A Randomized Controlled Trial of Bibliotherapy for Carers of Young People With First-Episode Psychosis

Abstract

Caring for young people with first-episode psychosis (FEP) is challenging and can adversely affect carer well-being, with limited evidence-based support materials available. We aimed to examine whether completion of a self-directed problem-solving bibliotherapy among carers of young people with FEP led to a better experience of caring, less distress and expressed emotion, and better general health than carers who only received treatment as usual (TAU). A randomized controlled trial was conducted across two early-intervention psychosis services in Melbourne, Australia. A total of 124 carers were randomized to problem-solving bibliotherapy intervention (PSBI) or TAU and assessed at baseline, 6-week and 16-week follow-up. Intent-to-treat analyses were carried out and indicated that recipients of PSBI had a more favorable experience of caring than those receiving TAU, and these effects were sustained at both follow-up time points. Across the other measures, both groups demonstrated improvements by week 16, although the PBSI group tended to improve earlier. The PSBI group experienced a greater reduction in negative emotional evaluations of the need to provide additional support to young people with FEP than the TAU group by week 6, while the level of psychological distress decreased at a greater rate from baseline to 6 weeks in the PSBI compared with the TAU group. These findings support the use of problem-solving bibliotherapy for first-time carers, particularly as a cost-effective adjunct to TAU.

The effectiveness of manual-guided, problem-solving-based self-learning programme for family caregivers of people with recent-onset psychosis: A randomised controlled trial with 6-month follow-up

“…This provides support for the application of bibliotherapy as an effective approach to family intervention in facilitating and empowering family caregivers to care for the patients in early-intervention psychosis services. Indeed, these findings were more positive and long-lasting (over 6 months) than those found in another bibliotherapy programme conducted with 16-week follow-up in two early psychosis services in Melbourne, Australia (McCann et al, 2013). While McCann et al's clinical trial of bibliotherapy for family caregivers of young psychotic patients indicated only a few significant improvements in negative caregiving experience and distress at 6-week follow-up, the results in this study indicate more significant substantive improvements in wider varieties 25 of caregiver (i.e., family burden and caregiving appraisals and experiences) and patient (psychosocial functioning, psychotic symptoms and re-hospitalisation rates) outcomes at 6-month after completion of the SPBB, compared to those receiving usual family care only.…”

“…The self-reading manual itself is ready to access or reach and provides readers (caregivers) an opportunity to study and revise the reading material at their convenience of time and place as needed, without spending much time to attend the therapy sessions. It can also empower caregivers to be engaged in their self-care and more able to focus on the specific needs of their families (McCann et al, 2013, Petrakis et al, 2013.…”

“…Nevertheless, this controlled trial of bibilotherapy is one of very little research in family caregivers of people with recent-onset psychosis, and has strengthened its wider application from people with depression and anxiety to those with early psychosis (Fanner and Urquhart, 2008, McKenna et al, 2010, McCann et al, 2013.…”

“…With consideration to the study hypotheses and outcomes, the sample size was calculated on the basis of two clinical trials of family intervention, including one for Chinese psychotic patients using psycho-educational approach (Chien and Bressington, 2015) and another one for Australians with first-episode psychosis using bibliotherapy (McCann et al, 2013). The effect sizes on family burden/distress were found to be 0.68 and 0.52, and rehospitalisation rate (days of re-admissions) were 0.60 and 0.50, in the two studies.…”

“…Its benefits are mainly on improving participants' problem-solving ability, emotional regulation and psychosocial functioning. A recent small-scale controlled trial has provided evidence on the effect of a family bibliotherapy programme in first-episode psychosis on enhancing the families' positive caregiving experiences and reducing their expressed emotion and psychological distress over a 16-week follow-up (McCann et al, 2013).…”