Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence

Abstract

Although pharmacotherapy is the mainstay of treatment for bipolar disorder, medication offers only partial relief for patients. Treatment with pharmacologic interventions alone is associated with disappointingly low rates of remission, high rates of recurrence, residual symptoms, and psychosocial impairment. Bipolar-specific therapy is increasingly recommended as an essential component of illness management. This review summarizes the available data on psychotherapy for adults with bipolar disorder. We conducted a search of the literature for outcome studies published between 1995 and 2013 and identified 35 reports of 28 randomized controlled trials testing individual or group psychosocial interventions for adults with bipolar disorder. These reports include systematic trials investigating the efficacy and effectiveness of individual psychoeducation, group psychoeducation, individual cognitive-behavioral therapy, group cognitive-behavioral therapy, family therapy, interpersonal and social rhythm therapy, and integrated care management. The evidence demonstrates that bipolar disorder-specific psychotherapies, when added to medication for the treatment of bipolar disorder, consistently show advantages over medication alone on measures of symptom burden and risk of relapse. Whether delivered in a group or individual format, those who receive bipolar disorder-specific psychotherapy fare better than those who do not. Psychotherapeutic strategies common to most bipolar disorder-specific interventions are identified.

Perioperative psychotherapy for persistent post-surgical pain and physical impairment: a meta-analysis of randomised trials

“…43 Although psychoeducation as an intervention may have beneficial effects for some conditions (e.g. bipolar disorder), 44 our findings suggest that providing information and support alone for surgical patients is not sufficient and that more active psychotherapy is needed. This result is consistent with research underscoring the beneficial effects of active psychotherapy for a wide range of mental health and health conditions.…”

Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial

“…Average reported post-treatment attrition rates for individual-based psychosocial treatments are approximately 25% (median 27%, range 9%–41%; (Ball et al, 2006; Fava, Rafanelli, Tomba, Guidi, & Grandi, 2011; Frank et al, 2005; Jones et al, 2015; Meyer & Hautzinger, 2012; Miklowitz et al, 2007; Parikh et al, 2012; Reilly-Harrington et al, 2007; Scott et al, 2006; Swartz, Frank, & Cheng, 2012; Zaretsky, Lancee, Miller, Harris, & Parikh, 2008; for recent reviews, see Chatterton et al, 2017; Salcedo et al, 2016; Stratford et al, 2015; Swartz & Swanson, 2014). For example, Parikh et al (2012), Zaretsky et al (2008), and Reilly-Harrington et al (2007) report acute post-treatment attrition rates of 29%, 28% and 40% respectively for adjunctive individual CBT treatment conditions in their studies.…”

Children in the US are at High Risk for Psychiatric Disorders: Early Monitoring by Parents May Enhance Awareness and Treatment

“…Not only were there markedly fewer relapses initially over the first 2 years in the specialty clinic group, but these differences persisted and were magnified over the subsequent 4 years even though all patients had returned to TAU after 2 years. These data together with a large number of controlled studies showing superior effects of randomized psychotherapy/psycho-education compared to TAU in children and adults with bipolar disorder [32][33][34], provide strong evidence for the benefits of multi-modal psychotherapeutic and pharmacological treatment.…”