Skip to main content

Advertisement

Log in

A critical update on psychological interventions for bipolar disorders

  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

An Erratum to this article was published on 04 February 2010

Abstract

Although pharmacotherapy is the mainstay of treatment for bipolar disorder, the combination of evidence-based psychological interventions and drug treatment enhances overall effectiveness, mostly by further protecting patients from relapse/recurrence. In recent years, well-designed controlled studies have added weight to evidence favoring specific psychotherapy modalities for bipolar disorders. However, critical issues that may limit the benefits of psychotherapy in day-to-day clinical practice have emerged. In this article, we critically examine the effectiveness of psychosocial approaches to bipolar illness by reviewing the literature, which has been substantially enriched during the past 5 years. Recent studies further support the fact that psychoeducation and cognitivebehavioral therapy are effective in bipolar disorder, especially the early stages. Family interventions based on a psychoeducational model are also effective. Intensive psychotherapies may be more effective than short, managed care-based ones. Group psychoeducation seems to have long-lasting effects and to be cost-effective. Future studies should focus on neurobiological markers of response to psychotherapy and tailor interventions to specific subtypes.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References and Recommended Reading

  1. Perlis RH, Ostacher MJ, Patel JK, et al.: Predictors of recurrence in bipolar disorder: primary outcomes from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD). Am J Psychiatry 2006, 163:217–224.

    Article  PubMed  Google Scholar 

  2. Judd LL, Akiskal HS, Schettler PJ, et al.: The long-term natural history of the weekly symptomatic status of bipolar I disorder. Arch Gen Psychiatry 2002, 59:530–537.

    Article  PubMed  Google Scholar 

  3. Colom F, Vieta E, Martinez-Aran A, et al.: Clinical factors associated with treatment noncompliance in euthymic bipolar patients. J Clin Psychiatry 2000, 61:549–555.

    CAS  PubMed  Google Scholar 

  4. Martinez-Aran A, Vieta E, Reinares M, et al.: Cognitive function across manic or hypomanic, depressed, and euthymic states in bipolar disorder. Am J Psychiatry 2004, 161:262–270.

    Article  PubMed  Google Scholar 

  5. Martinez-Aran A, Vieta E, Colom F, et al.: Cognitive impairment in euthymic bipolar patients: implications for clinical and functional outcome. Bipolar Disord 2004, 6:224–232.

    Article  CAS  PubMed  Google Scholar 

  6. Martinez-Aran A, Scott J, Colom F, et al.: Treatment nonadherence and neurocognitive impairment in bipolar disorder. J Clin Psychiatry 2009, 70:1017–1023.

    Article  PubMed  Google Scholar 

  7. Colom F, Vieta E, Sanchez-Moreno J, et al.: Psychoeducation in bipolar patients with comorbid personality disorders. Bipolar Disord 2004, 6:294–298.

    Article  PubMed  Google Scholar 

  8. Vieta E, Colom F, Corbella B, et al.: Clinical correlates of psychiatric comorbidity in bipolar I patients. Bipolar Disord 2001, 3:253–258.

    Article  CAS  PubMed  Google Scholar 

  9. Vieta E: Improving treatment adherence in bipolar disorder through psychoeducation. J Clin Psychiatry 2005, 66(Suppl 1):24–29.

    PubMed  Google Scholar 

  10. Rosa AR, Reinares M, Franco C, et al.: Clinical predictors of functional outcome of bipolar patients in remission. Bipolar Disord 2009, 11:401–409.

    Article  PubMed  Google Scholar 

  11. Vieta E, Colom F: Psychological interventions in bipolar disorder: from wishful thinking to an evidence-based approach. Acta Psychiatr Scand Suppl 2004, 422:34–38.

    Article  PubMed  Google Scholar 

  12. Vieta E, Pacchiarotti I, Scott J, et al.: Evidence-based research on the efficacy of psychologic interventions in bipolar disorders: a critical review. Curr Psychiatry Rep 2005, 7:449–455.

    Article  PubMed  Google Scholar 

  13. 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, 60:145–152.

    Article  PubMed  Google Scholar 

  14. Lam DH, Hayward P, Watkins ER, et al.: Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. Am J Psychiatry 2005, 162:324–329.

    Article  PubMed  Google Scholar 

  15. Scott J, Paykel E, Morriss R, et al.: Cognitive behaviour therapy for severe and recurrent bipolar disorders: a randomised controlled trial. Br J Psychiatry 2006, 188:313–320.

