Impact of cognitive-psychoeducational interventions in bipolar patients and their relatives

Bernhard, Britta; Schaub, Annette; Kümmler, Petra; Dittmann, Sandra; Severus, Emanuel; Seemüller, Florian; Born, Christoph; Forsthoff, Anna; Licht, Rasmus Wentzer; Grunze, Heinz

doi:10.1016/j.eurpsy.2005.09.007

Cited by 50 publications

(49 citation statements)

References 51 publications

(60 reference statements)

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“…The results from these evaluations are comparable to results found using the same measures in studies with similar methodologies and goals (Friedman, 2005;Glueckaf et al, 2002;Weisman et al, 1998). Consistent with the findings of previous research, participant knowledge increased, specifically about symptoms of the disorder, despite the fact that the sample was highly knowledgeable before the study (Bernhard et al, 2006;Reinares et al, 2004). Although there were low levels of anger before the intervention, anger was highly correlated with blaming attributions before the workshop, suggesting that anger may still be an important target that warrants a direct intervention.…”

Section: Discussionsupporting

confidence: 87%

“…Another methodological limitation was the length of the follow-up period. After 1 week, participants may not have had enough time to implement, practice, and fine-tune the skills learned in the workshop (Bernhard et al, 2006;Doss, Thum, Sevier, Atkins, & Christensen, 2005). Nonetheless, it must be stated that this intervention may simply not be effective.…”

Section: Discussionmentioning

confidence: 99%

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An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

Eisner

Johnson

2008

Behavior Therapy

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Expressed emotion (EE) is a robust predictor of outcome in bipolar disorder. Despite decades of research, interventions to reduce EE levels have had only modest effects. This study used an expanded model of EE to develop an intervention. Research has demonstrated a strong link between attributions and EE in families of patients with psychiatric disorders. There is also substantial research to suggest that anger can drive blaming attributions. Combining these ideas, this study built on previous psychoeducation interventions through the addition of an acceptance component designed to decrease anger and blaming attributions among family members of those with bipolar disorder. Twenty-eight family members attended a 1-day or 2-evening multifamily group workshop and completed a followup assessment 1 week later. At follow-up, participants demonstrated more knowledge about bipolar disorder. Anger, blaming attributions, and number of criticisms remained unchanged. Results of this study are consistent with others in that it is difficult to change EE. Implications for future clinical research in this area are addressed.The construct of expressed emotion (EE) is defined as critical, hostile, or emotionally overinvolved (EOI) attitudes toward a relative with a psychiatric disorder (Hooley, Rosen, & Richters, 1995). EE has been linked with poor patient outcome for several psychiatric disorders (Barrowclough & Hooley, 2003;Butzlaff & Hooley, 1998). Butzlaff and Hooley (1998) found a meta-analytic effect size of r=.39 across six studies that examined the relationship between EE and relapse within mood disorders. More recent research suggests that, although EE was unrelated to manic relapse, high EE was related to a five-fold increase in the odds of a depressive recurrence, even after controlling for symptom severity (Yan, Hammen, Cohen, Daley, & Henry, 2004). Criticism has been found to be the most important element of EE for understanding the course of mood disorders (Hooley et al., 1995) and for bipolar depression (Kim & Miklowitz, 2004). Thus, EE has an influence on bipolar relapse, more specifically for depression.What drives high levels of criticism? According to Weiner's (1995) attribution-affect model, attributions influence the way people experience emotion. In particular, when an individual perceives that another person is in control of his or her behavior, this leads to a judgment that the other person is responsible for his or her behavior. A judgment that the other person is responsible elicits anger and criticism. High EE relatives who are critical have a tendency to view symptoms of mental illness as behaviors that are within the patient's control (Barrowclough, Johnston, & Tarrier, 1994). Because high EE relatives believe the patient is in control of his or her behavior, they believe the patient must also be capable of modifying this behavior. Thus, relatives struggle to normalize the patient's behavior through negative feedback and controlling behavior of their own (Hooley & Campbell, 2002 Several studie...

