Individual Family - Psychoeducational Psychotherapy (IF-PEP)

Scientific Rating:
NR
Not able to be Rated
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

About This Program

The information in this program outline is provided by the program representative and edited by the CEBC staff. Individual Family - Psychoeducational Psychotherapy (IF-PEP) has been reviewed by the CEBC in the area of: Bipolar Disorder Treatment (Child & Adolescent), but lacks the necessary research evidence to be given a Scientific Rating.

Target Population: Children aged 7-14 with major mood disorders (depressive and bipolar spectrum) and their parents

For children/adolescents ages: 7 – 14

For parents/caregivers of children ages: 7 – 14

Brief Description

IF-PEP is a manual-based treatment for children aged 7-14 with mood disorders (depressive and bipolar spectrum disorders). IF-PEP is based on a biopsychosocial framework and utilizes cognitive-behavioral and family-systems based interventions. IF-PEP is a 20-24 session, 45-50-minutes-per-session treatment with 20 scripted and 4 “in-the-bank” sessions that alternate between parents and children attending. One special session each is devoted to working with school professionals and siblings.

There is also a group version of Psychoeducational Psychotherapy known as Multi-Family Psychoeducational Psychotherapy (MF-PEP), that has been rated in this topic area as well.

Program Goals:

The goals of Individual Family - Psychoeducational Psychotherapy (IF-PEP) are:

  • Learn about the symptoms of mood disorders
  • Effectively manage the symptoms of mood disorders
  • Improve communication
  • Improve problem solving
  • Improve emotion regulation
  • Decrease family tension
  • Improve consumer skills
  • Reduce symptom severity
  • Improve functioning

Essential Components

The essential components of Individual Family - Psychoeducational Psychotherapy (PEP) include:

  • Psychoeducation on mood disorders and their treatment
  • Emotion-regulation skills
  • Cognitive-behavioral skills
  • Problem solving skills
  • Communication (verbal and nonverbal) skills
  • Symptom management skills
  • Healthy habits (sleep hygiene, diet, exercise)

Child/Adolescent Services

Individual Family - Psychoeducational Psychotherapy (IF-PEP) directly provides services to children/adolescents and addresses the following:

  • Major mood disorder (bipolar or depressive), difficulty regulating emotion

Parent/Caregiver Services

Individual Family - Psychoeducational Psychotherapy (IF-PEP) directly provides services to parents/caregivers and addresses the following:

  • Having a child with a major mood disorder

Delivery Settings

This program is typically conducted in a(n):

  • Community Agency
  • Outpatient Clinic

Homework

Individual Family - Psychoeducational Psychotherapy (IF-PEP) includes a homework component:

Assignments that extend the lesson-of-the-day are given at each session and reviewed at each subsequent session.

Languages

Individual Family - Psychoeducational Psychotherapy (IF-PEP) has materials available in a language other than English:

Spanish

For information on which materials are available in this language, please check on the program's website or contact the program representative (contact information is listed at the bottom of this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

Therapist office, parent/child workbooks and/or treatment manual

Minimum Provider Qualifications

Master's- or Doctoral-level trained therapists

Education and Training Resources

There is a manual that describes how to implement this program, and there is training available for this program.

Training Contact:
Training is obtained:

It varies based on current knowledge.

Number of days/hours:

2 days (12 hrs — this covers assessment and treatment — usually providers also wish an in-service on assessing bipolar disorder in children)

Relevant Published, Peer-Reviewed Research

This program has been reviewed and it was determined that this program lacks the type of published, peer-reviewed research that meets the CEBC criteria for a scientific rating of 1 – 5. Therefore, the program has been given the classification of "NR - Not able to be Rated." It was reviewed because it was identified by the topic expert as a program being used in the field, or it is being marketed and/or used in California with children receiving services from child welfare or related systems and their parents/caregivers. Some programs that are not rated may have published, peer-reviewed research that does not meet the above stated criteria or may have eligible studies that have not yet been published in the peer-reviewed literature. For more information on the "NR - Not able to be Rated" classification, please see the Scientific Rating Scale.

