Family‐focused treatment for caregivers of patients with bipolar disorder

Abstract

Objectives-Family members of patients with bipolar disorder experience high rates of subjective and objective burden which place them at risk for adverse physical health and mental health outcomes. We present preliminary efficacy data from a novel variation of Family Focused Treatment [Miklowitz DJ. Bipolar Disorder: A Family-Focused Treatment Approach (2 nd ed.). New York: The Guilford Press, 2008] that aimed to reduce symptoms of bipolar disorder by working with caregivers to enhance illness management skills and self-care.Methods-The primary family caregivers of 46 patients with bipolar I (n = 40) or II (n = 6) disorder, diagnosed by the Structured Clinical Interview for DSM-IV Axis I Disorders, were assigned randomly to receive either: (i) a 12-15-session family-focused, cognitive-behavioral intervention designed to provide the caregiver with skills for managing the relative's illness, attaining self-care goals, and reducing strain, depression, and health risk behavior [FamilyFocused Treatment-Health Promoting Intervention (FFT-HPI)]; or (ii) an 8-12-session health education (HE) intervention delivered via videotapes. We assessed patients pre-and posttreatment on levels of depression and mania and caregivers on levels of burden, health behavior, and coping.Results-Randomization to FFT-HPI was associated with significant decreases in caregiver depressive symptoms and health risk behavior. Greater reductions in depressive symptoms among patients were also observed in the FFT-HPI group. Reduction in patients' depression was partially mediated by reductions in caregivers' depression levels. Decreases in caregivers' depression were partially mediated by reductions in caregivers' levels of avoidance coping.Conclusions-Families coping with bipolar disorder may benefit from family interventions as a result of changes in the caregivers' ability to manage stress and regulate their moods, even when the patient is not available for treatment. Keywordsdepression; health burden; illness management; psychoeducation; stress Bipolar disorder affects the family members of a patient and is affected by the family environments associated with caregiving. From 89% to 91% of family members report NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript feelings of emotional distress (i.e., 'subjective burden') in relation to the severity of the patient's illness symptoms (1,2); between 24% and 38% score above the standard cutoffs on self-report measures of depressive symptoms (2). Patient suicidal ideation and behavior in particular have been associated with increased symptoms of caregiver depression (3). For family members with their own history of mood disorders, caregiving more than doubles the risk of recurrence of an episode of major depression in the caregiver compared to the risk of recurrence among persons with a history of mood disorder but without caregiving responsibilities (4).Recent studies suggest that subjective burden and/or depression also compromise caregivers' ability to effectively man...

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013

“…A family-focused treatment approach designed to help caregivers improve illness management skills and their own self-care was shown to effectively reduce depressive symptoms and health-risk behavior among caregivers and family members, and reduce depressive symptoms in patients (23).…”

La sobrecarga del cuidador en el trastorno bipolar

“…La importancia del estrés ambiental en la evolución del TB, la carga experimentada por los familiares que conviven con el paciente y la demanda de las familias de recibir más información sobre el TB y para saber elaborar adecuadas estrategias de afrontamiento son algunas de las razones que fundamentan la introducción de intervenciones psi-anales de psicología, 2013, vol. 29, nº 2 (mayo) coeducativas centradas en la familia del paciente bipolar (Reinares, Colom, Martínez-Arán, Benabarre y Vieta, 2002a;Perlick et al, 2010). Por otro lado la falta de conocimiento sobre la enfermedad genera a menudo desesperación que puede llevar al desarrollo de concepciones erróneas que animan al abuso de sustancias y al incumplimiento del tratamiento .…”

“…Algunos trabajos han señalado que los efectos beneficiosos de la intervención familiar son: reducción del nivel subjetivo de sobrecarga (Fallon y Pederson, 1985;Reinares et al, 2004), disminución de la sintomatología depresiva de los cuidadores (Perlick et al, 2010); mejora del conocimiento acerca de la enfermedad (van Gent y Zwart, 1991; Bauer, 1997;Bauer, McBride, Chase, Sachs y Shea 1998;Reinares et al, 2004), cambio de las creencias sobre el impacto en sus vidas y la enfermedad (Reinares et al, 2004), reducción del número de recaídas (Miklowitz y Goldstein, 1990;Perry, Tarrier, Morris, McCarthy y Limb, 1999;Miklowitz et al, 2000) y de ingresos hospitalarios (Davenport, Ebert, Adland y Goodwin, 1977); además aumenta el tiempo hasta la recurrencia (Reinares et al, 2010) y mejora el cumplimiento terapéutico (Miklowitz, George, Richards, Simoneau y Suddath, 2003). Dichas intervenciones también han demostrado su eficacia en programas a corto plazo (Bernhard et al, 2006;Perlick et al, 2010).…”

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

Psychoeducation for Bipolar Mood Disorder

“…Further probation in this research area is suggested (Miklowitz & Taylor, 2006). As well, in a trial in September 2010, FFT interventions had led to a reduction in depression and healthy risk behavior in both caregivers and patients (Perlick et al, 2010).…”