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 99%

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

Eisner

Johnson

2008

Behavior Therapy

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“…Dichas intervenciones también han demostrado su eficacia en programas a corto plazo (Bernhard et al, 2006;Perlick et al, 2010).…”

Section: Eficacia De La Psicoeducación Familiarunclassified

“…Son numerosas las consecuencias de cuidar a un paciente con TB (ver Steele, Maruyama y Galynker, 2010 para revisión) en concreto se ha encontrado asociación con la sintomatología depresiva, fumar más, dormir peor y, en consecuencia, tener peor salud general y sufrir un mayor número de enfermedades médicas crónicas (Goldstein, Rea y Miklowitz, 2002;Bernhard et al, 2006;Perlick, Hohenstein, Clarkin, Kaczynski y Rosenheck, 2005Goossens, Wijngaarden, Knoppert-Van Der Klein y Achterberg, 2008).…”

Section: Introductionunclassified

La sobrecarga del cuidador en el trastorno bipolar

2013

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Resumen: La sobrecarga del cuidador de pacientes con trastorno bipolar ha sido estudiada con especial atención en los últimos años. Este artículo de revisión pretende hacer un resumen sobre esta cuestión. En concreto queremos conocer como es el nivel de sobrecarga en esta enfermedad, cuales son las variables clínicas que se asocian a un nivel mayor o menor de sobrecarga, que estilos de afrontamiento desarrollados por los cuidadores son más adaptativos para soportar dicha carga, cual es el impacto que sufre el cuidador a nivel sanitario, familiar, legal, económico y laboral, y que programas psicoeducativos han demostrado ser eficaces a la hora de tratar a los cuidadores. Palabras claves: Trastorno bipolar; cuidadores; sobrecarga familiar. Title: Caregivers burden in bipolar disorderAbstract: The excessive workload of the caregivers of patients with bipolar disorder has been studied with special attention in recent years. This review article intends to sum up the information and conclusions reported in studies to date. Specifically, we attempt to describe how the level of overload may be assessed, which clinical variables are associated with a greater or lesser overload, what coping mechanisms adopted by caregivers may be more adequate, what type of repercussions or impact may be suffered by the caregiver in terms of family, work, economic or legal matters, and which psychoeducational programs have proven more effective for treating caregivers.

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“…Studies on coping in caregivers of BD patients, with coping styles affected by caregiver burden and distress (Chadda, Singh, & Ganguly, 2007), make this singular population another target for interventions (Bernhard et al, 2006). Therefore, coping could be seen as a possible target for psychosocial interventions because of the substantial, although partial, causal link between stress and BD (Kapczinski et al, 2008).…”

Section: Coping As a Possible Target For Interventions In Bipolar Dismentioning

confidence: 99%

New perspectives on coping in bipolar disorder.

Grassi‐Oliveira

Daruy-Filho

Brietzke

2010

Psychology & Neuroscience

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Bipolar disorder (BD) is a prevalent and highly disabling psychiatric condition. Despite the widely acknowledged importance of psychosocial interventions that involve a complex cognitive, behavioral, and biological process to help patients cope better with their illness, few studies have systematically evaluated coping in BD. Therefore, our objective was to examine recent developments in current research on coping in BD. Several studies have documented a strong association between BD and numerous neuroanatomical and neuropsychological abnormalities, particularly multiple episodes and longer durations of the disorder. The most marked effects of BD encompass brain areas involved in executive function, which may affect the mechanisms underlying an adequate selection of coping strategies. Thus, the ability of individuals to reduce their own stress burden is impaired, increasing vulnerability to stressful life events and negatively affecting the course of BD. Psychosocial interventions that focus on BD should be evaluated for their ability to improve coping abilities, and research on BD should consider neuropsychological impairment and cognitive-behavioral strategies for coping with stress.

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Impact of cognitive-psychoeducational interventions in bipolar patients and their relatives

Abstract: These findings show that psychoeducational interventions in bipolar patients and their relatives improve patients' and their relatives' knowledge of the illness and the burden of the disorder as well as high expressed emotions are reduced in relatives at 1-year follow-up.

Cited by 50 publications

References 51 publications

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

An Acceptance-Based Psychoeducation Intervention to Reduce Expressed Emotion in Relatives of Bipolar Patients

La sobrecarga del cuidador en el trastorno bipolar

New perspectives on coping in bipolar disorder.

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