FAMILY-BASED INTERPERSONAL PSYCHOTHERAPY – AN EASY TRAINING MODEL FOR FRONTLINE WORKERS以家庭為中心的人際取向心理治療一個簡單的方法去裝備前線社工

Dr. Chung Pui Yin, Joseph

Associate Consultant

Department of Psychiatry

Pamela Youde Nethersole Eastern Hospital

Level D Supervisor Certification in IPT, Interpersonal Psychotherapy Institute

IN HONG KONG, THE WEIGHTED ONE-WEEK PREVALENCE OF DEPRESSIVE EPISODE AMONG CHINESE ADULTS AGED 16-75 WAS 2.9%. (LAM, 2015)

每 2 個有 1 個中學生受抑鬱困擾。約四分之一（25%）受訪學生出現達臨床關注水平的高焦慮徵狀。

BOTH ADULT OR ADOLESCENT DEPRESSION AFFECT THE FAMILY

EFFECTIVE TOOLS FOR THE TREATMENT OF DEPRESSION ARENEEDED IN BOTH PRIMARY, SECONDARY AND TERTIARY LEVELOF THE MENTAL HEALTH MODEL

DIFFERENT PSYCHOLOGICAL TOOLS TO TREAT DEPRESSION:- CBT- IPT- BEHAVIORAL ACTIVATION- MBCT- EFT- SUPPORTIVE PSYCHOTHERAPY- SOLUTION-FOCUSED THERAPY- COUNSELING

NICE GUIDELINE FOR ADULT DEPRESSION:

FOR PEOPLE WITH PERSISTENT SUBTHRESHOLD DEPRESSIVE SYMPTOMS OR MILD TO MODERATE DEPRESSION WHO HAVE NOT BENEFITED FROM A LOW-INTENSITY PSYCHOSOCIAL INTERVENTION, DISCUSS THE RELATIVE MERITS OF DIFFERENT INTERVENTIONS WITH THE PERSON AND PROVIDE:

AN ANTIDEPRESSANT (NORMALLY A SELECTIVE SEROTONIN REUPTAKE INHIBITOR [SSRI]) OR

A HIGH-INTENSITY PSYCHOLOGICAL INTERVENTION, NORMALLY ONE OF THE FOLLOWING OPTIONS:

CBT

INTERPERSONAL THERAPY (IPT)

BEHAVIOURAL ACTIVATION (BUT NOTE THAT THE EVIDENCE IS LESS ROBUST THAN FOR CBT OR IPT)

BEHAVIOURAL COUPLES THERAPY FOR PEOPLE WHO HAVE A REGULAR PARTNER AND WHERETHE RELATIONSHIP MAY CONTRIBUTE TO THE DEVELOPMENT OR MAINTENANCE OF DEPRESSION

NICE GUIDELINE FOR CHILDREN AND ADOLESCENTS DEPRESSION:

1.5.2 INTERVENTIONS FOR MILD DEPRESSION

1.5.2.1 DISCUSS THE CHOICE OF PSYCHOLOGICAL THERAPIES WITH CHILDREN AND YOUNG PEOPLE AND THEIR FAMILY MEMBERS OR CARERS (AS APPROPRIATE). EXPLAIN THAT THERE IS NO GOOD-QUALITY EVIDENCE THAT ONE TYPE OF PSYCHOLOGICAL THERAPY IS BETTER THAN THE OTHERS. [NEW 2015]

1.6.1 TREATMENTS FOR MODERATE TO SEVERE DEPRESSION

1.6.1.2 OFFER CHILDREN AND YOUNG PEOPLE WITH MODERATE TO SEVERE DEPRESSION A SPECIFIC PSYCHOLOGICAL THERAPY (INDIVIDUAL CBT, INTERPERSONAL THERAPY, FAMILY THERAPY, OR PSYCHODYNAMIC PSYCHOTHERAPY) THAT RUNS FOR AT LEAST 3 MONTHS. [NEW 2015]

• Developed by late Dr. Gerald L. Kerman & Myrna M. Weissman (Professor of Epidemiology and Psychiatry, Vagelos College of Physicians and Surgeons and the Mailman School of Public health at Columbia University)

• Initially a control arm in a RCT for the efficacy of imipramine in depression.

