The Latest on Psychotherapy
A review of nine randomized controlled trials (RCTs) within the past two years investigated cognitive behavior therapy (CBT), psychoeducation, family therapy, interpersonal and social rhythm therapy, or components thereof, for patients with bipolar disorder or family members. Not surprisingly, most studies found interventions improved outcomes, but it was impossible to identify the best treatment because studies varied in number of sessions, therapist expertise, choice of outcome measures, and pretty much every other element of study design.
Nevertheless, two findings are striking. First, a novel family-focused self-care CBT for caregivers alone improved their mental health in several ways, including a decrease in depression. This decrease was associated with a decline in depressive and manic symptoms among patients (Perlick DA et al, Bipolar Disord 2010;12:627–637). Second, community mental health team members with six two-hour sessions of relapse prevention training using group CBT parlayed that education into slightly improved patient functioning on a social and occupational scale, and an increase of 8.5 weeks until the next patient episode (Lobban F et al, Br J Psychiatry 2010;196:59–63) (Schottle D et al, Curr Opin Psychiatry 2011;24:549–555).
TCRBH’s Take: Parents whose children have bipolar disorder tend to be quite stressed (Steele A et al, J Affect Disord 2010;121(1–2):10–21), and parents’ “expressed emotion,” is associated with relapse rates in bipolar disorder (Yan LJ et al, J Affect Disord 2004;83(2–3):199–206). Consequently, it follows that helping parents would help identified patients. Similarly, given the success of paraprofessionals, most notably peer providers, in improving outcomes and reducing re-hospitalization (Sledge WH et al, Psychiatr Serv 2011;62(5):541–544), it stands to reason that community mental health team members would be successful with relapse prevention (or delay). Given huge cuts in mental health budgets, and the high cost of hospitalization, it might make clinical and fiscal sense to offer short-term psychoeducation for caregivers, and short-term relapse prevention treatment by paraprofessionals routinely.