An Internet-Based Intervention for the Relatives of People with Mental Illnesses
An Open Pilot Trial with Two Groups
Abstract
Abstract. Relatives of individuals with mental illness are exposed to an elevated level of burden. Consequently, it is important to provide them with coping strategies. We explored the benefits of an online skills-training intervention. This open, uncontrolled interventional pilot study included 104 relatives of individuals with a mental illness. They participated either in a face-to-face group (n = 60) or online intervention (n = 44); participants were free to choose the type of intervention. Depressive symptoms and emotion regulation were assessed before and after the interventions. The analysis was based on an intention-to-treat model. About one-third of both samples did not complete the posttest assessments. The results of a multivariate analysis of variance revealed a significant effect of the interaction between time and intervention type, F(2,101) = 11.77, p < .01. Reductions in depressive symptoms, F(1,102) = 9.41, p < .01, ε2p = .08, and emotion-regulation difficulty, F(1,102) = 8.01, p < .01, ε2p = .07, following the online intervention were greater relative to the group intervention. Despite the limitations of this study because of group differences, the results demonstrated the benefits of an online intervention for the relatives. These encouraging initial results require further confirmation using a randomized controlled trial.
References
2014). Effectiveness of internet-based versus folder support interventions for young informal carers of persons with mental illness: A randomized controlled trial. Patient Education and Counseling, 94, 362–371. https://doi.org/10.1016/j.pec.2013.10.020
(2009). Internet-based and other computerized psychological treatments for adult depression: A meta-analysis. Cognitive Behaviour Therapy, 38, 196–205. https://doi.org/10.1080/16506070903318960
(2013). Effectiveness of guided Internet-based cognitive behavior therapy in regular clinical settings. Verhaltenstherapie, 23, 140–148. https://doi.org/10.1159/000354779
(2008). A comprehensive review and a meta-analysis of the effectiveness of Internet-based psychotherapeutic interventions. Journal of Technology in Human Services, 26, 109–160. https://doi.org/10.1080/15228830802094429
(2009). Defining Internet-supported therapeutic interventions. Annals of Behavioral Medicine, 38, 4–17. https://doi.org/10.1007/s12160-009-9130-7
(2012). Daily stress and cortisol patterns in parents of adult children with a serious mental illness. Health Psychology, 31, 130–134. https://doi.org/10.1037/a0025325
(2012). Emotion regulation and mental health: Recent findings, current challenges, and future directions. Current Opinion in Psychiatry, 25, 128–134. https://doi.org/10.1097/YCO.0b013e3283503669
(2015). Effectiveness of an Internet intervention for family caregivers of people with dementia: Results of a randomized controlled trial. PLoS One, 10, e0116622. https://doi.org/10.1371/journal.pone.0116622
(2014). A systematic review of Internet‐based supportive interventions for caregivers of patients with dementia. International Journal of Geriatric Psychiatry, 29, 331–344. https://doi.org/10.1002/gps.4016
(2011). State-of-the-art treatment via the Internet: An optimistic vision of the future. Cognitive Behaviour Therapy, 40, 79–81. https://doi.org/10.1080/16506073.2011.575591
(2009). Adherence in Internet interventions for anxiety and depression: Systematic review. Journal of Medical Internet Research, 11, e13. https://doi.org/10.2196/jmir.1194
(1992). A power primer. Psychological Bulletin, 112, 155–159. https://doi.org/10.1037/0033-2909.112.1.155
(1991). Programme Profamille,
(Profamille program . Québec, Canada: Unité de psychiatrie sociale et préventive du CHU et Centre de recherche Université Laval Robert-Giffard.2013). The Difficulties in Emotion Regulation Scale (DERS): Factor structure and consistency of a French translation. Swiss Journal of Psychology, 72, 5–11. https://doi.org/10.1024/1421-0185/a000093
(2013). Predictors and moderators of response to internet-delivered interpersonal psychotherapy and cognitive behavior therapy for depression. Journal of Affective Disorders, 151, 343–351. https://doi.org/10.1016/j.jad.2013.06.020
(2005). Technological innovations in clinical assessment and psychotherapy. Psychotherapy and Psychosomatics, 74, 336–343. https://doi.org/10.1159/000087780
(2007). G* Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39, 175–191. https://doi.org/10.3758/BF03193146
(2015). Efficacy of psychoeducational family intervention for bipolar I disorder: A controlled, multicentric, real-world study. Journal of Affective Disorders, 172, 291–299. https://doi.org/10.1016/j.jad.2014.10.021
(2016). Feasibility of a psychoeducational family intervention for people with bipolar I disorder and their relatives: Results from an Italian real-world multicentre study. Journal of Affective Disorders, 190, 657–662. https://doi.org/10.1016/j.jad.2015.10.060
(2008). Famille et troubles bipolaires
([Family and bipolar disorders] [Group manual]. Fribourg (CH): Réseau Fribourgeois de Santé Mentale.2001). Validating and invalidating behaviors coding scale. Reno, NV: University of Nevada.