Child Welfare Outcomes: Not Specified

Show relevant research...

Fristad, M. A. (2006). Psychoeducational treatment for school-aged children with bipolar disorder. Development and Psychopathology, 18, 1289-1306. doi:10.1017/S0954579406060627 

Type of Study: Randomized controlled trial
Number of Participants: 20 children (and their families)

Population:

  • Age — 8-11 years
  • Race/Ethnicity — 90% Caucasian
  • Gender — 85% Male and 15% Female
  • Status — Participants were children with primary mood disorder diagnoses including bipolar I disorder, bipolar II disorder, and bipolar disorder, not otherwise specified.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Participants were randomized, by pairs, into the Individual Family Psychoeducation (IFP, otherwise known as Individual Family - Psychoeducational Psychotherapy (PEP)) plus treatment as usual (IFP + TAU, n = 10) condition, or into a waitlist-control condition plus TAU (WLC + TAU, n = 10) Measures included the Children’s Interview for Psychiatric Syndromes – Child and Parent Forms; the Children’s Depression Rating Scale – Revised (CDRS-R) and Mania Rating Scale (MRS) in order to assess severity of mood impairment; and Mood Severity Index (MSI), which measured overall mood severity. Also, the Expressed Emotion Adjective Checklist (EEAC) assessed family expressed emotion (EE). Follow-up assessments of both groups were conducted 6 months after study entry, at 12 months, and at 18 months. After 12 months, the WLC + TAU group received IFP. Results showed that children’s mood improved immediately following treatment, with gains continuing for 12 months post-IFP. Additionally, families who received immediate IFP treatment showed higher scores on the EEAC, which reflects better family climate. Limitations include the small sample size, which made the findings described above not statistically significant and does not establish the practice's benefit over the control group.

Length of postintervention follow-up: 12 months (treatment group) and 6 months (WLC group).

Leffler, J. M., Fristad, M. A. & Klaus, N. M. (2010). Psychoeducational Psychotherapy (PEP) for children with bipolar disorder: Two case studies. Journal of Family Psychotherapy, 21(4). doi:10.1080/08975353.2010.529051

Type of Study: Case studies
Number of Participants: 2

Population:

  • Age — 8-12 years
  • Race/Ethnicity — White
  • Gender — 1 Male and 1 Female
  • Status — Female participant had baseline mood diagnosis of bipolar disorder, most recent episode-mixed; male participant had a baseline diagnosis of bipolar disorder, most recent episode-hypomanic.

Location/Institution: Not Specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Two children presenting with bipolar disorder were treated with an expanded version of Individual Family - Psychoeducational Psychotherapy (PEP), lengthened from 16 to 24 sessions. Measures included the Children’s Interview for Psychiatric Syndromes-Child and Parent (ChIPS & P-ChIPS) forms, which are structured psychiatric interviews to assess psychopathology according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria with parents of children and adolescents. The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children – Mania Rating Scale (K-MRS) and Depression Rating Scale (K-DRS) were used to assess mood severity. Additionally, the Children’s Global Assessment Scale (C-GAS) was used to measure the children’s overall functional capacity; the Expressed Emotion Adjective Checklist (EEAC) assessed positive and negative emotions expressed by the parent and child toward each other, as reported by the parent; and the Treatment Beliefs Questionnaire- Parent and Child Forms (TBQ-P and TBQ-C) were self-report measures used to assess beliefs about treatments (pharmacologic and psychosocial). Both subject’s K-MRS scores improved from pre- to post-treatment, but remained in the symptomatic range. For the K-DRS, the female subject's current functioning score was reduced by 18% from pre- to post-treatment, while the male subject’s score increased by 28%. Functioning improved over time for both children, though both were still notably impaired at the end of the study. Results suggested improved family functioning, improvement in children’s manic symptoms, and overall level of functioning. Limitations include the small sample size, the homogeneity in race/ethnicity (both White), and the lack of follow-up data.

