Mental health disorders including bipolar disorders are the contributing cause of disability worldwide. The growing mental health treatment gap, in which more than 70% of people in need of mental health services do not have access to care, contributes to the documented global burden of disease associated with mental disorders (van Luenen et al., 2017). This gap persists even though evidence-based mental health interventions are effective in environments with limited resources. Experts have considered applying diverse strategies, including medicinal and non-medicinal-based approaches to bridge the gap. Psychoeducation combines cognitive-behavioral therapy (CBT), group psychotherapy, and education to enlighten patients and their relatives about the disorder and available therapy options so that they can collaborate with psychotherapists to achieve the best possible outcome. Psychoeducation belongs to a group of Psychosocial interventions. This essay will detail the application of psychoeducation to a 65 years old bipolar affective disorder patient who has refused to take medication.
Theories Behind Psychosocial Interventions
Although scholars and psychologists first used the term psychosocial in the 1890s, therapists, psychologists, and social workers developed detailed framework of the psychosocial field after the interwar era (van Luenen et al., 2017). These models represented a significant shift in how society and human nature were previously viewed. Sociological, psychological, and biological advancements increased understanding of human interaction with the environment. With the emergence of theories such as Erikson and Piaget’s theories, detailed knowledge of psychology contributed mainly to understanding human psychology. Psychosocial interventions rarely use medicinal approaches but usually aim to improve the victim’s well-being by enhancing their mental well-being. This works through a mediator in which the action of psychosocial interventions leads to a specific outcome via biological, behavioral, cognitive, emotional, social, or environmental changes; these variations explain or mediate the development. These changes can affect the result in various ways, ranging from the essential central nervous system functions to beliefs and perceptions. It is worth noting that the outcomes of psychosocial interventions include desired changes in three areas: symptoms, functioning, and well-being.
Influence Of Psychosocial Interventions in Mental Health
Numerous studies entailing psychosocial interventions found that Psychoeducation plays a crucial role in improving the mental health of individuals. A study investigating PSI’s impacts on people living with HIV/AIDS found that Mood disorders such as clinically significant depression affect 33% of PLWH students. In comparison, anxiety disorders affect 20% of the victims (van Luenen et al., 2017). A variety of psychosocial aspects, such as social exclusion, stigma, discernment, a lack of social care, and substance abuse, can exacerbate depression and anxiety. As a result, people living with HIV can suffer from various mental health issues. According to research, people with depressive symptoms have higher rates of ART adherence and HIV-related morbidity and mortality. The study proposed a variety of psychosocial interventions for people with mental disorders that have been developed, including cognitive-behavioral therapy, supportive frameworks, meditation, and anxiety management (van Luenen et al., 2017). Numerous reviews and meta-analyses demonstrated the efficacy of these interventions in treating the signs of depression, anxiety, and other emotional suffering in people living with HIV/AIDS. The finding has shown that stress management interventions significantly reduced anxiety and depression syndrome among the victims.
Additionally, PSI is crucial in mental health since they help in the management and treatment of mental health disorders. Studies investigating the effectiveness of PSI intervention in low- and middle-income countries found in managing mental illnesses such as psychosis and schizophrenia found that applying CBT, family-based services, and community support helped the victims manage stress and drug adherence (Sarkhel, Singh and Arora, 2020). In Ireland, the management of mental health initially relied on pharmacological intervention to treat and manage mental well-being. Since Ireland joined the European Union in 1973, advanced mental well-being was expected, which included training mental health nurses on the PSI and application. The approaches are also crucial in treating substance and drug abuse victims and trauma patients. Patients and families can benefit from psychosocial interventions as early as the first psychotic episode, which can help improve the overall outcome of trauma treatment, increase patient satisfaction with their care, and promote better well-being for patients and their relatives.
