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Therapy Partners Factsheet Evidence-based Treatments for Bipolar Disorder

Here at Therapy Partners, we know that sometimes feelings and emotions can overwhelm you particularly if you are waiting for or have recently been given a formal diagnosis.

This blog aims to explain a little about bipolar disorder and has useful links for clients and families to help gain further insight into the condition and explain how therapy might help.

The two main types of treatment for bipolar disorder are medication and talking therapies, Therapy Partners offer a range of individual and family-based treatments, and we can work collaboratively with your  Doctor/ Psychiatrist who can provide medication.

 

 

The Benefits of choosing Therapy Partners for your Therapy and Counselling include:

  • The opportunity to explore the issues that are interfering with your life and relationships.
  • Ability to express and discharge thoughts and feelings in a safe and confidential environment.
  • Work through unresolved issues
  • Think about your situation more clearly.
  • Increase in self-awareness and confidence.
  • Develop coping skills, better equipping you to cope during times of vulnerability.
  • Make healthier personal choices.
  • Maintain and sustain more honest and open relationships!

 

In terms of bipolar disorder, our evidenced-based interventions will help you:

  • Understand, make sense of, or find meaning in your bipolar disorder,
  • Identify early warning signs and symptoms.
  • Develop strategies to cope with early symptoms, triggers and
  • Set goals and plans for staying well.

 

Overview about Bipolar

Bipolar disorder, formerly called manic depression, is a mental health condition that causes extreme mood swings that include emotional highs (mania or hypomania) and lows (depression). When you become depressed, you may feel sad or hopeless and lose interest or pleasure in most activities. When your mood shifts to mania or hypomania (less extreme than mania), you may feel euphoric, full of energy, or unusually irritable. These mood swings can affect sleep, energy, activity, judgment, Behavior, and the ability to think clearly.

Episodes of mood swings may occur rarely or multiple times a year. While most people will experience some emotional symptoms between episodes, some may not experience any. Although bipolar disorder is a lifelong condition, you can manage your mood swings and other symptoms by following a treatment plan. In most cases, bipolar disorder is treated with medications and psychological counselling (psychotherapy).

 

EVIDENCE-BASED TREATMENTS

Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy.  Various Systematic literature reviews carried out following randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder have concluded that a  strong evidence base exists for psychoeducation, cognitive-behavioural therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay the time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder.

 

Psychoeducation

Psychoeducation educates patients about their illnesses and the most effective ways of treating symptoms and preventing relapse. Psychoeducation covers topics such as the nature and course of bipolar disorder, the importance of active involvement in treatment, the potential benefits and adverse effects of various treatment options, the identification of early signs of relapse, and behaviour changes that reduce the likelihood of relapse.

 

Family-Based Therapy 

Mental illness affects the whole family. With family-based therapy, the clinician meets the family to discuss issues the family is experiencing. Families are given psychoeducation sessions and information where they learn basic facts about mental illness, coping skills, communication skills, problem-solving skills, and ways to work with one another toward recovery and maintenance of the family relationship for their loved one.

Individuals with bipolar disorder can participate in family interventions alongside taking medication with the intention of having fewer relapses, longer time between relapses, better medication adherence, less severe mood symptoms, and increased positive communication between family members.

Therapy Partners offer a range of family programs available to fit the specific needs of each family. Some families benefit from just a few sessions, while more intensive services are especially helpful for families that are experiencing high levels of stress and tension and for individuals with bipolar disorder who are chronically symptomatic or prone to relapse. Generally, these longer-term interventions last 6-9 months and can be conducted in single-family or multi-family formats.

 

Family Focussed Therapy (FFT)

FFT is a manualized treatment developed by Miklowitz to decrease overall stress for individuals with bipolar disorder by improving family and primary relationship functioning (1). FFT posits that unsupportive and negative interactions and highly expressed emotion within the family or primary relationships increase an individual’s stress—which, in turn, increases vulnerability to developing affective symptoms and episodes. FFT involves three core phases: psychoeducation, communication enhancement training, and problem-solving. First, the clinician promotes an understanding of the illness, the vulnerability-stress model, and the importance of medication adherence with the individual and his or her family member or other support. Next, the clinician helps them improve their communication through role plays and skill practice. Finally, the clinician strengthens the problem-solving abilities of both the individual and the family member or other support. FFT is typically delivered to single individual and family sessions.

FFT is an efficacious and effective treatment that reduces the illness burden for not only the individual but also the family.

 

Cognitive Behavioural Therapy (CBT)

The core objectives of CBT are to identify and change maladaptive thoughts, beliefs, and behaviors that contribute to and escalate symptoms (2). CBT for bipolar disorder rests on the premise that thoughts, feelings, and behaviors are interconnected and that shifts in mood and cognitive processes during affective episodes influence behaviour, all of which can lead to a vicious cycle that contributes to illness burden. Modification of automatic thoughts and elimination of distorted thinking interrupt the problematic affective cycle. CBT includes psychoeducation, thought records, mood diaries, and activity schedules. In CBT, the clinician helps an individual link mood and thoughts, recognize and monitor symptoms and prodromes, develop behavioural strategies for symptoms, learn basic CBT techniques, improve sleep and activity routines, improve medication adherence, and resolve psychosocial problems (3,4) (CBT can be administered individually or in a group format (CBT-G) and has been adapted in many ways to include other strategies, such as MBCT, or to target comorbid conditions, such as integrated group therapy (IGT) for substance use in bipolar disorder.

 

Useful links

https://www.nhs.uk/mental-health/conditions/bipolar-disorder/overview/

https://www.ouh.nhs.uk/research/patients/priority-setting-partnerships/bipolar/what-is-bipolar-disorder.aspx

Bipolar disorder | Royal College of Psychiatrists (rcpsych.ac.uk)

https://www.nhsinform.scot/illnesses-and-conditions/mental-health/bipolar-disorder

https://www.mind.org.uk/information-support/types-of-mental-health-problems/bipolar-disorder/supporting-someone-with-bipolar/

Evidence-Based Psychotherapies for Bipolar Disorder | FOCUS (psychiatryonline.org)

 

References

  1. Miklowitz DJ: Bipolar Disorder: A Family-Focused Treatment Approach, 2nd ed. New York, Guilford Press, 2008
  2. Basco MR, Rush AJ: Cognitive-Behavioural Therapy for Bipolar Disorder. New York, NY, Guilford Press, 1996
  3. Lam DH, Watkins ER, Hayward P, et al.: A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder: outcome of the first year. Arch Gen Psychiatry 2003; 60:145–152Crossref, Google Scholar
  4. Miklowitz DJ, Otto MW, Frank E, et al.: Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Arch Gen Psychiatry 2007; 64:419–426Crossref, Google Scholar

 

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