BP Disorder Bipolar Research Paper

Pages: 20 (6099 words)  ·  Bibliography Sources: ≈ 20  ·  File: .docx  ·  Level: Doctorate  ·  Topic: Psychology

In the acute treatment phase the focus is on suppressing current symptoms and continues until the patient is considered to be in remission, which occurs when their symptoms have been significantly are reduced and controlled for a significant time period.

2. Continuation treatment is designed to prevent a reoccurrence of the symptoms from the current or from the same depressive or manic episode.

3. Maintenance treatment is designed to prevent a recurrence of symptoms after the last episode has been controlled.

There have been numerous studies that have demonstrated that when treated with medications the relapse rates for bipolar disorder are substantially reduced and the overall improvement of symptoms is quite substantial (e.g., Goldberg, 2004). For these reasons medications will continue to be the first-line treatments for bipolar disorder, but this does not mean than psychotherapy cannot be used to help these patients or to assist with their treatment. For bipolar patients in psychotherapy, being on medications is often viewed as a necessary evil. This is because that many patients experience side-effects from mood stabilizers or atypical antipsychotics and yet have to continue to do the work in therapy (as well as their daily routines) in order to adjust and to move forward. Both patients and therapists need to be cognizant of the complications of medical interventions such as psychotropic drugs when judging their daily levels of functioning and progress in treatment.


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There are many roles for the uses of psychotherapy in the treatment of bipolar disorder. Some of the roles for psychotherapy would be to psychoeducational, to teach skills for symptom management, to enhance functioning in social and occupational areas, and to keep patients adherent to their medication routines. Other important goals would be to help these patients learn to cope with stress triggers recognizing that certain types of life events and family tensions are potential risk factors that contribute to the expression of the disorder.


Research Paper on BP Disorder Bipolar Disorder, Originally Assignment

One of the most distressing issues regarding bipolar disorder is that patients have traditionally expressed their resentment regarding how little information they are given about the disorder that plagues them or the medications that they are prescribed (Goodwin, 2007). Psychoeducational sessions should consist of actual lectures about the disorder, the medications involved, the need for adherence, what to expect side-effect wise, etc. Early studies that used manual-based education programs that teach patients about the signs and symptoms of the disorder and medication management display significantly lower rates of relapses than those that only receive medication management instruction, although the relapse rates in some studies were still high attributing to the chronic nature of the disorder (e.g., Colom et al., 2005). Psychoeducation may also have an effect on the severity of manic symptoms as well. For example, Simon et al. (2005) examined psychoeducation in the context of a multi-component managed care program. The program consisted of patients treated with a case management program (pharmacotherapy, telephone-based monitoring, care planning with a team, and group psychoeducation) compared to patients receiving pharmacotherapy alone. Over a two-year follow-up period had lower mania scores on standard measures and spent less time in manic or hypomanic episodes than the pharmacotherapy group, but there was no effect on depressive symptoms. Thus, it appears that psychoeducation should be an important part of any treatment program for bipolar disorder.

Cognitive Behavioral Therapy

There has been quite a bit of research investigating the use of Cognitive Behavioral Therapy (CBT) used in conjunction with medications for treating bipolar patients. In a review of therapy studies Goodwin (2007) reports that between the years 1960 and 1998 there were more than 30 published studies that investigated the use of combined psychological and pharmacological treatments for bipolar disorder. However, the majority of the studies were not large and had a collective mean sample size of about 25 participants. The bulk of the studies addressed group or family therapies for bipolar disorder with a small number (four) reporting on the results of individual psychotherapy for bipolar disorder. In addition, nearly 20 of these studies were open cohort designs without a control group. In spite of the methodological limitations of many of the studies reviewed the participants in a majority of the studies that received adjunctive psychotherapeutic treatments demonstrated better clinical and social outcomes than the participants undergoing standard treatments comprised of medications (most often mood stabilizers) with some outpatient support. There was also evidence of observer-rated differences between the combined and traditional treatment groups that approached statistical significance. Overall these results motivated later randomized controlled trials using more targeted interventions.

