My Story: The Use of Narrative Therapy in Individual and Group Counseling

Optimising participation in a pulmonary rehabilitation programme for people living with chronic respiratory diseases in rural India: a feasibility study

Background

Pulmonary rehabilitation (PR) plays a vital role in managing chronic obstructive pulmonary disease and other chronic respiratory diseases (CRDs). However, implementation of this multidisciplinary approach in resource-poor settings may not be sufficient because of referrers' uncertainty regarding the effectiveness of PR, inconvenient timing, travel issues, patients' lack of motivation, and poor family support. The aim was to test the feasibility of a peer-led, professionally assisted community-based PR programme for CRD patients in a rural, low literacy setting.

Methods

We conducted a single-centre, pre-post feasibility study. Participants with a confirmed diagnosis of CRD were recruited and treatment was optimised. After completing baseline assessments, the participants underwent eight weeks of PR training (16 sessions) in six groups at five local facilities led by peers selected by the participants and assisted by professionals. Exercise capacity was assessed with 6-Minute Walk Test. Other outcomes were: International Physical Activity Questionnaire; Hospital Anxiety and Depression Scale; London Chest Activity of Daily Living scale. Upper and lower limb strength were assessed using a handheld dynamometer and cycle ergometer, respectively. Descriptive analysis was performed, and pre-and post-outcomes were compared using parametric tests.

Results

Thirty participants (20 chronic obstructive pulmonary disease and 10 asthma; 15 female; median age 57.5 years) completed baseline and endline assessments. Seventy percent completed at least 12/16 sessions. After eight weeks of training, the 6-Minute Walk Test had improved from 263.3 (standard deviation (SD) = 72.3) to 319.6 (SD = 84.7) metres (P < 0.001) with significant improvement in modified Medical Research Council (P = 0.022), London Chest Activity of Daily Living scale (P < 0.001) and dominant handgrip strength (P < 0.001) but no significant change in physical activity (P = 0.791).

Conclusions

The community-based PR led by peer volunteers and supported by professionals proved to be feasible in our low-resource setting and was associated with improved exercise tolerance and other outcomes.

Registration

The study was registered at the Clinical Trials Registry - India (CTRI/2020/09/027818).

An unexpected visitor and a sword play: a randomized controlled trial of collective narrative therapy groups for primary carers of people with schizophrenia

BACKGROUND

Most family carer support programs focus on supporting carers with caregiving-related knowledge and skills to help their family members who suffer from schizophrenia in their recovery process while carers' inner resources and preferred identities are less emphasized in the existing studies.

AIMS

The present study uses collective narrative therapy groups (CNTG) to promote the inner strengths and agency of family carers and help them to explore their preferred identities while caring for family members with schizophrenia.

METHOD

To ensure an evidence-based intervention, 89 Chinese family carers of people with schizophrenia took part in this three-wave longitudinal program evaluation study using a randomized controlled trial design.

RESULTS

Compared with the control group, family carers in CNTG reported better family relationships, a lesser caregiving burden, and more perceived inner resources. Repeated one-way ANOVA revealed that CNTG improved family relationships, the caregiving burden, the level of hope and inner resources in the posttest, and a statistically significantly better mental health condition in the follow-up.

CONCLUSION

This study shows that collective narrative psychotherapy is effective in supporting family carers of people with schizophrenia in Hong Kong. Based on the research findings, we discuss the strengths of the program and its implications for practitioners.

Healing with Stories: using the Transformative Storytelling technique to generate empowering narratives for informal caregivers. A Method Demonstration (Preprint)

Background

Objective

Methods

Results

Conclusions

Outside-in or Inside-out? A Randomized Controlled Trial of Two Empowerment Approaches for Family Caregivers of People with Schizophrenia

Training-based intervention such as psychoeducational groups has become increasingly popular to empower family caregivers of people with schizophrenia, yet existing supportive programs for caregivers tend to focus more on the needs of the patients rather than the development of the caregivers. This study aimed to compare the outcomes of a skill-based empowerment psychoeducational group and an inner-resource enhancing empowerment narrative therapy group for family caregivers of people with schizophrenia. We conducted a randomized controlled trial with a longitudinal design. The sample consisted of 132 family caregivers who were randomly assigned to eight sessions of the two groups (i.e. a narrative-based group, or a psychoeducational group), or a control group with delayed treatment. Psychometric scales were administrated throughout the project. Both the psychoeducational group and the narrative group showed significant improvements in family relationships, caregiving burden, and coping skills compared with the control group across the three time points (pretest, posttest, and 2-month follow-up). A statistically significant advancement in coping skills was found in the psychoeducational group. The narrative group outperformed the psychoeducational group and the control group in the enhancement of inner resources, perceived control, and level of hope. The findings call for the need of an integrative empowerment approach that both values the inner strength and unique experiences of the caregivers and at the same time provides them with necessary skills and knowledge in taking care of their family members with schizophrenia.

How digital storytelling is used in mental health: A scoping review

The creative arts can be used to support stakeholders of mental health services to communicate and share their lived experience. Digital storytelling is one method that has been used to capture people's lived experience. In this scoping review, we were interested in mapping how digital storytelling has been used in mental health, and to identify gaps in the literature. Nine databases were searched to identify peer reviewed literature published between January 2000 and August 2015; 15 articles were included in the review. The articles were categorized across four broad areas: educational interventions, learning skills, learning about other people's lived experience, and learning about personal lived experience. We identify that while digital storytelling has potential as a participatory process to promote mutual understanding of and empathy towards lived experiences in mental health, there is a dearth of research in this area. More research is needed on the use of digital storytelling in mental health to determine its effectiveness in progressing a recovery orientation in service provision that is built on solidarity and a social justice agenda.