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Psychotherapy for Bipolar Disorder

The following treatment guidelines are meant as a reference tool only, and are not intended as treatment advice or to replace the clinical decision-making process of psychiatrists or other health professionals who administer these treatments. In clinical practice there are often good reasons why treatment approaches differ from what is described here.

 

Psychotherapy can be a very important part of a person's treatment for their Bipolar Disorder. Though not all patients with Bipolar Disorder automatically require psychotherapy, there are certain circumstances where it should be strongly considered:

  • It has been shown to be effective for helping to resolve Depressive Episodes [ref, ref].
  • It can help to prevent future relapses into any Bipolar mood episode (Hypomanic, Manic, Mixed or Depressive Episode) [ref].
  • It can be useful for those individuals who do not respond adequately to medications, who have a negative outlook on life, or who have significant problems in interpersonal relationships [ref].
  • However, there is no evidence that it is useful for treating manic symptoms while the are present.

There are three main types of psychotherapy, discussed below, that have been shown in studies to be effective in improving the outcomes of Bipolar Disorder.   In all of these studies, the people receiving the psychotherapy were also taking medications, and there is no evidence that the psychotherapy would work without medications.  For this reason, it is standard practice that psychotherapy always be given in combination with medication.

For individuals who are in the full midst of an intense or severe Manic, Mixed or Depressive Episode, it is usually best that any psychotherapy not begin until their symptoms have resolved to the point where they can participate effectively in the therapy.

Cognitive Behavioral Therapy (CBT) for Bipolar Disorder

CBT has been adapted for Bipolar Disorder, where it has been shown to help reduce mood fluctuations, reduce the risk of relapses and reduce the need for hospitalizations [ref].  It also helps individuals become more consistent at taking their medications and it is effective in reducing the amount of medications needed to treat the condition [ref].  CBT has also been shown to improve the overall level of functioning at work, school and in relationships in people with Bipolar Disorder [ref].

There is some evidence to suggest that CBT is less effective for people with recurrent forms of Bipolar Disorder who have had more than 12 Bipolar mood episodes (Hypomanic, Manic, Mixed or Depressive Episode) in their lifetime [ref].  For this reason, it makes sense for individuals to consider undergoing this therapy earlier in the course of their condition.

Interpersonal and Social Rhythm Therapy (IPSRT) for Bipolar Disorder

IPSRT is an adaptation of Interpersonal Therapy (IPT) with an added focus on helping individuals manage stressful life events, regulate their sleep, social rhythms and routines, and take their medications consistently.  This therapy has been shown to be effective in reducing sub-syndromal depressive symptoms [ref], improving the individual's overall level of functioning at work, school and in relationships [ref], and helping the individual maintain their recovery for longer periods of time after a mood episode has resolved [ref].

Family Therapy for Bipolar Disorder

Family Therapy brings the individual's immediate family members into therapy, and addresses issues that occur within the family system.  It can help family members improve their abilities to communicate with one another while reducing excessive emotional outbursts [ref]. In Multifamily Therapy, several families can be included in the therapy sessions.

Family Therapy has been shown to be effective in Bipolar Disorder in reducing the number of hospitalizations needed, improving depressive symptoms, and allowing the patient to become more consistent at taking their medications [ref, ref]. It can also help individuals maintain their recovery for longer periods of time after a mood episode has resolved [ref].

 

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