Psychosocial Interventions for Bipolar Affective Disorder
Psychosocial interventions are crucial to patients in the case scenario of the 65 years old bipolar patient. Bipolar disorder, previously known as manic depression, is a mental disease designated by extreme mood fluctuations, such as mania (also known as hypomania) and depression (Miklowitz et al., 2020). Bipolar disorder affects more than one percent of the global populace. Bipolar disorders are among the chief causes of disability among young persons because they can cause mental and functional damage and a high risk of death (Rabelo et al., 2021). Patients frequently have psychological and non-psychological medical conditions, which may contribute to a higher death rate. This disorder severely affects individual well-being, especially the lows characterized by depression.
People who are depressed have difficulty falling and staying asleep, whereas those who are not depressed tend to sleep much more than usual. For those suffering from depression, even seemingly insignificant decisions like what to eat for dinner can become overwhelming. Suicidal ideation can result from negative thinking in people dealing with feelings of loss, guilt, or helplessness. Bipolar depression is more difficult to treat and requires a treatment strategy tailored to the patient’s needs. Treatment of bipolar disorders involves combinations of medical and supportive approaches. Medical adherence Is crucial among patients since drugs stabilize mood and reduce stress. Supportive strategies involve the application of psychosocial interventions. In this case, the patient is declining medications; thus, PSI exists as the only hope for the 65 years old patient.
Interventions for Bipolar affective disorder Patient
Psychoeducation comprises problem-solving and communication training, briefing the patient about the existing condition, and self-asserting. Psychosocial interventions include psychological-based approaches, family interventionists, and social and educative strategies. For the patient described, combinations of these approaches will benefit the patient by improving health through reducing stress and anxiety, enhancing the relationship with surrounding individuals, and aiding in the improvement of behavior.
Cognitive Behavioral Therapy
Cognitive-behavioral therapy (CBT), a mental treatment, has been revealed to benefit depression, anxiety disorders, alcohol and drug abuse, marital issues, and severe mental illness (Özdel, Kart, and Türkçapar, 2021). CBT has been shown in numerous studies to improve functioning and overall well-being. Multiple studies have shown cognitive-behavioral therapy to be as effecient as, if not more operative than, other types of mental therapy or psychiatric therapies. CBT efforts usually involve changing the pattern of thinking based on the principle that psychological problems are based on the learned way of unhelpful thinking.
As a nurse, I will employ CBT to address the depressive symptoms resulting from manic episodes. This will be achieved by determining the problem because the patient has declined to take the drugs. The first approach will be to determine the reasons behind withdrawal from medication and come up with a solution. This includes attitude towards medication, drug side effects, and substance abuse. A patient’s knowledge of their illness and medications can impact drug compliance. Attitude and belief that bipolar drugs are meant to treat psychosis and induce weight could be why the patient declined medication (Özdel, Kart, and Türkçapar, 2021). After discovering the underlying problem and analyzing the negative behavior associated with it as a nurse, it will be the right time to initiate change. This includes talking with the patient to induce positive thinking and actions that alter the view of medications. Speaking of the advantages of finishing the prescribed drugs.
In addition to problem identification, CBT can be used to understand complex situations leading to depressive thoughts and Intense mood changes (Özdel, Kart, and Türkçapar, 2021). Through group sessions and “homework” assignments, patients are taught coping skills such as changing their thoughts, emotions, and behaviors. Cognitive Behavioral Therapy (CBT) therapists concentrate on the present rather than the past. Knowing a little about one’s history is essential, but the goal is to move forward towards time and learn new methods of dealing with life’s challenges.
CBT also encompasses coping and stress reduction (Luciano et al., 2019). It has been discovered that stress and coping play an essential role in health. Life events and adverse conditions can positively or negatively impact a individual’s ability to handle stress effectively. Psychosocial stress may significantly affect the disease’s onset and progression. According to a recent pathophysiological model of bipolar disorder, neurofunctional and neurostructural injuries incurred by the recurrence of BD can impact the relationship between stress and episodic relapse, which may be modulated by coping skills (Luciano et al., 2019). As a nurse, I will suggest problem-focused coping strategies to the patient, such as socializing. Encouraging the patient to interact with family members and stress constantly will reduce the occurrence of anxiety compared to when the patient spends time alone. Regular visiting or keeping psychiatry appointments will enable the nurse to examine how patients cope with stress. Seeking knowledge about the disorder is another coping strategy, but this might be challenging to the patient due to age. Keeping a journal and encouraging self-monitoring is a coping strategy and will encourage the patient to experience less stress.
