STOCKHOLM -- Adjunctive treatment with psychotherapy can be very beneficial to patients with bipolar disorder, decreasing relapse rates by up to 40% and significantly improving social functioning.
These kinds of therapies appear to be especially effective for patients in the early stages of the disorder and for those with mild or less complex forms, researchers said at the annual congress of the European College of Neuropsychopharmacology.
Despite optimal medical therapy, up to 50% of bipolar patients continue to have symptoms, said Jan Scott, M.D., of the Institute of Psychiatry, London.
Adjunctive psychotherapy is not common, she said, because the disorder is seen as primarily biologically driven and because psychotherapists "aren't keen about taking on manic and hypomanic patients." Nevertheless, recent studies have consistently shown that psychotherapy--including cognitive-behavioral therapy (CBT) and programs teaching stress management and identification of early warning symptoms of relapse--is highly effective.
Since 1999, 20 randomized controlled studies of some form of psychosocial adjunctive therapy for bipolar disorder have been published or started. Most examine the effect of a brief series of interventions (6-12 sessions) vs. treatment as usual. The interventions place great emphasis on helping patients develop skills in self-management of the disorder and then encouraging them to use those skills in daily life. Patients then see any positive changes as a result of their own efforts as well as those of the therapist; this reward increases their motivation to be compliant.
Studies indicate that peer-led self-help groups are the most successful interventions for patients with less severe illness, while those with more serious illness are best served with individual, therapistled sessions, Dr. Scott said.
She shared some results of the British Medical Research Council's recent randomized controlled trial of CBT in bipolar disorder. The five-center study involved 250 patients: 50% had attempted suicide, 22% had a history of violence, 50% had a history of substance abuse, 10% had a borderline personality disorder, 25% had at least one comorbid Axis I disorder, and 32% were depressed at the study outset. Half of the group received treatment as usual, and half received a CBT intervention in addition to their regular treatment.
At the end of the 72-week study, there were no significant differences in relapse rates between the two groups. …