There have since been a large number of studies in several different countries. Many of the trials focus on psychoeducational models and the best researched manualized psychotherapeutic approaches: interpersonal social rhythms therapy, CBT, and family focused therapy (FFT). Some studies have concentrated on techniques drawn from these manualized therapies. Therapies are primarily used to improve awareness, adherence to medications, to instruct the patient in the recognition of prodromal symptoms, and techniques aimed at relapse prevention.

For instance, Lam et al. (2005) compared a CBT/pharmacotherapy group (14 sessions and two booster sessions) with a control (pharmacotherapy) group of bipolar patients who had been in remission for six months but were believed to be at high risk for relapse. At a year follow-up the relapse rated in the CBT group was significantly lower than the control group (44% compared to 75%). The CBT group also demonstrated higher social functioning. However, at the 18-month follow up period the two groups did not differ significantly in regards to relapse rates. As one would expect, the effects of CBT were more salient on depression than on mania. It appears the addition of psychoeducation programs oriented towards symptom management have stronger effects on mania than depression (Butler, Chapman, Forman, & Beck, 2006). Lam et al. (2005) recommended that CBT techniques need to be formulated specifically for bipolar disorder as opposed to using techniques aimed at depression. Therapeutic techniques should address the specific cognitive distortions and cognitive styles associated with mania and hypomania including grandiosity, a pressured sense of time, etc.

A large scale study by Scott et al. (2006) looked a CBT (22 sessions) plus medications vs. A medication only group in the UK recruited across five different sites. There were no differences to relapse; however, a there was a treatment by prior episodes interaction with CBT associated with longer time to relapse for those with 12 or less prior relapses. Thus, CBT may be more effective the earlier in the course of the disorder it is applied.

Miklowitz (2008b) discussed the results of studies of adjunctive therapies for bipolar disorder. Eighteen studies performed between 1984 and 2008 were included in the analysis. The effects of the treatment of different types of modalities varied depending on the clinical condition of patients at the beginning of treatment and the type of symptoms occurring at follow-up. Interpersonal therapy, family therapy, and systematic were most effective in preventing relapses when there were started following an acute episode. CBT and group psychoeducation were most effective when started during recovery of an episode. Individual psychoeducation and systematic care demonstrated greater effectiveness for manic as opposed to depressive symptoms and family therapy and CBT demonstrated the opposite pattern (greater effectiveness for depressive symptoms). Overall Miklowitz found the results to indicate that treatments placing their emphasis on early recognition of symptoms and/or adherence to medications were more effective for mania, whereas those stressing cognitive and interpersonal coping skills have better results on the depressive symptoms.

The results of meta-analytic studies investigating CBT on bipolar disorder have been mixed with some indicating no overall effects (e.g., Lynch, Laws, & McKenna, 2010) and others indicating effects similar to the aforementioned studies (e.g., Butler et al., 2006). However, based on the above discussion several mediating variables would need to be considered. Given these findings we can propose how CBT can be most effective in applying to patients with bipolar disorder.

Early in treatment it is important to provide patients with a model of bipolar disorder and a sound justification for the upcoming treatment procedures. Next the therapist should discuss or instruct the patient in the cognitive-behavioral representation of the interplay between thinking, feeling, and behavior. Patients can then be asked to supplement this information by observing their experiences, testing the CBT model, and identifying the role of their thoughts in influencing their mood. Sessions can be presented in a problem-solving design that begins with a review of the previous learning, developing an agenda for the current session, completion of that list of items focusing on the practice of concepts, and finally ending with homework to enhance skills. This particular format maintains focus on the sequential, goal-oriented, skill development approach advocated in the original CBT literature (e.g., Beck, 1995). To assist making the treatment more palatable the use of metaphors and stories can be used as well.

A good deal of research in clinical and social psychology suggests that compliance with requests is improved when the person's agreement… [END OF PREVIEW] . . . READ MORE

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