Talk:WikiJournal Preprints/Psychotherapy: An important component of a comprehensive approach to the treatment of bipolar disorder

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Authors: Ellen A. Anderson[a][i]  , Lauren Gorelick Schneier[b], Lauren A. Yang[c], Anna R. Van Meter[d]  

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  1. Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, NY; Department of Psychology, University of South Dakota, SD
  2. Department of Psychology, Fairleigh Dickinson University, NJ
  3. Ferkauf Graduate School of Psychology, Yeshiva University, NY; Counseling and Psychological Services, San Jose State University, CA
  4. Zucker Hillside Hospital, Department of Psychiatry, Glen Oaks, NY; Feinstein Institutes for Medical Research, Institute for Behavioral Science, Manhasset, NY; Donald and Barbara Zucker School of Medicine at Hofstra, Northwell, Department of Psychiatry, Hempstead, NY
  1. ellen.anderson.a@gmail.com

This article has been declined for publication by the WikiJournal of Medicine.

It is archived here as a record. Discussion can be viewed below.

Bipolar disorder (BD) is a chronic mood disorder associated with debilitating symptoms of mania and depression that can have profound effects on both patients and their caregivers. The presentation of mood episodes in BD varies considerably and is categorized into several subtypes [1]. Bipolar I is characterized by at least one manic episode, which can result in hospitalization. Individuals with Bipolar II will have at least one hypomanic episode and one major depressive episode. Cyclothymic disorder is characterized by at least two years of chronic symptoms of hypomania and depression (or one year in children) that do not meet full threshold criteria for [hypo]manic or depressive episodes. If an individual has clear symptoms of mania, but does not meet criteria for any of the preceding subtypes due to insufficient duration or severity, they may receive a diagnosis of other specified bipolar and related disorder [1].

In addition to mood symptoms, BD is often associated with cognitive and functional impairments that contribute to lower quality of life [2]. The lifetime prevalence of BD in the United States is approximately 4% with similar rates regardless of race, ethnicity, and gender [3, 4]. Globally, it is estimated that BD affects more than 1% of the world’s population [5]. Onset of bipolar spectrum disorders typically begins in adolescence or early adulthood and often goes undiagnosed for several years [6-8]. This is due, in part, to the fact that the initial episode is usually depression, and a [hypo]manic episode may not become evident until later in the course of the illness [9]. Careful assessment of past and current symptoms of mania is crucial to the detection and diagnosis of BD.

Treatment for bipolar disorder typically focuses on reducing the severity of manic and/or depressive symptoms, preventing relapse, and improving overall functioning [10]. Because BD is a chronic disorder, treatment will vary across the course of illness (i.e., acute illness, symptom management, remission maintenance) and often involves a multidisciplinary approach including a combination of psychopharmacological and psychosocial interventions [11, 12]. Generally, treatment for BD is conducted in two phases. Each phase is associated with specific, evidence-based treatment methods, although treatment plans vary depending on the specific needs of the individual [13]. The first phase focuses on acute mood episode management. The goal of treatment in this phase is rapid reduction of mood symptom (manic, hypomanic, or depressive) frequency and severity. Symptoms that are commonly experienced during a manic episode include elevated mood, increased energy, decreased need for sleep, impulsivity, agitation, aggression, and psychosis [14]. Among the symptoms of a depressive episode, suicidal ideation and psychotic features are typically first targeted in acute treatment [15]. Treatment during this acute phase often involves the use of one or more medications such as mood stabilizers, second-generation antipsychotic drugs, and benzodiazepines [16]. The second phase, or maintenance phase, focuses on reducing the risk of relapse [17]. Treatment with medication alone is associated with low rates of remission, high rates of recurrence, the presence of residual symptoms, and significant psychosocial impairment [18]. Thus, the maintenance phase should also include psychosocial interventions to improve medication adherence and overall functioning [17]. When administered in conjunction with pharmacotherapy, psychosocial interventions have been shown to reduce relapse rates by up to 40% [18, 19]. Psychotherapies target certain features of BD that medication cannot, such as interpersonal challenges, acceptance of diagnosis, and identifying early indicators of mood deterioration (Bobo, 2017). Psychotherapy also addresses negative life experiences and stressors that can exacerbate symptoms [10, 17]. Treatment guidelines suggest a combination of both pharmacotherapy and targeted psychosocial intervention to achieve optimal outcomes.

