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Project
A Psychoeducational Approach to Stress Management. An Implementation and Effectiveness Study
There is a growing emphasis in high-income countries on the importance of mental health. However, the majority of people in need lack access toprofessional care and a significant number of those who do get professional attention ironically receive overtreatment. A number of barriers need to be addressed in order to overcome these issues. These barriers aresituated within the general public and the patients themselves, within the health professionals and within the policy makers. Addressing them successfully would allow mental healthcare to shift from an instance thatprimarily focuses on curing, to one that also pays attention to educating, coaching and promoting mental health. A first step in achieving thisgoal is to set up stepped care, which particularly requires extending the number of primary care interventions (e.g. psychoeducational group interventions).
In this doctoral dissertation we focused on three policy oriented research topics. A first topic is effectiveness, as we set out to evaluate the effectiveness of a local adaptation of a psychoeducational intervention for stress. A matched control design showed that people participating in the intervention showed a steady linear decline of stress and symptoms of depression. This improvement could be noticed up until 18 months follow-up and almost 30 percent of all participants experienced a clinically significant and reliable change. Furthermore, we wanted to gain additional insight in the overall evidence base for psychoeducational interventions that focus on stress reduction and we also wanted to chart possible moderators of effectiveness. A systematic review and meta-analysis was therefore conducted, which reported small but consistently positive effects of short-term effectiveness. For long-term effectiveness, results were less pronounced. As for the moderators, brief interventions for women appeared to be most effective. A second research topic is implementation, of which the importance became apparent during the previously mentioned intervention study. A recurring topic for researchers and partners who collaborate in the field is the dealing with issues of fidelity and adaptation of interventions. We set out to help address this issue andour personal experiences combined with a search in literature resulted in the construction of empowerment implementation, a framework for implementation research. The applicability of this framework was demonstrated using the psychoeducational intervention study mentioned earlier. A third and final research topic is prediction. We also wanted to investigate whether we could predict to what extent participants could benefit from our psychoeducational group intervention. We therefore considered theuse of overgeneral memory as such a predictor. In a first study, we found that the more specific responses participants provided on the Autobiographical Memory Task (AMT, which has the capacity to measure overgeneral memory), the more their problem solving strategies increased during the intervention. Because of these encouraging results, we set out to investigate whether the AMT could also be used to predict the evolution of anon-treated population, using the large convenience sample of control subjects from the effectiveness study. Results showed that, when controlling for baseline symptoms, overgeneral memory could predict long-term changes for both depression and anxiety after one year and 18 months.
After detailed reporting on each of these topics, the dissertation concludes with a general discussion in which a synthesis of the three topics is made. Furthermore, limitations and future perspectives are highlighted and we also reflect on the characteristics of a PhD focusing on policy oriented research. Finally, a number of general and specific policy recommendations are also made.
In this doctoral dissertation we focused on three policy oriented research topics. A first topic is effectiveness, as we set out to evaluate the effectiveness of a local adaptation of a psychoeducational intervention for stress. A matched control design showed that people participating in the intervention showed a steady linear decline of stress and symptoms of depression. This improvement could be noticed up until 18 months follow-up and almost 30 percent of all participants experienced a clinically significant and reliable change. Furthermore, we wanted to gain additional insight in the overall evidence base for psychoeducational interventions that focus on stress reduction and we also wanted to chart possible moderators of effectiveness. A systematic review and meta-analysis was therefore conducted, which reported small but consistently positive effects of short-term effectiveness. For long-term effectiveness, results were less pronounced. As for the moderators, brief interventions for women appeared to be most effective. A second research topic is implementation, of which the importance became apparent during the previously mentioned intervention study. A recurring topic for researchers and partners who collaborate in the field is the dealing with issues of fidelity and adaptation of interventions. We set out to help address this issue andour personal experiences combined with a search in literature resulted in the construction of empowerment implementation, a framework for implementation research. The applicability of this framework was demonstrated using the psychoeducational intervention study mentioned earlier. A third and final research topic is prediction. We also wanted to investigate whether we could predict to what extent participants could benefit from our psychoeducational group intervention. We therefore considered theuse of overgeneral memory as such a predictor. In a first study, we found that the more specific responses participants provided on the Autobiographical Memory Task (AMT, which has the capacity to measure overgeneral memory), the more their problem solving strategies increased during the intervention. Because of these encouraging results, we set out to investigate whether the AMT could also be used to predict the evolution of anon-treated population, using the large convenience sample of control subjects from the effectiveness study. Results showed that, when controlling for baseline symptoms, overgeneral memory could predict long-term changes for both depression and anxiety after one year and 18 months.
After detailed reporting on each of these topics, the dissertation concludes with a general discussion in which a synthesis of the three topics is made. Furthermore, limitations and future perspectives are highlighted and we also reflect on the characteristics of a PhD focusing on policy oriented research. Finally, a number of general and specific policy recommendations are also made.
Date:1 Sep 2009 → 17 Jun 2013
Keywords:Stress, Coping, Psycho-education
Disciplines:Biological and physiological psychology, General psychology, Other psychology and cognitive sciences
Project type:PhD project