Length of postintervention follow-up: None.

Fristad, M. A., Young, A. S., Vesco, A. T., Nader, E. S., Healy, K. Z., Gardner, W., ... Arnold, L. E. (2015). A randomized controlled trial of Individual Family Psychoeducational Psychotherapy and omega-3 fatty acids in youth with subsyndromal bipolar disorder. Journal of Child and Adolescent Psychopharmacology, 25(10), 764-774. doi:10.1089/cap.2015.0132

Type of Study: Randomized controlled trial
Number of Participants: 23

Population:

  • Age — Children: 7-14 years (Mean=10.2 years); Parents: 36-42 years (Mean=38.8 years)
  • Race/Ethnicity — Children: 74% White, 13% Black/African American, 4.3% Asian, and 8.7% Other; Parents: Not specified
  • Gender — Children: 57% Male, Parents: Not specified
  • Status — Participants were children with bipolar disorder who were referred from clinical and community settings.

Location/Institution: Not specified

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study evaluates efficacy of omega-3 fatty acid supplementation (O3), Individual Family Psychoeducational Psychotherapy (IF-PEP), and their combination in youth with subsyndromal bipolar disorders (bipolar disorder not otherwise specified [BP-NOS], cyclothymic disorder. Participants were randomly assigned to one of four groups: (O3 + PEP: n = 5; O3 + Active Monitoring [AM]: n = 5; Placebo [PBO] + PEP: n = 7; PBO + AM: n = 6). Results showed combined therapy (O3+PEP) was associated with greater improvement in depressive symptoms than PBO+AM. IF-PEP demonstrated medium to large effects on depressive symptoms compared with AM. Additionally, combined therapy was more effective than O3 monotherapy, but not more effective than IF-PEP monotherapy. Limitations of the study include the small sample size, results may not be generalizable to fish oil supplements that do not utilize a 7:1 EPA:DHA ratio, and lack of follow-up.

Length of postintervention follow-up: None.

Young , A. S., Arnold, E. L., Wolfson, H. L., & Fristad, M. A. (2016). Psychoeducational psychotherapy and omega-3 supplementation improve co-occurring behavioral problems in youth with depression: Results from a pilot RCT. Journal of Abnormal Child Psychology. Advance online publication. doi:10.1007/s10802-016-0203-3

Type of Study: Randomized controlled trial
Number of Participants: 72

Population:

  • Age — 7-14 years
  • Race/Ethnicity — 57% Caucasian, 30% African American, and 13% Biracial
  • Gender — 56.9% Male
  • Status — Participants were children with depression who were referred from clinical and community settings.

Location/Institution: Large Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study investigated benefits of omega-3 fatty acid supplementation and Individual-Family Psychoeducational Psychotherapy (IF-PEP); a family-focused, cognitive-behavioral therapy) for behavior problems among youth with depression. Participants were block-randomized to receive combined treatment (IF-PEP + omega-3 supplementation), IF-PEP monotherapy (plus placebo), omega-3 monotherapy, or placebo alone. Measures utilized include demographic questionnaire, the Eyberg Child Behavior Inventory (ECBI), the Children’s Depression Rating Scale-Revised (CDRS-R), K-SADS Depression Rating Scale (KDRS), the Swanson, Nolan, and Pelham-IV (SNAPIV). Results indicated combination treatment yielded the most robust effects across behavioral outcomes, providing preliminary support for combining these interventions in treating the severity and frequency of behavior problems overall as well as hyperactivity/impulsivity among youth with depression. Omega-3 supplementation alone may have particular promise in alleviating inattentive symptoms among youth with depression. None of the treatments had a significant effect on SNAP-IV ODD scores or ECBI Problem scores relative to placebo, although trends were evident, with combined treatment yielding medium effects. Thus, this study offers only modest support for the efficacy of omega-3 supplementation and/or PEP in treating oppositional behaviors. Limitations of the study include the small sample size, participants’ depression symptoms were mild; thus, results may not be generalizable to youth with severe depression, and length of follow-up.