WHAT IS IPT?

IPT RCT EVIDENCE IN DEPRESSION

• ADULT DEPRESSION

• PERINATAL DEPRESSION

• ELDERLY DEPRESSION

• ADOLESCENT DEPRESSION

• PREADOLESCENT DEPRESSION

• DYSTHYMIA

• INDIVIDUAL OR GROUP IPT

• Adult Depression

• Adolescent Depression

• Depression in Older Adults

• Perinatal Depression

• Depression in Medical Patients

• Dysthymia

• Bipolar Affective Disorder (IPSRT)

• Bulimia Nervosa

• Emerging evidence (1 +ve RCT): PTSD

Can also be used to manage distress related to grief, interpersonal disputes and role transitions

APPLICABILITY AND RCT EVIDENCE

RCTs

RESULTS OF PAIRED-SAMPLE T-TEST FOR YOUTH GROUP IN BOKSS (N=10)

Variable Mean t Sig.

Pre-test Post-test

PHQ9 9.4 7.0 2.11 .064

PRE- AND POST- TEST SCORE OF DEPRESSION

0

1

2

3

4

5

6

7

8

9

10

pre test post test

PHQ

GAD9

CLIENT’S FEEDBACK

• “有很多不同經歷的人，但分享著相似的想法，情緒和應對方法，希望可增加堂數”

•“喜歡大家一起商討解決方法的時候”

•“喜歡組員勇於發言的時候”

•“我喜歡跟組員分享，大家互相支持的時候”

Symptoms Reduction

Improve Interpersonal Relationships

Increase Social Support

GOALS OF IPT

Short-term

Non-transference /cognitive-based

Bio-psychosocial,

cultural, spiritual model

Collaborative, strength-based,

therapist as coach

Focus on communications

and social support

CHARACTERISTICS OF IPT

Assessment –Initial Phase

• Complete psychiatric history (including

attachment style)

• Interpersonal Inventory

• Interpersonal Formulation

• Interpersonal Summary

1-3 sessions

Middle Phase

• Work on IPT Problem areas: 1) Grief & Loss 2)

Interpersonal disputes 3) Role Transitions 4)

Interpersonal Deficits

4-12 sessions

Conclusion of Acute Treatment 1-2 sessions

Maintenance Treatment Per contract

IPT STRUCTURE

INTERPERSONAL INVENTORY

To understand current

relationships and social

support network

Identify communication

styles

Relationship Issues Family Issues

Medical or

Physical Issues

Religious or

Spiritual Support

• Expression of Affect

• Link Improvement in relationships to improvement in Mood

• Interpersonal Incidents

• Look into the details of interaction

• Communication analysis

• Expectations

• Communication patterns

• Problem-solving/Decision Analysis

• Brainstorming

• Role Play

• Practice new ways of communication

IPT TECHNIQUES

FAMILY-BASED INTERPERSONAL PSYCHOTHERAPY (FB-IPT)

LAURA J. DIETZ, PH.DASSISTANT PROFESSOR OF PSYCHOLOGYUNIVERSITY OF PITTSBURGH AT JOHNSTOWN

REBECCA J. WEINBERG, PSYD

LAURA MUFSON, PH.DPROFESSOR OF MEDICAL PSYCHOLOGY IN PSYCHIATRYCOLUMBIA UNIVERISTY MEDICAL CENTER

ACTIVELY INVOLVES PARENTS IN BOTH CONJOINT AND DYADIC SESSIONS WITH PREADOLESCENTS DURING THE DIFFERENT PHASES OF TREATMENT.

PARENT TIPS

STRIKE WHILE THE IRON’S COLDCONSIDER THE INTENTION, NOT THE OUTCOMEKIND AND FIRMPUT ON YOUR OWN OXYGEN MASK FIRST

TWEEN TIPS

USE GOOD TIMINGGIVE TO GETMAKE “I FEEL” STATEMENTSHAVE A FEW SOLUTIONS IN MINDMEET IN THE MIDDLELET’S MAKE A DEAL

RCT ON FB-IPT (DIETZ, 2015)

TREATMENT OUTCOME

TRAINING

2-DAY WORKSHOPCLINICAL SUPERVISION

EXPERIENCED MENTAL HEALTH PROFESSIONALS CAN OBTAIN PROFICIENCY IN IPT WITH JUST 1-2 CASE SUPERVISION

IPT WORKSHOP

PYNEH

RESULTS

Traditional model:

Just one-third of the therapists who completed a 20-hour didactic course in IPT completed subsequent group supervision and conducted IPT with at least one patient.