(2004). Family Connections workbook and training manual. Rye, NY: National Education Alliance for Borderline Personality Disorder.
(1989). La version française de l’échelle CES-D (Center for Epidemiologic Studies-Depression Scale). Description et traduction de l’échelle d’autoévaluation.
(The French version of the CES-D (Center for Epidemiologic Studies-Depression Scale) . Psychiatrie et Psychobiologie, 4, 163–166.2010). A proof of concept trial of an online psychoeducational program for relatives of both veterans and civilians living with schizophrenia. Psychiatric Rehabilitation Journal, 33, 278–287. https://doi.org/10.2975/33.4.2010.278.287
(2004). Multidimensional assessment of emotion regulation and dysregulation: Development, factor structure, and initial validation of the Difficulties in Emotion Regulation Scale. Journal of Psychopathology and Behavioral Assessment, 26, 41–54. https://doi.org/10.1023/B:JOBA.0000007455.08539.94
(2010). Emotion-focused therapy: An overview. Turkish Psychological Counseling and Guidance Journal, 4(33), 1–12.
(2011). An off‐line pilot evaluation of a web‐based systemic cognitive‐behavioral intervention for carers of people with anorexia nervosa. International Journal of Eating Disorders, 44, 708–715. https://doi.org/10.1002/eat.20871
(2011). Mental disorder in Polish families: Is diagnosis a predictor of caregiver’s burden? Social Psychiatry and Psychiatric Epidemiology, 46, 363–372. https://doi.org/10.1007/s00127-010-0200-8
(2004). Clarifying the construct of mindfulness in the context of emotion regulation and the process of change in therapy. Clinical Psychology: Science and Practice, 11, 255–262. https://doi.org/10.1093/clipsy.bph080
(2008). Effet d’un programme psychoéducatif sur l’humeur des familles des malades souffrant de schizophrénie.
(Mood improvement in a family of schizophrenic patients after a psychoeducational program . Journal de Thérapie Comportementale et Cognitive, 18, 104–107. https://doi.org/10.1016/j.jtcc.2008.06.0032007). Understanding and engaging families: An education, skills and support program for relatives impacted by borderline personality disorder. Journal of Mental Health, 16, 69–82. https://doi.org/10.1080/09638230601182052
(2005). Family connections: A program for relatives of persons with borderline personality disorder. Family Process, 44, 217–225. https://doi.org/10.1111/j.1545-5300.2005.00055.x
(2014). The effects of mindfulness-based stress reduction program on the mental health of family caregivers: A randomized controlled trial. Psychotherapy and Psychosomatics, 83, 45–53. https://doi.org/10.1159/000353278
(2013). Evaluation of a web‐based skills intervention for carers of people with anorexia nervosa: A randomized controlled trial. International Journal of Eating Disorders, 46, 634–638. https://doi.org/10.1002/eat.22144
(2015). Reducing caregiver stress with internet-based interventions: A systematic review of open-label and randomized controlled trials. Journal of the American Medical Informatics Association, 22, e194–e209. https://doi.org/10.1136/amiajnl-2014-002817
(1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19. https://doi.org/10.1037/0022-006X.59.1.12
(2010). Cognitive model of caregiving in psychosis. The British Journal of Psychiatry, 196, 259–265. https://doi.org/10.1192/bjp.bp. 109.070466
(2005). Integrating mindfulness meditation with cognitive and behavioural therapies: The challenge of combining acceptance-and change-based strategies. The Canadian Journal of Psychiatry, 50, 863–869. https://doi.org/10.1177/070674370505001310
(2000). Manuel d’entraînement aux compétences pour traiter le trouble de personnalité état-limite.
