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

Table 3 The essential elements of psychoeducation

Elements	Techniques and uses
Imparting information	The objective is to provide patients and families with information about the illness and its management[29,34]
	Comprehensive information about symptoms, causes, treatments, and the prognosis of the illness is provided
	Misconceptions about the illness are corrected[17]
	The impact of the illness on the patient’s behaviour is also discussed[18]
	Knowledge-based competence allows patients and families to cope with the consequences of the illness and improves their engagement with treatment[18,34,54]
	Conveying information also aids the development of adequate treatment alliances[55]
	Informing patients and families about the illness is usually a two-step process. The first step consists of conveying information that is universal and common for all patients and families
	A series of structured lectures is used to convey such information as efficiently as possible[18,20,34,54]
	The most effective way to convey the basic information about the illness is by utilising psychoeducational groups[17,18,20,34,54]. Groups also help in providing support, reducing feelings of isolation, and normalising the experience of the illness
	Cognitive-behavioural techniques are utilised for this stage[18]
	The methods to convey information are didactic, explicit, and standardised[17,18,56]
	The next step is to provide information specific to the patient and the family that is tailored to their circumstances[18,21]. This is usually done on an individual basis and utilises supportive techniques[18]. Didactic lectures eventually give way to a two-way communication pattern at this stage
	The information is conveyed in the simplest manner by avoiding professional jargon as much as possible[17,18]
	Written sources of the informational material are almost always required[17,34,38,54]. Different formats, such as face-to-face contact, films or videos, self-help manuals, or digital modes, can be utilised
	The information should be in the local language and adapted to the social and cultural backgrounds of the patients and their families[33]
Enhancing coping skills	The information provided during the initial phases of psychoeducation is used as a basis for teaching specific management skills for patients and families as they deal with the illness[18,20,34,38]
	Cognitive-behavioural techniques of role-play and modelling are employed to teach coping skills[20,57]
	Cognitive-behavioural techniques are also used to enhance the presentation of information by allowing people to rehearse, review and integrate the information taught[34]
	Stress management and promotion of healthy lifestyles are encouraged as techniques to improve coping with the illness[20,38]
	Informational and emotional support are also provided to enhance the learning of coping skills[39,41,48]
	The areas addressed include day-to-day survival skills, common emotional responses to the illness, family atmosphere and conflicts, dealing with illness-related crises, and coping with stigma[39,41,51,57-59]
	Psychoeducational treatments teach problem-solving and communication skills, and the use of resources during periods of crisis[20,39,41,57,60]
	The eventual goal is to transform patients into experts in dealing with their illnesses and for family members to learn to act as “co-therapists” working on equal footing with professionals[18]
	The enhanced ability to cope with the illness can positively influence attitudes and behaviours towards the illness and its treatment, promote active participation in the treatment, enhance the motivation for treatment, and improve engagement with the treatment[18,34,40]
Fostering treatment alliances	The treatment alliance is the most crucial part of psychoeducation[18,21]
	It forms the basis for delivering the other two components of information giving and enhancing coping competence[18,55]
	The alliance is founded on mutual trust rather than the clinician’s authority[19]
	The other components of an effective alliance are collaborative relationships between clinicians, patients and families (mutual agreement on goals and tasks of treatment and emotional bonding), a patient-centred focus, shared decision-making, open communication, confidence in the therapist, support, and stability and continuity of the treatment relationship[19,61-63]
	Client-centred therapy techniques such as empathy, unconditional positive regard, and genuineness are used to build alliances with patients and families[18,21]
	Empathic listening counteracts the dysfunctional cognitions while accepting feelings of uncertainty and demoralisation[18]
	Providing emotional support and promoting stability in treatment relationships also builds strong alliances[18,38]
	The holistic approach followed treats patients and family members with respect and dignity and considers their strengths and weaknesses[38,63]
	Patients and families are viewed as invaluable allies who work with the clinicians to share the burden of managing the illness and moving towards patient recovery[18,64]
	Instilling hope, providing reassurance, and not blaming the patient or families for the illness are the other important aspects of an effective alliance[18,63]