Individual Family – Psychoeducational Psychotherapy (IF-PEP)

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

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.

Mary A. Fristad, PhD, ABPP

• Agency/Affiliation: The Ohio State University/Nationwide Children's Hospital
• Email: mary.fristad@nationwidechildrens.org
• Phone: (614) 722-6872

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

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 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

Recommended Intensity

Weekly 45-50-minute sessions, though it can be biweekly sessions

Recommended Duration

Varies from 10-24 weeks (depends if sessions are weekly or biweekly)

Delivery Settings

This program is typically conducted in a(n):

• Community-based Agency / Organization / Provider
• Outpatient Clinic

Homework

This program does include 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 the following languages 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 in this page).

Resources Needed to Run Program

The typical resources for implementing the program are:

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

Prerequisite/Minimum Provider Qualifications

Master’s- or Doctoral-level trained therapists

Manual Information

There is a manual that describes how to deliver this program.

Training Information

There is training available for this program.

Training Contact

Training Type/Location:

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)

“What is included in the Relevant Published, Peer-Reviewed Research section?”

• Fristad, M. A. (2006). Psychoeducational treatment for school-aged children with bipolar disorder. Development and Psychopathology, 18(4), 1289–1306. https://doi.org/10.1017/S0954579406060627

  Type of Study: Randomized controlled trial

  Participants: 20 children

  Sample / Population:

  • Age — 8–11 years
  • Race/Ethnicity — 90% Caucasian
  • Gender — 85% Male
  • Status —

    Participants were children with primary mood disorder diagnoses including bipolar I disorder, bipolar II disorder, and bipolar disorder, not otherwise specified.

  Location/Institution: Academic health center

  Summary:

  The purpose of the study was to test the effectiveness of Individual Family Psychoeducation (IFP) [now called Individual Family – Psychoeducational Psychotherapy (IF-PEP). Participants were randomized into IFP plus treatment as usual (IFP + TAU) condition, or into a waitlist-control condition plus TAU (WLC + TAU). Measures utilized include the Children’s Interview for Psychiatric Syndromes – Child and Parent Forms, the Children’s Depression Rating Scale – Revised (CDRS-R), Mania Rating Scale (MRS), Mood Severity Index (MSI), and Expressed Emotion Adjective Checklist (EEAC). Follow-up assessments of both groups were conducted 6 months, 12 months, and 18 months after study entry. After 12 months, the WLC + TAU group received IFP. Results indicate 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; IFP was not examined separately from TAU; and the study did not establish the practice’s benefit over the control group.

  Length of controlled 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. https://doi.org/10.1089/cap.2015.0132

  Type of Study: Randomized controlled trial

  Participants: 23

  Sample / 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, 9% Bi/Multiracial, and 4% Asian; 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: Academic health center

  Summary:

  The purpose of the study was to evaluate 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 [CYC]). Participants were randomly assigned to one of four groups: (O3 + IF-PEP; O3 + Active Monitoring (AM); Placebo [PBO] + IF-PEP; or to PBO + AM). Measures utilized include the e Kiddie Schedule for Affective Disorders (K-SADS), Kiddie Schedule for Depression Scales (KDRS), Kiddie Schedule for Mania Scales (KMRS), Children’s Depression Rating Scale-Revised (CDRS-R), and Young Mania Rating Scale (YMRS). Results indicate that combined therapy (O3+IF-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 include the small sample size, results may not be generalizable to fish oil supplements that do not utilize a 7:1 EPA:DHA (Eicosapentaenoic acid/ Docosahexaenoic acid) ratio, and lack of follow-up.

  Length of controlled postintervention follow-up: None.

• Vesco, A. T., Young, A. S., Arnold, L. E., & Fristad, M. A. (2017). Omega‐3 supplementation associated with improved parent‐rated executive function in youth with mood disorders: Secondary analyses of the omega 3 and therapy (OATS) trials. Journal of Child Psychology and Psychiatry, 59(6), 628–636. https://doi.org/10.1111/jcpp.12830

  Type of Study: Randomized controlled trial

  Participants: 95

  Sample / Population:

  • Age — Children: 7–14 years
  • Race/Ethnicity — Children: 62%White, 27% Black/African American, 12% Biracial, and 1% Asian; Parents: 66% White, 29% Black/African American, 4% Biracial/Multiracial, and 1% Asian
  • Gender — Children: 57% Male; Parents: Not specified
  • Status —

    Participants were children with depression or bipolar disorder who were referred from clinical and community settings.

  Location/Institution: Large Midwestern city

  Summary:

  The study used the same sample as Fristad et al. (2015). The purpose of the study was to assess the impact of omega-3 supplementation (Ω3) and Individual Family-Psychoeducational Psychotherapy (IF-PEP), each alone and in combination, on executive functioning (EF) in youth with mood disorders. Participants were randomly assigned to one of four groups: Ω3 monotherapy; IF-PEP monotherapy with pill placebo (PBO); combined intervention (Ω3 and IF-PEP); or PBO-only (no study intervention). Measures utilized include the Behavior Rating Inventory of Executive Functioning (BRIEF), the parent-report Global Executive Composite (GEC), the Kiddie Schedule for Depression Scale (KDRS), the Kiddie Schedule for Mania Scales (KMRS), the Children’s Depression Rating Scale-Revised (CDRS-R), and the Young Mania Rating Scale (YMRS). Results indicate that participants receiving Ω3 (aggregating combined and monotherapy) improved significantly more than aggregated placebo on the GEC and Metacognition Indices (MI). Ω3 alone and combined with IF-PEP each surpassed placebo on the GEC. Moderation by attention-deficit/hyperactivity disorder (ADHD) comorbidity was nonsignificant although those with ADHD showed nominally greater gains. IF-PEP monotherapy had negligible effect. Limitations include that the BRIEF, possibly reflecting parental bias, may differ from observation and performance-based tests, the results may not generalize to an EPA:DHA ratio other than the 7:1 used in this study, issues with baseline equivalence, lack of significant effects for IF-PEP, the original participants with Bipolar disorder were also analyzed with participants from another study that focused on depression, and concerns about generalizability.

  Length of controlled postintervention follow-up: None.

• 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