Intensive Psychosocial Intervention Enhances Functioning in Patients With Bipolar Depression: Results From a 9-Month Randomized Controlled Trial

Abstract

Objective-Psychosocial interventions are effective adjuncts to pharmacotherapy in delaying recurrences of bipolar disorder; however, to date their effects on life functioning have been given little attention. In a randomized trial, the authors examined the impact of intensive psychosocial treatment plus pharmacotherapy on the functional outcomes of patients with bipolar disorder over the 9 months following a depressive episode.Method-Participants were 152 depressed outpatients with bipolar I or bipolar II disorder in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. All patients received pharmacotherapy. Eighty-four patients were randomly assigned to intensive psychosocial intervention (30 sessions over 9 months of interpersonal and social rhythm therapy, cognitive behavior therapy [CBT], or family-focused therapy), and 68 patients were randomly assigned to collaborative care (a 3-session psychoeducational treatment). Independent evaluators rated the four subscales of the Longitudinal Interval Follow-Up Evaluation-Range of Impaired Functioning Tool (LIFE-RIFT) (relationships, satisfaction with activities, work/role functioning, and recreational activities) through structured interviews given at baseline and every 3 months over a 9-month period.Address correspondence and reprint requests to Dr. Miklowitz, Department of Psychology, University of Colorado, Muenzinger Building, Boulder, CO 80309-0345; miklow@psych.colorado.edu. Any opinions, findings, and conclusions or recommendations expressed in this article are those of the authors and do not necessarily reflect the views of NIMH.Clinical Trial Registration: clinicaltrials.gov identifier: NCT00012558.Drs. Miklowitz, Reilly-Harrington, Kogan, Thomas, Araga, and Gonzalez report no competing interests. NIH Public AccessAuthor Manuscript Am J Psychiatry. Author manuscript; available in PMC 2013 February 22. Published in final edited form as: Am J Psychiatry. 2007 September ; 164(9): 1340-1347. doi:10.1176/appi.ajp.2007.07020311. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptResults-Patients in intensive psychotherapy had better total functioning, relationship functioning, and life satisfaction scores over 9 months than patients in collaborative care, even after pretreatment functioning and concurrent depression scores were covaried. No effects of psychosocial intervention were observed on work/role functioning or recreation scores during this 9-month period.Conclusions-Intensive psychosocial treatment enhances relationship functioning and life satisfaction among patients with bipolar disorder. Alternate interventions focused on the specific cognitive deficits of individuals with bipolar disorder may be necessary to enhance vocational functioning after a depressive episode.Bipolar disorder is the sixth leading cause of disability worldwide (1). Although the severity of mood episodes is the major determinant of patients' ability to work or have relationships, many patients experience fun...

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

“…Based on this and the findings of the study by Miklowitz and colleagues in acute bipolar depression,84 CBT is still recommended as an adjunctive second‐line treatment for acute bipolar depression (level 2). The recommendation is also second‐line for maintenance treatment (level 2) for patients with fewer episodes and less severe form of illness.…”

“…Despite evidence of efficacy for CBT for MDD and psychosis, the results of CBT trials for BD have been mixed. One large RCT supports it use for acute bipolar depression84 in a trial that compared the efficacy of up to 30 (mean 14) CBT sessions against those of FFT, IPSRT, and a three‐session control intervention, but it was not possible to identify whether the benefits came from changes in the medications prescribed or the psychosocial treatments. Efficacy of CBT in relapse prevention was observed in one RCT,85 but not in another larger RCT, at least in patients who had multiple mood episodes 86.…”

“…The first, large trial98 showed no effect of IPSRT compared to a control condition but did show benefit for reduction of relapse and improved occupational functioning. An acute bipolar depression study84 showed intensive IPSRT (up to 30 sessions; mean 14) out‐performed a three‐session control condition, but it is impossible to state whether the performance was related to the intensity and number of sessions, changes in medication use, or specific attributes of IPSRT. Two small studies failed to demonstrate specific benefits of IPSRT compared to control conditions 99, 100.…”

Medicating mood with maintenance in mind: bipolar depression pharmacotherapy

“…Cognitive and psychosocial functioning have been found to be impaired in bipolar depression and euthymia, possibly because of residual subsyndromal depressive symptomatology (15,16). Psychological interventions adjunctive to medications appear to have greatest benefit in reducing risk of relapse and can improve social functioning and medication adherence (150)(151)(152)(153). The therapeutic effect can be optimised by targeting patients following a depressive episode, and psychological treatments are best instituted early in the course of the illness as they appear to be less effective in those with a high number (>12) of prior mood episodes (152,154).…”

The Treatment of Bipolar Disorder

“…Over 1 year, patients in intensive therapy recovered more rapidly (hazard ratio [HR] 1·47, 95% CI 1·08-2·0) and were more likely to be clinically well (1·58, 1·17-2·13) in any study month than those in brief treatment. 61 Effects extended to relationship functioning and life satis faction. 62 No differences emerged between the three intensive modalities in symptoms or psychosocial functioning over 1 year.…”