Psychosocial Interventions: Empirically-Derived Treatments for Bipolar Disorder

Abstract

Background: Over the past decade, a variety of psychosocial interventions have been reported to be beneficial for bipolar disorder. Acceptance of this literature has been slow in part because most studies have been small and lack rigorous methodology. Furthermore, skepticism about the potential efficacy of psychosocial treatments stems from recognition of the indisputable biological basis of the disorder. Well powered randomized trials are the standard by which pharmacologic strategies demonstrate efficacy. Thus, we review the randomized controlled trials of psychosocial interventions as an adjunct to medication in the treatment of bipolar disorder.Methods: We conducted a literature search to identify randomized controlled studies of Cognitive-Behavioral therapy (CBT), Psychoeducation (PE), Family-Focused Therapy (FFT), and interpersonal social rhythm therapy (IPSRT) for bipolar disorder. Only studies which randomized at least 80 individuals diagnosed with bipolar disorder were selected for review.Results: Nine studies met our inclusion criteria and of these, eight found that adding one of the above psychosocial interventions to pharmacotherapy improved treatment outcomes for individuals with bipolar disorder. None of the psychosocial interventions claims benefit for acute treatment of hypomania or mania; however, CBT, FFT, and IPSRT appear efficacious in treating depressive symptoms and preventing new episodes. PE appears helpful against the recurrence of hypomania or mania, but not depression.Conclusions: These findings support the use of psychosocial interventions in treating individuals with bipolar disorder.

Psychotherapy use in bipolar disorder: Association with functioning and illness severity

“…Unexpectedly, psychotherapy (while taking study medications) did not improve clinical outcomes over the study duration. This study highlights the under-utilization of psychotherapy services in individuals with bipolar disorder despite evidence that adjunctive psychotherapies are effective for mood stabilization and the prevention of relapses (Sylvia et al, 2008). These data support similar findings from other studies (Evans-Lacko et al, 2011;Schaffer et al, 2006;Weiss et al, 2000), but add to our understanding of the characteristics of bipolar patients who utilize psychotherapy services (e.g., those with higher anxiety and suicide risk).…”

Efetividade da Terapia Cognitivo-Comportamental para os Transtornos do Humor e Ansiedade: Uma Revisão de Revisões Sistemáticas

“…A psicoeducação, isoladamente, demonstrou auxiliar contra a recorrência de hipomania e mania, mas não para depressão (Sylvia et al, 2008).…”