    Article  PubMed  Google Scholar 

  16. Ball JR, Mitchell PB, Corry JC, et al.: A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change. J Clin Psychiatry 2006, 67:277–286.

    Article  PubMed  Google Scholar 

  17. Frank E, Kupfer DJ, Thase ME, et al.: Two year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Arch Gen Psychiatry 2005, 62:996–1004.

    Article  PubMed  Google Scholar 

  18. Miklowitz DJ, George EL, Richards JA, et al.: A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry 2003, 60:904–912.

    Article  PubMed  Google Scholar 

  19. Rea MM, Tompson MC, Miklowitz DJ, et al.: Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. J Consult Clin Psychol 2003, 71:482–492.

    Article  PubMed  Google Scholar 

  20. Reinares M, Colom F, Sanchez-Moreno J, et al.: Impact of caregiver group psychoeducation on the course and outcome of bipolar patients in remission: a randomised controlled trial. Bipolar Disord 2008, 10:511–519. (Published erratum appears in Bipolar Disord 2008, 10:657.)

    Article  PubMed  Google Scholar 

  21. Miller IW, Keitner GI, Ryan CE, et al.: Family treatment for bipolar disorder: family impairment by treatment interactions. J Clin Psychiatry 2008, 69:732–740.

    Article  PubMed  Google Scholar 

  22. Colom F, Vieta E, Martinez-Aran A, et al.: A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003, 60:402–407.

    Article  PubMed  Google Scholar 

  23. Colom F, Vieta E, Sánchez-Moreno J, et al.: Group psychoeducation for stabilised bipolar disorders: 5-year outcome of a randomised clinical trial. Br J Psychiatry 2009, 194:260–265. (Published erratum appears in Br J Psychiatry 2009, 194:571.)

    Article  CAS  PubMed  Google Scholar 

  24. Bauer MS, McBride L, Williford WO, et al.: Collaborative care for bipolar disorder: Part II. Impact on clinical outcome, function, and costs. Psychiatr Serv 2006, 57:937–945.

    Article  PubMed  Google Scholar 

  25. Simon GE, Ludman EJ, Bauer MS, et al.: Long-term effectiveness and cost of a systematic care management program for bipolar disorder. Arch Gen Psychiatry 2006, 63:500–508.

    Article  PubMed  Google Scholar 

  26. Scott J, Colom F, Vieta E: A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders. Int J Neuropsychopharmacol 2007, 10:123–129.

    Article  CAS  PubMed  Google Scholar 

  27. Beynon S, Soares-Weiser K, Woolacott N, et al.: Psychosocial interventions for the prevention of relapse in bipolar disorder: a systematic review of controlled trials. Br J Psychiatry 2008, 192:5–11.

    Article  PubMed  Google Scholar 

  28. Miklowitz DJ: Adjunctive psychotherapy for bipolar disorder: state of the evidence. Am J Psychiatry 2008, 165:1408–1419.

    Article  PubMed  Google Scholar 

  29. 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, 64:419–426.

    Article  PubMed  Google Scholar 

  30. Yatham LN, Kennedy SH, Schaffer A, et al.: 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 2009. Bipolar Disord 2009, 11:225–255.

    Article  CAS  PubMed  Google Scholar 

  31. Hirschfeld RMA, Keck PE, Gitlin MJ, et al.: Practice guideline for the treatment of patients with bipolar disorder, third edition. Am J Psychiatry 2009 (in press).

  32. Cochran SD: Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. J Consult Clin Psychol 1984, 52:873–878.

    Article  CAS  PubMed  Google Scholar 

  33. Perry A, Tarrier N, Morriss R, et al.: Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999, 318:149–153.

    CAS  PubMed  Google Scholar 

  34. Colom F, Vieta E, Sánchez-Moreno J, et al.: Stabilizing the stabilizer: group psychoeducation enhances the stability of serum lithium levels. Bipolar Disord 2005, 7(Suppl 5):32–36.

    Article  PubMed  Google Scholar 

  35. Colom F, Vieta E, Reinares M, et al.: Psychoeducation efficacy in bipolar disorders: beyond compliance enhancement. J Clin Psychiatry 2003, 64:1101–1105.

    Article  PubMed  Google Scholar 

  36. Scott J, Colom F, Popova E, et al.: Long-term mental health resource utilization and cost of care following group psychoeducation or unstructured group support for bipolar disorders: a cost-benefit analysis. J Clin Psychiatry 2009, 70:378–386.