COMMUNITY-BASED MODEL OF SUPERVISION

• Group supervision of 5-6 mental health professionals.

• 10 biweekly supervision of 1 hour, to complete 2 cases for each therapist undergoing training.

• Each meeting began with a brief (5–10 min) review of a component or technique of treatment structured through a meeting syllabus.

• Followed by open case consultation time in which clinicians discussed and received feedback on their IPT cases.

• Completion of 2 case portfolios for each therapist.

LOS ANGELES EXPERIENCE

• From 2011-2016, 1430 clinicians within the Los Angeles County Department of Mental Health (LAC-DMH) system have completed Level A training in IPT. A total of 344 of those have already left the LAC-DMH system (24.1%). A total of 322 have completed the entire Community Training Program and been certified in IPT (22.5%).

• Training by 14 expert consultants who have provided 1394 consultation sessions.

• In 2015, 2619 unique patients received IPT within the LACDMH system

• Patients received 13 sessions of IPT on average

• The top four reported diagnoses treated were depressive disorder NOS, dysthymic disorder, major depressive disorder (MDD) recurrent, and MDD single episode.

PYNEH

• Started IPT group supervision of psychiatric nurses since March 2019

• 4 nurses per batch

TRAINING

https://www.interpersonalpsychotherapy.org/ https://iptinstitute.com/

My email: chungpy2@ha.org.hk

• Read the Manual : The Guide to Interpersonal Psychotherapy (Myrna M. Weissman, John C. Markowitz, Gerald L. Klerman)

TRAINING

FB-IPT

THANK YOU!

Q&A

References

Lam LC, Wong CS, Wang MJ, et al. Prevalence, psychosocial correlates and service

utilization of depressive and anxiety disorders in Hong Kong: the Hong Kong Mental

Morbidity Survey (HKMMS). Soc Psychiatry Psychiatr Epidemiol 2015; 50(9): 1379-88.

NICE Guideline on Depression in adults: recognition and management

NICE Guideline on Depression in children and young people: identification and

management

P Cuijpers. Interpersonal psychotherapy for depression: a meta-analysis. Am J

Psychiatry. 2011 Jun;168(6):581-92.

P BOLTON. GROUP INTERPERSONAL PSYCHOTHERAPY FOR DEPRESSION IN RURAL UGANDA: A RANDOMIZED CONTROLLED TRIAL. JAMA. 2003 JUN 18;289(23):3117-24.

LJ DIETZ. FAMILY-BASED INTERPERSONAL PSYCHOTHERAPY (FB-IPT) FOR DEPRESSED PREADOLESCENTS: EXAMINING EFFICACY AND POTENTIAL TREATMENT MECHANISMS. J AM ACAD CHILD ADOLESC PSYCHIATRY. 2015 MAR; 54(3): 191–199.

ROUNSAVILLE, B. J., CHEVRON, E. S., WEISSMAN, M. M., PRUSOFF, B. A.,& FRANK, E. (1986). TRAINING THERAPISTS TO PERFORM INTERPERSONAL PSYCHOTHERAPY IN CLINICAL TRIALS. COMPREHENSIVE PSYCHIATRY, 27, 364–371.

S STUART. A NEW COMMUNITY-BASED MODEL FOR TRAINING IN EVIDENCE-BASEDPSYCHOTHERAPY PRACTICE. COMMUNITY MENTAL HEALTH JOURNAL. PUBLISHED ONLINE 02 FEBRUARY 2018.

REAY, R., STUART, S., & OWEN, C. (2003). IMPLEMENTATION AND EFFECTIVENESSOF INTERPERSONAL PSYCHOTHERAPY IN A COMMUNITY MENTAL HEALTHSERVICE. AUSTRALASIAN PSYCHIATRY, 11, 284–289.