Psychoeducation against depression, anxiety, alexithymia and fibromyalgia: a pilot study in primary care for patients on sick leave

Abstract

Objectives: Feasibility testing of a psychoeducational method -The Affect School and Script Analyses (ASSA) – in a Swedish primary care setting. Exploring associations between psychological, and medically unexplained physical symptoms (MUPS). Design: Pilot study. Setting: Three Swedish primary care centers serving 20,000 people. Intervention: 8 weekly 2-hour sessions with a 5–7 participant group led by two instructors - followed by 10 individual hour-long sessions. Subjects: Thirty-six patients, 29 women (81%), on sick-leave due to depression, anxiety, or fibromyalgia. Outcome measures: Feasibility in terms of participation rates and expected improvements of psychological symptoms and MUPS, assessed by self-report instruments pre-, one-week post-, and 18 months post-intervention. Regression coefficients between psychological symptoms and MUPS. Results: The entire 26-hour psychoeducational intervention was completed by 30 patients (83%), and 33 patients (92%) completed the 16-hour Affect School. One-week post-intervention median test score changes were significantly favorable for 27 respondents, with p < .05 after correction for multiple testing for 9 of 11 measures (depression, anxiety, alexithymia, MUPS, general health, self-affirmation, self-love, self-blame, and self-hate); 18 months post intervention the results remained significantly favorable for 15 respondents for 7 of 11 measures (depression, alexithymia, MUPS, general health, self-affirmation, self-love, and self-hate). Conclusions: A psychoeducational method previously untested in primary care for mostly women patients on sick-leave due to depression, anxiety, or fibromyalgia had >80% participation rates, and clear improvements of self-assessed psychological symptoms and MUPS. The ASSA intervention thus showed adequate feasibility in a Swedish primary care setting.Key Points A pilot study of a psychoeducational intervention – The Affect School and Script Analyses (ASSA) – was performed in primary care • The intervention showed feasibility for patients on sick-leave due to depression, anxiety, or fibromyalgia • 92% completed the 8 weeks/16 hours Affect School and 83% completed the entire 26-hour ASSA intervention • 9 of 11 self-reported measures improved significantly one-week post intervention • 7 of 11 self-reported measures improved significantly 18 months post-intervention

Managing functional disorders: opportunities and threats

“…However, CBT is not widely available and modifications suitable for large groups of patients are necessary. Psychoeducation in groups can alleviate the symptoms in these patients [13]. Web-based, guided self-help is another promising alternative [14].…”

Evaluation of the Affect School as supplementary treatment of Swedish women with eating disorders: a randomized clinical trial

“…The method is based on the affect theories developed by Tomkins, Nathanson, and Ekman and is a structured educational group intervention [ 24 , 25 ]. Previous studies on the AS have shown significant reductions in stress and psychological symptoms in a sample of social workers with high levels of chronic stress [ 24 ], as well as improvements regarding alexithymia, depression, social relations, and quality of life in primary care patients [ 25 ], and improvements of depression, anxiety, and fibromyalgia in samples of women on sick leave in primary care [ 26 ]. The AS has not previously been evaluated as a method for patients with ED.…”

A piece of a puzzle—Patient and psychologist experiences of the Affect School as additional treatment in a Swedish eating disorder unit

“…Since its inception the AS has been used within a number of areas in conjunction with pain treatment, e.g. stress-related problems, depression, and anxiety [11][12][13][14].…”