RESEARCH WEEKLY: Psychological interventions for adults with bipolar disorder: a review

(July 26, 2016) Bipolar disorder is a serious mental illness associated with risk for relapse, hospitalization, unemployment and suicide, among other poor outcomes. Mood-stabilizing medication is the standard of care for the condition, but the possible role of supplementary psychotherapy is of interest to many patients and clinicians.

Matthijs Oud and a team of international researchers conducted the first comprehensive systematic review and analysis of psychological therapies that have been tested for their effectiveness in treating bipolar disorder. They found the evidence for psychotherapies to be “much stronger” than was available “only a few years ago” but also found that the preponderance of studies on the subject were of low or mediocre quality.

Despite the quality issue, “Overall, on the basis of this review, we would recommend the use of psychological interventions in the treatment of people with bipolar disorder to reduce relapse rates and to reduce depressive symptoms,” the authors concluded. “Although there is insufficient evidence to recommend one specific treatment over the others, the best evidence is for individual structured psychological interventions, and there is weaker – but still promising – evidence for group and family interventions and for collaborative care.”

“Almost all” the psychological interventions were supplementary to medication therapy. The studies reviewed involved more than 6,000 participants, primarily in North America and Europe.t three days of July shed additional light on the condition and impacts of inmates with serious psychiatric disease.

Psychotherapies Reviewed
The psychotherapies reviewed included

• Individual therapy, either face-to-face or online, including cognitive behavioral therapy and medication adherence therapy;
• Group therapy;
• Family psychoeducation;
• Collaborative care;
• Integrated therapy (combining cognitive and interpersonal therapies);
• Family-focused therapy; and
• Interpersonal and Social Rhythm Therapy (known as IPSRT).

The authors found:

• Moderate-quality evidence that individual psychological therapy reduced the risk of relapse by one-third;
• Moderate-quality evidence that collaborative care reduced hospital admissions by one-third;
• Low-quality evidence showing a substantial reduction in relapse rates for people who received family psychoeducation;
• Evidence that group therapy reduced risk of relapse and possibly improved some symptoms; and
• “No evidence” of benefit for other types of psychological interventions such as IPSRT.

The authors said their findings are consistent with previous reports that psychotherapy may reduce the transition to psychosis, that family interventions reduce relapse in both early and established cases of schizophrenia, and that psychotherapy is the most effective treatment for major depression.

Encouraging to Families
In their discussion of “implications for practice,” the authors made special note of the value of family-based therapies for treating bipolar and schizophrenia.

“It is also worth considering family psychological interventions, not just because the trials show some promise, but also because the benefits of family interventions for psychosis (including schizophrenia and bipolar disorder) suggest that relapse rates can be reduced in both early and later psychosis,” they said. “It seems likely, on the basis of this broader evidence as well as the evidence in this review, that family interventions could be beneficial for people with bipolar disorder and should be made available routinely to help reduce relapse rates….

“It is important to keep in mind that people with bipolar disorder are often only partially adherent to pharmacotherapy, which may contribute to the recurrence of symptoms and to relapse. Group or family psychoeducational interventions and collaborative care could help these people develop skills related to medication use, stress management, recognizing early symptoms and coping with symptoms. Such skills could reduce risk of relapse and improve response.”

The research team suggested further study to establish the long-term effectiveness of psychological intervention and the comparative strengths among different psychotherapies. Studying treatment results separately for people in different phases of the disease (e.g., manic, depressive, non-symptomatic) would also be useful, according to the authors.

References:
Oud, Matthijs et al. (31 March, 2016. Psychological interventions for adults with bipolar disorder: Systematic review and meta-analysis. The British Journal of Psychiatry.