse or number of relapses with depression, but it significantly improved overall social functioning and employment.

The researchers concluded that teaching patients to recognise early symptoms of manic relapse and seek early treatment is associated with important clinical improvements in time to first manic relapse, social functioning, and employment.

Perry, A, Tarrier, N, Morriss, R et al: "Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment." British Medical Journal 318:149-153, 1999. Full copy of paper.

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Prophylactic Education

Prophylactic means "to guard against" or "prevent." We take prophylactic medication to prevent future episodes of mental illness. There is recent evidence that education about mental illness can also exert a strong prophylactic effect (but do keep taking the tablets). The article "Teaching Wellness" summarises four recent scientific studies on the effectiveness of education in improving the outcome for bipolar disorder.

Evidence-Based Practices

Education features strongly in the Evidence-Based Practices program of the Substance Abuse and Mental Health Services Administration (SAMHSA) and its Center for Mental Health Services (CMHS). This program seeks to promote the use of evidence-based practices in mental health. Evidence-based practices are those which have been proven effective through controlled research studies. Obtaining widespread adoption of these and similar effective practices is at the center of SAMHSA's services improvement mission.

Six toolkits have been developed for mental health professionals. Two of these are focussed on education, the Illness Management and Recovery toolkit, and the Family Psychoeducation toolkit. The Illness Management and Recovery toolkit is a study program for consumers with instructions to the provider regarding how to teach it. The Family Psychoeducation toolkit (and the other four toolkits) are aimed at providers. Both one-on-one and group teaching have been investigated. The toolkits are available online.

The program is due to complete the pilot testing phase in Summer 2005 and then to begin national demonstration. It is encouraging to note that this effort to disseminate the use of education in mental health proceeds from a recognition of the value of education from controlled scientific studies.

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Prophylactic education teaches the facts of life—the facts of living a life in the company of a serious mental illness. Some education is beginning to be offered by the professional mental health community, typically in a one-on-one context. This makes it expensive and not widely available, but do make use of it if you find it available to you. Examples include: Family Psychoeducation and Cognitive Behavioral Therapy. Evidence shows that a group setting can work just as well as the therapist/patient setting. Education in a group setting is offered by mental health non-profits, is much more widely available, and is typically free.

For those in the USA, NAMI offers the Peer-to-Peer Recovery Education Course for those with a serious mental illness and the Family-to-Family Education Program for their caregivers. I highly recommend these free education courses. Check out the promotional video and find out if they are offered by your local NAMI affiliate. (I am involved in providing the Peer-to-Peer course in my local NAMI.) Other similar consumer-taught recovery courses offered by non-profits in the USA include Bridges and the WRAP program from Mary Ellen Copeland.

Support groups are also an excellent resource. It is very comforting to discover that we are not alone and that others suffer similar difficulties. We can learn from those who have successfully managed similar problems to those we are facing. Both NAMI and the Depression and Bipolar Support Alliance offer local support groups across the USA.

And don't overlook the value of a good book. There are some excellent guidebooks for patients and their caregivers available now on specific mental illnesses. I found many of them to be available in my local public library. Take a look at my book reviews.

I'm sorry, you can't go home until you're better.

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