Targeted psychosocial interventions for bipolar disorder

Abstract

Pharmacotherapy is the foundation of treatment for bipolar disorder, but research suggests that adjunctive psychosocial interventions that are manualized, reproducible, time-limited, empirically supported, and strategically target a number of critical domains, can efficiently provide additional benefits. Psychoeducation as an adjunct of pharmacotherapy may be beneficial, but questions remain about the utility of this treatment for patients who are already compliant with medication treatment. Family educational interventions have demonstrated encouraging results in relapse prevention, but follow-up data are limited and application to patients who have limited social networks may be problematic. Reports on interpersonal and social rhythm therapy in patients with bipolar disorder are scarce, and what is available shows no differential effect on time to remission or relapse, but a significant impact on subsyndromal symptoms. Follow-up data suggest that patients receiving cognitive behavior therapy have significantly fewer bipolar episodes, shorter episodes, fewer hospitalizations, and less subsyndromal mood symptoms. It is unclear, however, if cognitive behavior therapy is superior to other active psychosocial treatments and whether its mechanism in patients with bipolar disorder is through changing dysfunctional cognitions or simply enhancing early symptom detection. Psychotherapies should be considered early in the course of illness to improve medication compliance and to help patients identify prodromes of relapse in order to take steps for prevention. In addition, some strategies may have a beneficial effect on residual symptoms, particularly symptoms of depression, and thus help move patients toward a more comprehensive functional recovery.

Is Cognitive-Behavioural Therapy More Effective Than Psychoeducation in Bipolar Disorder?

“…For example, it was recently asserted that PE may be most effective for reducing the risk of manic relapse, whereas a form of interpersonal therapy for BD-interpersonal and social rhythm therapy-may be most effective for treating depressive symptoms without having any significant impact on relapse. 14,16,19 Although PE, FFT, and CBT all share similar goals, our clinical experience suggests that CBT and FFT may require more therapist expertise and patient motivation. CBT and FFT are generally more personalized treatments, requiring more therapist flexibility to tailor the treatment to the patient's needs and goals.…”

“…[10][11][12][13] Although PE, CBT, and FFT are distinct treatments, all share an emphasis on the following: empowering the patient to become an active participant in treatment; becoming more aware of the nature and treatment of BD and the need to adhere to pharmacotherapy treatment; and recognizing the prodromal symptoms of major depression and hypomania to forestall a full-blown relapse. [14][15][16] However, still unanswered is how these 3 distinct, active psychosocial treatments compare with each other, and whether these psychotherapeutic interventions have incremental clinical value when added to the treatment of patients with BD who are already adherent to effective moodstabilizing pharmacotherapy. This latter question is critically important.…”

The Use of Narrative Therapy with Clients Diagnosed with Bipolar Disorder

“…Research has supported the effectiveness of NT with clients diagnosed with mood disorders (e.g., Havens & Ghaemi, 2005;Judd & Akiskal, 2003;Robertson et al, 2005). As Zarensky (2003) noted, clients diagnosed with BD improve their quality of life when they continue taking medication and are in counseling. As the reviewed research supported, and this case illustration suggests, NT may be an effective therapeutic approach to support the holistic functionality of clients diagnosed with BD.…”

Psicoterapia em grupo de pacientes com transtorno afetivo bipolar

“…O grande número de revisões publicadas recentemente (Scott e Gutierrez, 2004;Sajatovic et al, 2004;Colom e Vieta, 2004a;Gutierrez e Scott, 2004;Colom e Vieta, 2004b;Scott, 1995;Gonzales-Pinto, 2004;Swartz e Frank, 2001;Zaretsky, 2003;Jones, 2004;Huxley et al, 2000) é reflexo desse empenho em entender melhor as alternativas psicoterápicas disponíveis para tratar essa população.…”