Behavioral Family Therapy
Another popular model of PSI is Behavioral Family Therapy (BFT). This category includes family education, problem-solving, and interaction skills training. Rabelo et al. (2021) contend that multiple family models are more effective than single-family interventions in reducing relapse rates and increasing social functioning. These interventions are intended to reduce relapse. These interventions modify BFT in various core elements, delivered in a healthcare setting, and tied to multiple families in group settings (Miklowitz et al., 2020). Studies on the effectiveness of the family-focused treatment when dealing with psychiatric illness found that psychoeducation composed of oral sessions impacted the patient. The session had a stress-reducing feature that declined the chances of the victim committing suicide. The sessions also stabilized the vulnerabilities of the psychiatric patients (Miklowitz et al., 2020). As a nurse to the bipolar patient, family-focused therapy will engage the patient in enhanced communication training that engages patients in active listening and increases expression of praise rather than criticism towards the patient.
The social category of PSI
The social aspect of PSI involves the social factors surrounding bipolar patients. this includes self-help initiatives, social and spirituals support, social inclusion and well-being, and quality of life improvement (Sarkhel, Singh, and Arora, 2020). The primary goal of social skills training is to impart individuals with or without sensitive issues about the oral and nonverbal activities that occur during social relations. Another objective of communal skills training is to advance a patient’s capacity to interact socially. Many patients in psychiatric facilities have never learned how to ask and answer questions, express their thoughts and feelings, or maintain eye contact when conversing with another person.
This aids in developing social skills, role performance, and community reintegration. Spirituality is a desire to understand one’s place in the world and a sense of belonging. Spirituality in psychiatric nursing developed due to the ability to interact with others and a value-influenced way of thinking. Spirituality has an impact on many people’s decisions. Its goal is to help people improve their relationships with others, themselves, and the unknown. Stress management can be easier if patients have a spiritual sense of peace, direction, and forgiveness. This is especially important if one is going through a difficult time or is sick.
Over the last decades, researchers have discovered that people who have spirituality (a sense of purpose and participate in religious communities) have a higher quality of life and are less likely to suffer from mental illness. Both practitioners and researchers recognize the significance of spirituality in the healing process. A study on whether spiritual support groups influenced the mental well-being of nine mental health patients attending a local spiritual group was conducted. Inclusion criteria included a mental illness diagnosis, a history of more than a year of constant contact with a local psychiatric service, and a referral to a mental illness day center as part of a recovery plan.
Five mental well-being participants were also chosen for their expertise in the study. It is consistent with Forrester-Jones et al. (2017) findings that spiritual support helps individuals struggling with the uncertainty and disturbance of mental health problems and that spirituality is significantly linked with psychological adjustment. The SSG appeared to deliver a vital framework in which participants could enquire, debate, and’ sort out’ spiritual matters more softly than official religious organizations. Encouraging the sense of spirituality in the patient encourage will enable the patient to experience purpose in life and regain confidence. In this case, the stress and anxiety decline. Impacting the aspect of hope in patient life might trigger them to evade suicidal thoughts and ideas and accepts medication. In communities with spiritual support groups, encouraging the patient to join will benefit the patient.
Educative Psychosocial Intervention
Education-based psychosocial approaches involve training the patients on strategies to improve their well-being. This includes techniques such as prevention of relapse, medication management, and adherence, physical health promotion, and monitoring. As a nurse dealing with a bipolar disorder patient, the education approach will encourage the patient to continue with medication and adhere to the dosage. This approach is crucial since experienced nurses will always find a way to please the patient. As a nurse, my role will be to inform the patient of warning signs of bipolar disorder and how to take action where to seek help in incase of worsening situations. Management of the condition such as visiting a psychotherapist or engaging in stress-reducing activities such as hobbies and socialization. Despite the patient being old aged 65 years, it would be better to assign the patient a guardian to monitor their health. This can be a close relative to the family who later establishes a link with the nurse.
