Development and Trial of a Resilience Psychoeducational Group Intervention for Adult Psychiatric Inpatients

Background and Purpose: Increasing attention has been paid to the question of why some patients with severe and persistent mental illness (SPMI) are observed with the ability to minimize relapses and recover more quickly. Psychoeducational relapse prevention groups have become part of standard care in psychiatric inpatient units, but are often attended only once by an individual patient due to brief lengths of stay on such units. Single introductory psychoeducational sessions are also part of outpatient intervention protocols. The objectives of this study were to develop and test a resiliency theory-based group psychoeducational brief treatment protocol.

Methods: The study design consisted of systematic literature review as the basis for intervention design, followed by testing of the manualized intervention using a mixed methods multiple case study design. The Brief Resilience Scale (BRS), a six-item five point Likert scale, was utilized as the quantitative measure analyzed as one of the descriptive statistics, with both online and hand-scoring tested for ease of use by participants. Qualitative ethnographic methods were utilized during a pre-intervention period of four months in a tertiary level adult inpatient psychiatric unit and the intervention period of one month. An individual patient who completed the BRS online and manually, but did not receive the group psychoeducational intervention, was a 63 year old white male with minimal cognitive impairment. The group sample was comprised of 2 males and 7 females ages 22-77 with mild to moderate cognitive impairment.

Results:

The systematic review located no manualized protocols specific to psychoeducational intervention and no resilience theory-based group interventions for the SPMI population, although several studies meeting inclusion criteria found individual, group, and family psychoeducation to be an effective intervention for this population. Three full text tested protocols for SPMI group interventions were identified and were adapted within a resilience theory framework for this study’s single-session group intervention protocol. Results for the individual participant were his ability to understand the instructions and complete and score the BRS either online or manually within 3 minutes, with a score of 24 out of a possible 30. BRS scores averaged 12.63 and 12.75 for two groups; all but two completed it independently with manual scoring within 3 to 5  minutes. Group participants with a range of functional level expressed responded positively and indicated that the activity made them think more about what they have, and helped them expand their view of ways to increase resilient factors in their lives. Participation was increased in overall quantity and in number of group member interactions with this intervention compared to other group sessions.

Conclusions and Implications:

Briefer group interventions are increasingly being sought or implemented in practice due to high relapse, drop-out, and no-show rates in this population and to improve cost-effectiveness.This brief intervention appears appropriate and useful in an inpatient setting with adult patients with SPMI. Observed usefulness encompassed the process outcomes of increased group participation, reflection, and goal setting. Further investigation is needed to determine its impact on clinical outcomes.