Psychoeducational treatments for obsessive-compulsive disorder: A narrative review emphasizing family-based approaches

Table 2 The fundamental principles of psychoeducation

Principles	Explanation
Simple form of psychotherapy	Unlike the more complex or “skilled” psychotherapies, psychoeducational treatments are a simpler form of psychotherapy. Psychoeducation is not based on an elaborate theoretical framework. Psychoeducation is easily understood by clinicians, patients, and their families. The techniques used are simple and do not require extensive training. The person providing the treatment needs to have expertise and experience in dealing with psychiatric disorders and the basic skills for conducting psychotherapy. Psychoeducation is traditionally delivered by trained mental health professionals, but models using peer education are also effective. Psychoeducation can be used in different clinical and non-clinical settings. Psychoeducation has specific and modest goals. Psychoeducation is an easy-to-administer and relatively inexpensive form of treatment. Psychoeducation is usually more accessible than complex psychotherapies[19,35,36,44,45]
Structured form of psychotherapy requiring several skills	Psychoeducation is also a highly structured form of therapy. Research suggests that structured and evidence-based psychoeducational treatments are more effective than unstructured interventions. Psychoeducation integrates educational, behavioural, cognitive, and supportive techniques. The skillful delivery of psychoeducation requires that the therapist be conversant with health education techniques, proficient in teaching coping strategies, and have the ability to foster alliances through support and empathy[19,32,44,46]
Flexible treatment with diverse uses	Although psychoeducation is a structured form of therapy, it incorporates a degree of flexibility and sensitivity to the needs of the patients and their families. The simplicity and flexibility of psychoeducation ensure that it is useful in many psychiatric disorders and in community, outpatient, day-care, and inpatient settings. Psychoeducational treatments can be tailored according to the phases of the illness. Cultural adaptations are also possible. In theory, it should be easier to disseminate and implement psychoeducation than more complex interventions. However, in practice, there are several barriers to the dissemination and implementation of psychoeducation in clinical settings[20,31,33,34,47]
Core component of treatment	Psychoeducation is a core component of most psychotherapies. Psychoeducation forms a part of the routine management of all psychiatric disorders. Medications, psychoeducation, and more complex psychotherapies are the three principal elements of treatment for all psychiatric disorders[21,48]
Adjunctive treatment	Psychoeducation was developed as an adjunct to medication treatment particularly in severe mental illnesses. As an adjunctive treatment, the principal goal of psychoeducation is to improve medication adherence. Psychoeducation also addresses the domains of functional impairment and interpersonal problems that are not addressed by medications. The combination of medications and psychoeducation is often better than either treatment delivered alone. The efficacy of psychoeducation results from a synergistic combination of pharmacological, psychotherapeutic, and social approaches[17,18,40,49,50]
Patient-centredness, collaboration, and shared decision-making	Psychoeducation follows a patient-centred approach in which consideration is given to patients’ and families’ views and preferences about treatment. Psychoeducation is based on an equal partnership and collaboration between professionals with illness expertise and patients and families with personal expertise. Decisions about the treatment are the outcome of open discussions between professionals, patients, and families. A “teamwork” approach is followed, in which patients, families and professionals share a common understanding of the disorder and its treatment. The collaborative, person-centred, and shared-decision making approaches are useful in fostering strong treatment alliances, which are a fundamental component of psychoeducation[11,20,31,36,51]
Positive orientation	Psychoeducation aims to instill hope and optimism about the outcome of treatment in patients and families through improvement of awareness and social interactions. Patients are encouraged to believe that they can lead productive lives despite the negative impact of the illness on their lives. Psychoeducation uses a “no fault” approach by avoiding blaming either the patient or the family for the illness. Psychoeducation replaces the feelings of despair, fear, stigma, and low self-esteem with optimism and increased self-worth, and encourages patients and families to be active partners rather than passive recipients of treatment[18,19,21,34,52]
Normalization	Psychoeducation attempts to normalize the patient’s symptoms and dysfunction by focusing more on the healthy aspects of the person’ functioning and attempting to reach an optimal level of functioning rather than curing the illness[21,32,43]
The positive cycle of treatment engagement and psychoeducation	Information about the illness leads to the understanding that it is a treatable condition. This persuades patients and families to commit to long-term treatment and their motivation for treatment is enhanced. Treatment engagement and adherence is one of the principal tasks of psychoeducation. Treatment engagement creates a positive cycle - adherence reduces symptoms and allows the patient to take part in psychoeducation, which in turn facilitates subsequent adherence[17,18,21,35,36]
Medical model and biopsychosocial approach	In clinical settings, psychoeducational treatments follow a medical model by considering all psychiatric disorders to be primarily caused by abnormalities of brain structure and function. In other settings, the predominant approach is a biopsychosocial one. The biopsychosocial approach is more holistic and competence-based, treats the person as a whole, and considers individual strengths and weaknesses. Psychoeducation focuses on the present and avoids delving in the past[19,20,31,34,38]
Stepped care approach	Psychoeducation follows a stepped care approach, where the treatments proceed from simple to more complex techniques, and from stand-alone psychoeducational treatments to psychoeducation integrated with other psychotherapeutic interventions[29,53]