Using Virtual Reality (VR) training to support caregivers of people with psychosis with their communication styles: a feasibility study

Student thesis: Doctoral ThesisDoctor of Philosophy

Abstract

Background & aims:
First episode psychosis (FEP) can be a difficult and challenging period for individuals living with a diagnosis. However, it can also be a challenging time for close others in their network, who may lack knowledge and understanding of psychosis and its management. Research has highlighted how informal carers of people with FEP provide essential support but often have unmet educational and support needs. Family psychoeducation interventions are frequently included as part of treatment and best practice guidelines for psychotic disorders. However, no systematic reviews have reviewed the efficacy of carer only psychoeducation interventions at the FEP stage. Subsequently, the systematic review aimed to evaluate the effectiveness of psychoeducational interventions in improving knowledge/ understanding about psychosis and its management for informal carers of people with FEP. Changes across other carer-focused outcomes, such as psychological well-being, and the key psychoeducation intervention components (e.g., its administration and format) were also reviewed.

Methods:
Six databases were searched (PsychINFO, MEDLINE, EMBASE, Cochrane Library, Web of Science, and Google Scholar). Studies were included if they delivered carer-focused psychoeducation interventions to informal carers of people with FEP and quantitatively measured any carer-focused outcome. Following identification, a narrative synthesis of study findings was completed. The quality of the included studies was evaluated using the Effective Public Health Practice Project quality assessment tool for quantitative studies (National Collaborating Centre for Methods and Tools, 1998).

Results:
Twelve studies, conducted across different countries/regions, were included in the review which provided data on 861 carers. Although there was an under-reporting of socio-demographic characteristics (e.g., ethnicity), most of the studies’ participants were parental females. Most of the included studies employed RCT designs. Consistent improvements were reported on measures of carer knowledge and understanding of psychosis, including their illness-related beliefs. Additional benefits were also found across other carer-focused outcomes, including expressed emotion, appraisals of caregiving, perceived burden, and ways of coping. There was high variability in the type of psychoeducation interventions applied which differed in their timeframe, session length, additional components, format, and facilitators. Most of the studies were rated as “weak” which reflected a low quality of available evidence.

Conclusion:
Delivering carer-focused psychoeducation interventions during the FEP stage appears to improve the carers knowledge and understanding of psychosis and its management, along with their illness-related beliefs. Additional benefits are observable across a range of other carer-focused outcomes. Clinically, there is flexibility in how psychoeducation interventions can be effectively delivered to help suit the needs of carers, clinicians, and services. However, a stronger quality of evidence is required to better understand the more nuanced elements of the psychoeducation interventions (e.g., around its cultural applicability and mechanisms of action).
Date of Award1 Nov 2024
Original languageEnglish
Awarding Institution
  • King's College London
SupervisorJuliana Onwumere (Supervisor) & Lucia Valmaggia (Supervisor)

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