    Article  PubMed  Google Scholar 

  37. Colom F, Vieta E, Sanchez-Moreno J, et al.: Psychoeducation for bipolar II disorder: an exploratory, 5-years outcome subanalysis. J Affect Disord 2009, 112:30–35.

    Article  CAS  PubMed  Google Scholar 

  38. Zaretsky A, Lancee W, Miller C, et al.: Is cognitive-behavioural therapy more effective than psychoeducation in bipolar disorder? Can J Psychiatry 2008, 53:441–448.

    PubMed  Google Scholar 

  39. Reinares M, Vieta E, Colom F, et al.: What really matters to bipolar patients’ caregivers: sources of family burden. J Affect Disord 2006, 94:157–163.

    Article  CAS  PubMed  Google Scholar 

  40. Miklowitz DJ, Simoneau TL, George EL, et al.: Familyfocused treatment of bipolar disorder: 1-year effects of a psychoeducational program in conjunction with pharmacotherapy. Biol Psychiatry 2000, 48:582–592.

    Article  CAS  PubMed  Google Scholar 

  41. Miklowitz DJ, Richards JA, George EL, et al.: Integrated family and individual therapy for bipolar disorder: results of a treatment development study. J Clin Psychiatry 2003, 64:182–191.

    PubMed  Google Scholar 

  42. Miller IW, Solomon DA, Ryan CE, Keitner GI: Does adjunctive family therapy enhance recovery from bipolar I mood episodes? J Affect Disord 2004, 82:431–436.

    PubMed  Google Scholar 

  43. Solomon DA, Keitner GI, Ryan CE, et al.: Preventing recurrence of bipolar I mood episodes and hospitalizations: family psychotherapy plus pharmacotherapy versus pharmacotherapy alone. Bipolar Disord 2008, 10:798–805.

    Article  PubMed  Google Scholar 

  44. Castle D, Berk M, Berk L, et al.: Pilot of a group intervention for bipolar disorder. Int J Psychiatr Clin Pract 2007, 11:279–284.

    Article  Google Scholar 

  45. Miklowitz DJ, Goodwin GM, Bauer MS, Geddes JR: Common and specific elements of psychological treatments for bipolar disorder: a survey of clinicians participating in randomized trials. J Psychiatr Pract 2008, 14:77–85.

    Article  PubMed  Google Scholar 

  46. Colom F, Vieta E, Daban C, et al.: Clinical and therapeutic implications of predominant polarity in bipolar disorder. J Affect Disord 2006, 93:13–17.

    Article  CAS  PubMed  Google Scholar 

  47. Berk M, Hallam K, McGorry PD: The potential utility of a staging model as a course specifier: a bipolar disorder perspective. J Affect Disord 2007, 100:279–281.

    Article  PubMed  Google Scholar 

  48. Kapczinski F, Vieta E, Andreazza AC, et al.: Allostatic load in bipolar disorder: implication for pathophysiology and treatment. Neurosci Biobehav Rev 2008, 32:675–692.

    Article  PubMed  Google Scholar 

  49. Berk M, Malhi GS, Hallam K, et al.: Early intervention in bipolar disorders: clinical, biochemical and neuroimaging imperatives. J Affect Disord 2009, 114:1–13.

    Article  PubMed  Google Scholar 

  50. Miklowitz DJ, Axelson DA, Birmaher B, et al.: Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial. Arch Gen Psychiatry 2008, 65:1053–1061.

    Article  PubMed  Google Scholar 

  51. Kapczinski F, Frey BN, Kauer-Sant’Anna M, Grassi-Oliveira R: Brain-derived neurotrophic factor and neuroplasticity in bipolar disorder. Expert Rev Neurother 2008, 8:1101–1113.

    Article  CAS  PubMed  Google Scholar 

  52. Koch JM, Hinze-Selch D, Stingele K, et al.: Changes in CREB phosphorylation and BDNF plasma levels during psychotherapy of depression. Psychother Psychosom 2009, 78:187–192.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Eduard Vieta.

Additional information

An erratum to this article can be found at http://dx.doi.org/10.1007/s11920-009-0090-1

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vieta, E., Pacchiarotti, I., Valentí, M. et al. A critical update on psychological interventions for bipolar disorders. Curr Psychiatry Rep 11, 494–502 (2009). https://doi.org/10.1007/s11920-009-0075-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11920-009-0075-0

Keywords

Navigation