(Skills training manual for treating borderline personality disorder . Geneva, Switzerland: Editions Médecine & Hygiène.2007). Psychological distress among Latino family caregivers of adults with schizophrenia: The roles of burden and stigma. Psychiatric Services, 58, 378–384. https://doi.org/10.1176/ps.2007.58.3.378
(2011). Psychometric properties of the Center for Epidemiologic Studies Depression Scale (CES-D) in French clinical and nonclinical adults. Revue d’Epidémiologie et de Santé Publique, 59, 327–340. https://doi.org/10.1016/j.respe.2011.03.061
(2014). Collateral outcomes in e-mental health: A systematic review of the evidence for added benefits of computerized cognitive behavior therapy interventions for mental health. Psychological Medicine, 44, 3137–3150. https://doi.org/10.1017/S0033291714000245
(2010). Family‐focused treatment for caregivers of patients with bipolar disorder. Bipolar Disorders, 12, 627–637. https://doi.org/10.1111/j.1399-5618.2010.00852.x
(2001). The effect of family interventions on relapse and rehospitalization in schizophrenia: A meta-analysis. Schizophrenia Bulletin, 27, 73–92. https://doi.org/10.1093/oxfordjournals.schbul.a006861
(2003). Common method biases in behavioral research: A critical review of the literature and recommended remedies. Journal of Applied Psychology, 88, 879–903. https://doi.org/10.1037/0021-9010.88.5.879
(2011). Establishing guidelines for executing and reporting internet intervention research. Cognitive Behaviour Therapy, 40, 82–97. https://doi.org/10.1080/16506073.2011.573807
(1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385–401. https://doi.org/10.1177/014662167700100306
(2017). Feasibility and acessibility of a tailored intervention for informal caregivers of people with severe psychiatric disorders: A pilot study. Frontiers in Psychiatry, 8, 178. https://doi.org/10.3389/fpsyt.2017.00178
(2012). Computer-based psychological treatments for depression: A systematic review and meta-analysis. Clinical Psychology Review, 32, 329–342. https://doi.org/10.1016/j.cpr.2012.02.004
(2010). Internet-based psychoeducational intervention for persons with schizophrenia and their supporters: One-year outcomes. Psychiatric Services, 61, 1099–1105. https://doi.org/10.1176/appi.ps.61.11.1099
(2005). A clinical trial to test the feasibility of a telehealth psychoeducational intervention for persons with schizophrenia and their families: Intervention and 3-month findings. Rehabilitation Psychology, 50, 325–336. https://doi.org/10.1037/0090-5550.50.4.325
(2006). Psychoeducation in schizophrenia: Results of a survey of all psychiatric institutions in Germany, Austria, and Switzerland. Schizophrenia Bulletin, 32, 765–775. https://doi.org/10.1093/schbul/sbl006
(2016). La santé mentale des proches de personnes en souffrance psychique
([Mental health of relatives of individuals with a mental illness] . Revue Francophone de Clinique Comportementale et Cognitive, 21(1), 4–19.2013). The E Sibling Project–Exploratory randomised controlled trial of an online multi-component psychoeducational intervention for siblings of individuals with first episode psychosis. BMC Psychiatry, 13, 123. https://doi.org/10.1186/1471-244X-13-123
(2010). Psychiatric symptoms in caregivers of patients with bipolar disorder: A review. Journal of Affective Disorders, 121, 10–21. https://doi.org/10.1016/j.jad.2009.04.020
(2006). International outcome measures in mental health: Quality of life, needs, service satisfaction, costs and impact on carers. London, UK: Gaskell.
(2015). The use of dialectical behavior therapy skills training as stand‐alone treatment: A systematic review of the treatment outcome literature. Journal of Clinical Psychology, 71, 1–20. https://doi.org/10.1002/jclp. 22114
(2009). Caring for people with depression or with schizophrenia: Are the consequences different? Psychiatry Research, 169, 62–69. https://doi.org/10.1016/j.psychres.2008.06.013
(2000). Caregiving in schizophrenia: Development, internal consistency and reliability of the Involvement Evaluation Questionnaire–European version–EPSILON Study 4. The British Journal of Psychiatry, 177, s21–s27. https://doi.org/10.1192/bjp.177.39.s21
. (2005). Size and burden of mental disorders in Europe: A critical review and appraisal of 27 studies. European Neuropsychopharmacology, 15, 357–376. https://doi.org/10.1016/j.euroneuro.2005.04.012
(2001). World Medical Association Declaration of Helsinki: Ethical principles for medical research involving human subjects. Bulletin of the World Health Organization, 79, 373–374.
. (