Assignment: Group Based Psychosocial Intervention for Bipolar Disorder Worksheet
Assignment: Group Based Psychosocial Intervention for Bipolar Disorder Worksheet
Assignment: Group Based Psychosocial Intervention for Bipolar Disorder Worksheet
Bipolar disorder is an extremely debilitating illness, in large part because of the difficulty in treating bipolar depressive episodes. Patients experience significantly greater impairment and longer times to recovery from depressive than manic episodes and high levels of residual depressive symptoms between episodes.1–7 The limited efficacy of pharmacotherapy alone8–11 has motivated the study of adjunctive psychosocial interventions. Randomized controlled trials support the efficacy of adjunctive cognitive behavior therapy (CBT),12,13 family-focused treatment (FFT) or similar forms of family psychoeducation,14–18 interpersonal and social rhythm therapy (IPSRT),19 and group psychoeducation20,21 in preventing depressive and manic recurrences, stabilizing symptoms, or enhancing functioning in 1- to 2-year periods. One multicenter effectiveness trial22 found no main effect of CBT on time to recurrence, although post hoc analyses revealed benefits in patients with fewer than 12 episodes.
Despite these important advances, it is unclear whether psychosocial treatments are effective for the acute treatment of depressed bipolar patients in routine practice settings. Family and interpersonal interventions have typically been initiated during or shortly after an acute manic, mixed, or depressive episode to prevent further recurrences,14–17,19 whereas CBT and group psychoeducation have generally commenced after lengthy periods of remission.13,20 Moreover, most studies have been single-site investigations of single treatments compared with routine care conducted in the academic center where the treatment was developed.
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We examined the effectiveness of adjunctive intensive psychosocial interventions in the context of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), a National Institute of Mental Health–sponsored study of the effectiveness of treatments for bipolar disorder. Across 15 study sites we randomly assigned patients to receive intensive psychosocial treatment (up to 30 sessions of CBT, IPSRT, or FFT in 9 months) or a minimal psychosocial intervention, collaborative care (CC), consisting of 3 sessions in 6 weeks. All 4 psychosocial treatments included psychoeducation, relapse prevention planning, and illness management interventions. Collaborative care was designed to provide a brief version of the most common psychosocial strategies shown to offer benefit for bipolar disorder.23,24 In contrast, the intensive treatments represented enhanced versions of these core psychoeducational interventions combined with additional treatment targets: disturbances in family relationships and communication in FFT, cognitive distortions and activity and skill deficits in CBT, and disturbances in interpersonal relationships and social rhythms in IPSRT. Consistent with the STEP-BD objective of evaluating interventions in routine practice, therapists were given modest levels of training (a weekend workshop and low-intensity ongoing monitoring) appropriate for a large-scale practical clinical trial.
We hypothesized that compared with adjunctive CC, adjunctive intensive psychosocial intervention would hasten time to recovery from bipolar depression and increase the likelihood of remaining well for 12 months. Secondarily, we explored whether the 3 intensive interventions (FFT, IPSRT, and CBT) differed in their impact on depressive symptoms.