Psychotherapy for Bipolar Disorder

Psychotherapy for Bipolar Disorder

At least 5 psychotherapy approaches for bipolar disorder have been been shown to be of benefit when added to medications for the treatment of bipolar disorder, compared to medications alone.  This essay will introduce you to each of these psychotherapies and show you some evidence of their success. These approaches are:

Prodome Detection

Psychoeducation

Cognitive Therapy

Interpersonal / Social Rhythm

Family Focused Therapy

However, in April 2007 a major research program publish their results testing three out of these five versus a 3-session.education program.  When any of these three were added to mood stabilizer treatment for patients with bipolar disorder experiencing significant depression, patients recovered more quickly and more were likely to stay well.  The three psychotherapies, all of which are described below, were:

Bipolar-specific Cognitive Behavioral Therapy

Interpersonal Therapy with Social Rhythm Therapy

Family-Focused Therapy (for patients with family who could join in treatment)

Here is a breakdown of the 5 psychotherapy approaches for bipolar disorder :

Prodrome Detection

In this study, a psychologist “with little previous clinical experience” met with patients up to 12 times (average 9) while the rest of the clinical team proceeded as usual.  She discussed with the patient her/his personal experience of bipolar disorder and the signs preceding manic and depressive episodes in the past.  They planned and rehearsed a plan for action should those symptoms appear again.  The plan was written on a laminated card, carried by the patient.  The therapist helped the patient keep a weekly diary, increasing to daily notes if symptoms were appearing.  She informed the rest of the treatment team (a psychiatrist and mental health worker and primary care physician) of the plan.  That was it, nothing any fancier than that, although it looks like she is a very smart person from the style of the write-up, of which she is the primary author.

Here are the striking results for prevention of manic episodes (prevention of depression was much less dramatic).  The lines show the total number of patients having some sort of manic recurrence (so, as time goes on, the number grows and grows).  If we watched long enough, and everyone had a relapse of some sort, the line would eventually flatten way up to the right at 1.0, meaning 100% of the patients had finally relapsed.  As you can see, in the control group that didn’t get to meet with the psychologist, 50% of the group (the 0.5 line from left to right) had relapsed in some way in about a year). 

prodromcatch

By comparison, in the group who met with the psychologist, in one year only about 20% relapsed.  We have to wonder if just anybody could get these results, besides Ms. Perry, but still, it’s pretty impressive.  I’m planning on adding some of her tricks, like the card thing, to my approach, based on this result — for patients who have clearly identifiable “episodes” and pre-episode warning signs.

Psycoeducation

This research team added 21 sessions of education about bipolar disorder, in groups of 8-12 patients each, to routine treatment in their clinic.  A control group received 21 sessions of “non-structured” meetings with the same two therapists, but in these groups, they tried not to teach about bipolar disorder (think about it: this was a very rigorous test of the theory that education itself is the active ingredient in the different outcomes shown below).

Look at the difference between these groups (this is the same kind of graph as shown above, except in reverse — it shows the total proportion of patients remaining well, so a curve that falls down more slowly means that more patients are staying well):

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