Psychological treatments

Psychological treatments can involve the person with bipolar disorder, the family or be designed specifically to support caregivers. Benefits of having specialized psychological treatments (conducted by trained health professionals) in addition to the person’s usual medications can include reductions in bipolar relapse, time spent ill, hospitalization, help with the effects of bipolar on the person, and improved functioning. ^{1- 8} Caregivers can also benefit from treatments that support them to deal with the illness, take care of themselves and reduce their distress.^{9, 10}

Psychological treatments involving the person with bipolar disorder

Psychoeducation: involves discussing and learning about bipolar disorder, its treatment and positive ways to manage the illness and keep well. For example, people with bipolar disorder who participated in group psychoeducation showed a greater reduction in bipolar relapse than those who participated in a supportive group without psychoeducation.¹ Some of these benefits, especially those related to depression were still experienced 5 years after treatment although people with fewer previous episodes benefited the most.

Cognitive behavioral therapy (CBT) or Cognitive Therapy (CT): involves psychoeducation with a focus on assisting the person to alter their thinking patterns to help change their mood, mood monitoring and setting small goals to build up activity levels when depressed.^2,3

Interpersonal Social Rhythm Therapy (IPSRT): involves psychoeducation with a focus on assisting people to regulate their sleep patterns, social and daily activities, and  dealing with the changes and losses sometimes connected to bipolar disorder. ⁴

Enhanced care programs are long term treatments that involve psychoeducation and frequent contact with a nurse care coordinator to help the person monitor their mood and medication, and work as a team with the treating doctor.^{5, 6}

Psychological treatments that include the family or caregivers

Family Focused Therapy (FFT) includes the person with bipolar disorder and their family member(s).⁷ It involves psychoeducation and learning ways to solve problems together and improve family communication. Benefits of combining medications and FFT for some people include fewer relapses  and hospitalizations and better daily functioning.⁸ It also helped people with bipolar depression to get better more quickly.

Caregiver group psychoeducation involves groups for caregivers of people with bipolar disorder. This involves psychoeducation about the illness and its treatment,  and caregivers can learn more about ways to help prevent relapse, deal with family stress and take care of themselves. Caregivers who participated in this psychoeducation experienced less distress and their relatives experienced a reduction in hypomanic and manic relapses.⁹

Family -Focused Treatment-Health Promoting Intervention combines information on the illness and ways to manage it (as in FFT) with helping caregivers to set personalized self-care goals and reduce depression and other health problems.¹⁰ This treatment helped caregivers to take better care of themselves and reduced caregiver depression. There was also a drop in the depression levels of their relatives with bipolar disorder.

Certain people with bipolar disorder may benefit more from specific types of psychological treatment.¹¹ However, overall the research suggests that combining medication and certain psychological treatments for bipolar disorder can be helpful and this is recommended in Bipolar disorder treatment guidelines

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References

1. Colom F, Vieta E, Sánchez-Moreno J, Palomino-Otiniano R. et al. Group psychoeducation for stabilized bipolar disorders: 5-year outcome of a randomized clinical trial. Brit J Psychiat 2009; 194 (3):  260-265.
2. Lam DH, Watkins ER, Hayward P, et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder. Arch Gen Psychiatry 2003; 60: 145–152.
3. Castle D, White C, Chamberlain J et al. Group-based psychosocialintervention for bipolar disorder. Randomised controlled trial. Brit J Psychiat 2010; 196: 383-388.
4. Frank E, Kupfer DJ, Thase ME, et al. Two-year outcomes for interpersonaland social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005; 62: 996-1004.
5. Bauer MS, McBride L, Williford WO, et al. Collaborative care for bipolar disorder: Part II. Impact on clinical outcome, function, and costs. Psychiatr Serv 2006; 57: 937-945.
6. Simon G.E, Ludman EJ, Bauer MS, Unutzer J, & OperskalskiB. Long-term effectiveness and cost of a systematic care management program for bipolar disorder. Arch Gen Psychiatry 2006; 63: 500–508.
7. Miklowitz DJ, George EL, Richards JA, Simoneau TL, Suddath RL. A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003; 60: 904-912.
8. Miklowitz, DJ, Otto MW, Frank E, et al. Intensive psychosocial intervention enhances functioning in patients with bipolar disorder: Results from a 9 month randomized controlled trial. Am J Psychiatry 2007; 164: 1340-1347.
9. Reinares M, Colom F, Sanchez-Moreno J, et al. Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomized controlled trail. Bipolar Disord 2008; 10: 511-19.
10. Perlick DA, Miklowitz DJ, Lopez N et al. Family-focused treatment for caregivers of patients with bipolar disorder. Bipolar Disord 2010; 12: 627-637.
11. Scott J, Paykel E, Morriss R, et al. Cognitive-behavioral therapy for severe and recurrent bipolar disorders: a randomized controlled trial. Brit J Psychiat 2006; 188: 313–320.