There are several interventions with evidence to support their use with individuals who have BD including psychoeducation, family-focused therapy (FFT), cognitive behavioral therapy (CBT), interpersonal and social rhythm therapy (IPSRT), and dialectical behavior therapy (DBT). Strong support for the benefits of psychotherapy came from The Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD [20]). Across 15 participating states, the study included a randomized controlled clinical trial examining the efficacy of cognitive-behavior therapy (CBT), family-focused therapy (FFT), and interpersonal and social rhythm therapy (IPSRT) for individuals with BD who were on mood stabilizers [20]. Individuals with BD (N=293) were randomly assigned to 30 sessions of FFT, IPRST, CBT, or Collaborative Care (CC; a three-session psychoeducational treatment), and to mood-stabilizing medications—with or without antidepressants. Patients in any of the psychotherapy conditions had higher recovery rates after one year and recovered 110 days faster on average than those in the CC condition. Furthermore, by one year, 77% of patients in FFT, 65% in interpersonal therapy, and 60% in CBT had recovered, compared to 52% of the patients in the CC group [20].

This review aims to summarize the existing treatment approaches for BD across the lifespan with a focus on evidence-based psychotherapies (See Box 1). First, several evidence-based psychotherapies will be described, followed by a brief summary of the role of psychopharmacology and alternative medical treatments.

Box 1. Highlights of psychotherapeutic interventions for bipolar disorder

Psychoeducation

  • Psychoeducation is an effective intervention for both children and adults with bipolar disorder in individual, group, and family settings
  • The intervention aims to equip individuals and their families with knowledge about the etiology of bipolar disorder, its symptoms, and to teach them strategies for recognizing and managing their symptoms
  • Strong research support

Family-Focused Therapy (FFT)

  • FFT is an effective intervention for adults and youth with bipolar disorder. It includes both the patient and one or more family members
  • The intervention includes psychoeducation about bipolar disorder and the importance of medication adherence, as well as family training on how to respond to symptoms and cope effectively, communication enhancement training, and effective problem-solving skills
  • Strong research support

Cognitive Behavioral Therapy (CBT)

  • CBT is an evidence-based treatment for adults and youth with bipolar disorder. It is usually administered as individual psychotherapy
  • The intervention includes psychoeducation about bipolar disorder, including symptoms, the biological basis of the illness, the importance of good sleep hygiene, and the need to medication on a consistent basis. CBT additionally educates the patients on how their thoughts, feelings, and behaviors influence one another, and helps the patient identify and change maladaptive thoughts and behaviors
  • Modest research support

Child- and Family-Focused Cognitive Behavioral Therapy (CFF-CBT)

  • CFF-CBT is a psychotherapy for children (7-13) with bipolar disorder and their families
  • The intervention aims to provide psychoeducation about bipolar disorder, improve self-esteem and coping skills, and develop interpersonal skills with peers and family
  • Modest research support

Interpersonal and Social Rhythm Therapy (IPSRT)

  • IPSRT is an evidence-based treatment for adults and youth with bipolar disorder
  • The intervention aims to identify interpersonal problem area(s) and disrupted daily routines that can increase the risk of mood episode onset and recurrence. Once problem areas are identified, behavior change is introduced
  • Modest research support

Dialectical Behavior Therapy (DBT)

  • DBT is an evidence-based treatment for adults and youth with bipolar disorder.
  • Treatment targets include emotion dysregulation, interpersonal challenges, distress intolerance, and reduced awareness. Features of DBT include modular skills training and phone calls for support between sessions
  • Modest research support

Submission withdrawn

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Comments by Andrew Leung ,
These editorial comments were submitted on , and refer to this previous version of the article

Authors wished to withdraw this submission. OhanaUnitedTalk page 04:25, 2 January 2024 (UTC)Reply

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