Medical adherence is essential to educative psychosocial intervention since most bipolar patients find it hard to stick to a medical routine. Mood stabilizers are the most commonly used drugs when dealing with bipolar. Antidepressants are also used in conjunction with mood stabilizers. Jawad et al. (2018) suggest that most bipolar disorder patients refuse or stop taking their medications due to difficulty remembering when to take the drugs, fear of addiction and side effects, preference for alternative medicines, and lack of awareness of their illness. According to a recent study, medication nonadherence is linked with an increased incidence of relapse extended hospital stays, and attempted suicide and higher overall treatment costs in patients with bipolar disorder (Jawad et al., 2018). Nonadherence is exacerbated by complex medication regimens, adverse drug effects, adverse patient attitudes toward drugs, poor awareness, rapid-cycle BD, comorbid substance misuse, and a deprived therapeutic association. Informing the patients of the dangers encountered with nonadherence to the drug regime will be my role as a nurse.
Mental health disorders such as bipolar disease remains a challenge globally. The majority of approaches to deal with these concerns focus on medical strategies. Advancement in the field of psychiatry has prompted the adoption of psychosocial practices that involve the use of non-medical approaches to improve the mental well-being of individuals. These interventions include cognitively oriented techniques such as CBT, focus and coping strategies, family Interventionist such as psychoeducation, and social and educative approaches. The psychoeducation approaches were provided in this essay to support 65 years old bipolar affective disorder patients.
Forrester-Jones, R., Dietzfelbinger, L., Stedman, D. and Richmond, P. (2017). Including the ‘Spiritual’ Within Mental Health Care in the UK, from the Experiences of People with Mental Health Problems. Journal of Religion and Health, [online] 57(1), pp.384–407. doi:10.1007/s10943-017-0502-1.
Jawad, I., Watson, S., Haddad, P.M., Talbot, P.S. and McAllister-Williams, R.H. (2018). Medication nonadherence in bipolar disorder: a narrative review. Therapeutic Advances in Psychopharmacology, [online] 8(12), pp.349–363. doi:10.1177/2045125318804364.
Luciano, M., Ciampi, C., Felice, G.D., Marone, L., Raia, M., Tarantino, G., Zinno, F. and Cerbo, A.D. (2019). Coping strategies of Bipolar patients’ relatives: a narrative review. Journal of Psychosocial Systems, [online] 3(2), pp.40–52. doi:10.23823/jps. v3i2.59.
Miklowitz, D.J., Merranko, J.A., Weintraub, M.J., Walshaw, P.D., Singh, M.K., Chang, K.D. and Schneck, C.D. (2020). Effects of family-focused therapy on suicidal ideation and behavior in youth at high risk for bipolar disorder. Journal of Affective Disorders, 275, pp.14–22. doi: 10.1016/j.jad.2020.06.015.
Özdel, K., Kart, A. and Türkçapar, M.H. (2021). COGNITIVE BEHAVIORAL THERAPY IN TREATMENT OF BIPOLAR DISORDER. Archives of Neuropsychiatry, 58. doi:10.29399/npa.27419.
Rabelo, J.L., Cruz, B.F., Ferreira, J.D.R., Viana, B. de M. and Barbosa, I.G. (2021). Psychoeducation in bipolar disorder: A systematic review. World Journal of Psychiatry, 11(12), pp.1407–1424. doi:10.5498/wjp. v11.i12.1407.
Sarkhel, S., Singh, O. and Arora, M. (2020). Clinical Practice Guidelines for Psychoeducation in Psychiatric Disorders General Principles of Psychoeducation. Indian Journal of Psychiatry, 62(8), p.319. doi: 10.4103/psychiatry.indianjpsychiatry_780_19.
van Luenen, S., Garnefski, N., Spinhoven, P., Spaan, P., Dusseldorp, E. and Kraaij, V. (2017). The Benefits of Psychosocial Interventions for Mental Health in People Living with HIV: A Systematic Review and Meta-analysis. AIDS and Behavior, 22(1), pp.9–42. doi:10.1007/s10461-017-1757-y.