Length of postintervention follow-up: 2, 4, 6, 9, and 12 weeks.

Fristad , M. A., Vesco, A. T., Young, A. S., Healy, Z. K., Nader, E. S., Seidenfeld, A. M., … Arnold, E. L. (2016). Pilot randomized controlled trial of omega-3 and Individual-Family Psychoeducational Psychotherapy for children and adolescents with depression. Journal of Clinical Child and Adolescent Psychology. Advance online publication. doi:10.1080/15374416.2016.1233500

Type of Study: Randomized controlled trial
Number of Participants: 72

Population:

  • Age — 7-14 years
  • Race/Ethnicity — 57% Caucasian, 30% African American, and 13% Biracial
  • Gender — 57% Male
  • Status — Participants were children with depression who were referred from clinical and community settings.

Location/Institution: Large Midwestern city

Summary: (To include comparison groups, outcomes, measures, notable limitations)
This study uses the same sample as Young, Arnold, Wolfson, & Fristad (2016). This study evaluates the feasibility and estimate effect sizes of using omega-3 fatty acids (Ω3), Individual-Family Psychoeducational Psychotherapy (IF-PEP), and the combination of omega-3 and IF-PEP, and the moderating effects of maternal depression and psychosocial stressors in youth with depression. Participants were randomly assigned to one of four groups: IF-PEP + omega-3, IF-PEP monotherapy (with pill placebo), omega-3 monotherapy, or placebo (without active intervention). Measures utilized include demographic questionnaire, and the Mania Rating Scale (KMRS), the Children’s Interview for Psychiatric Syndromes Child and Parent Versions (ChIPS/P-ChIPS), the Kaufman Brief Intelligence Test, 2nd Edition (KBIT-2), the Vineland Adaptive Behavior Scales, 2nd Edition (VABS-II), and the Family History Screen (FHS). Results indicated that combined IF-PEP + omega-3 is a promising treatment for co-occurring behavior symptoms in youth with depression. IF-PEP and Ω3, alone or in combination, did not significantly impact depressive trajectories compared to placebo alone in this pilot study, although small-medium effects were noted for Ω3 monotherapy and combined treatment relative to placebo. Limitations of the study include the small sample size, the effects of Ω3 may not be generalizable to fish oil supplements that differ in dose or EPA/DHA ratio, reliability of therapy video ratings was acceptable but not strong, results may not be generalizable to youth with severe presentations of depression, and length of follow-up.

Length of postintervention follow-up: 2, 4, 6, 9, and 12 weeks.

References

Fristad, M. A., Goldberg Arnold, J. S. & Leffler, J. (2011). Psychoeducational Pyschotherapy (PEP): Treatment Manual for Children with Mood Disorders. New York: Guilford Press.

Fristad, M. A. (2016). Evidence-based psychotherapies and nutritional interventions for children with bipolar spectrum disorders and their families. The Journal of Clinical Psychiatry, 77(suppl E1):e04. doi: 10.4088/JCP.15017su1c.04

Fristad, M. A., & MacPherson, H. (2014). Evidence-based psychosocial treatments for bipolar disorder in youth. Journal of Clinical Child and Adolescent Psychology, 43(3), 339-355. doi:10.1080/15374416.2013.822309

Contact Information

Name: Mary A. Fristad, PhD, ABPP
Agency/Affiliation: The Ohio State University
Email:
Phone: (614) 293-4572
Fax: (614) 293-4949

Date Research Evidence Last Reviewed by CEBC: August 2016

Date Program Content Last Reviewed by Program Staff: October 2017

Date Program Originally Loaded onto CEBC: August 2010