The 5 psychological treatments for bipolar disorder

Bipolar disorder (BD) is a psychological disorder of chronic affectivity, characterized mainly by the experience of phases of hyperarousal and hyperactivity (phases of hypomania or mania) that develop in alternation with other phases of low mood and inhibited (phases of depression), as well as with phases in which the patient is stable at the mood level (phase of euthymia).

Psychological treatments for bipolar disorder have been developed to primarily address the symptoms depressive and also to improve the patient's adherence to pharmacological treatment, whose objective is to treat episodes maniacs, because at the moment there is not enough scientific evidence to be able to treat them with the psychological treatment of unique way.

In this article we will see some of those psychological treatments for bipolar disorder that have positive results in terms of its effectiveness for the treatment of it throughout the different phases of its development.

• Related article: "Types of Bipolar Disorder and their characteristics"

The most used psychological treatments for bipolar disorder

This is a brief classification of psychological therapies and intervention modalities applied in patients with bipolar disorder.

1. psychoeducational intervention

One of the psychological treatments for bipolar disorder that has a long history in its treatment is psychoeducational intervention in an individual format; It is also usually carried out in a group and family format..

Psychoeducational intervention involves providing information about bipolar disorder so that people diagnosed with it can face it in the best possible way, as well as the possible consequences.

This psychological intervention is made up of the following modules, within the intervention in individual format:

• Increase the patient's awareness of her mental disorder.
• Increase patient adherence to their treatment.
• Train the patient in the detection and management of prodromal symptoms of bipolar disorder.
• Help the patient follow a healthy lifestyle and avoid harmful behaviors.
• Train the patient to regularize habits and stress management.

It should be noted that the studies carried out regarding the results regarding the effectiveness of the psychoeducational intervention indicate that it is more effective if applied in a group format over several months, starting with this intervention from the moment in which the diagnosis of bipolar disorder has been made in the patient.

On the other hand, when a patient with bipolar disorder has presented several episodes, comorbidity with other disorders or is in an advanced phase of the disorder, the Psychoeducational intervention would not be the most suitable treatment, so it would be necessary to resort to other psychological treatments for bipolar disorder that are appropriate in this case.

The Barcelona Group has developed a psychoeducational intervention approach that presents positive scientific guarantees in dealing with the symptoms of bipolar disorder. This intervention is carried out over 21 sessions in a group format, in which the modules that were previously listed in this section are worked on. In this sense, a clinical trial showed that psychoeducational intervention in a group format allowed to significantly reduce relapses and hospitalizations in patients with disorder bipolar.

It is noteworthy that the most recent studies recommend the use of psychoeducational intervention combined with psychopharmacological treatment. On the other hand, this intervention is recommended for the treatment of depression symptoms; however, it does not have enough evidence when it comes to addressing the symptoms of mania. However, psychoeducation is a good alternative due to its low cost compared to other psychological treatments for bipolar disorder (eg. g., cognitive-behavioral therapy).

• You may be interested: "Psychoeducation in psychological therapy"

2. cognitive behavioral therapy

Cognitive-behavioral therapy (CBT), when framed within psychological treatments for bipolar disorder, is based on the fact that in all human beings there is an interaction between their thoughts, emotions and behaviors, so thoughts directly influence the way they act and feel.

Therefore, the goal of this treatment is to train people with bipolar disorder to be able to master, examine and also modify the dysfunctional thoughts they may have, which will have a positive impact on their behaviors and emotions.

This type of psychological therapy for bipolar disorder can be used both individually and in groups and for a limited time. Some of the most used techniques in this treatment are problem solving, the modification of maladaptive coping styles or cognitive restructuring. Likewise, it should be said that there are specific manuals in which the approach to bipolar disorder from therapy is explained. cognitive-behavioral, among which the manual by Lam and collaborators stands out, dividing the therapy between 12 to 18 sessions, with a weekly frequency.

It is important to note that cognitive-behavioral therapy includes a psychoeducational intervention component that has been shown to strengthen the effects of both treatments psychological for bipolar disorder, the main benefits being the following: early detection and coping with the prodromal symptoms of the disorder, stabilization of the sleep routine, improve adherence to medication and help the patient to identify the possible triggering signs of an episode affective.

The results of large studies of cognitive-behavioral therapy as a treatment for the disorder bipolar, have shown that it is a therapy with great solvency and experimental support for this disorder mental; further, It is the most studied psychological therapy.

• Related article: "Cognitive-Behavioral Therapy: what is it and what principles is it based on?"

3. family therapy

Psychological treatments for bipolar disorder in a family format present two main modalities: family psychoeducational intervention and family-focused therapy.

These interventions are based on the hypothesis that states that there are high levels of hostility, critical attitude or an emotional overinvolvement of the relatives of the patient with a bipolar disorder, what is known as “high expressed emotion”, with very low results in terms of management and remission of the symptoms of the disorder, as well as a higher rate of relapse in the patient.

Family psychological therapy for bipolar disorder has the main objective of provide support to the patient and their family members, in order for them to learn more about bipolar disorder and its treatment, as well as training them to develop a series of strategies to deal with the disorder in an adaptive way that allows its management and also the reduction of the stress produced.

The main components of this class of psychological treatments for bipolar disorder are as follows: intervention family psychoeducational training, communication skills training and, lastly, problem solving training.

The family intervention for the treatment of bipolar disorder that has been studied the most is the FFT model (Family-Focused Therapy) or Miklowitz and Goldstein's Family-Centered Therapy, which is manualized and consists of 21 therapy sessions distributed over 9 months.

In most treatment guidelines it is recommended to combine family psychological intervention with pharmacological treatment.

• You may be interested: "Family therapy: types and forms of application"

4. Interpersonal and social rhythm therapy

Another of the most widely used psychological treatments for bipolar disorder is interpersonal and social rhythm therapy, which has been developed to improve the mood of people with bipolar disorder by intervening on affective episodes, and too to stabilize the patient's social and biological rhythms.

For this reason, intervention is carried out so that the patient learns to develop and maintain stable sleep routines, train a series of skills that allow the patient to reduce the quantity and severity of stressful social factors, which would improve the quality of their relationships interpersonal and, on the other hand, help the patient to develop new habits and skills that allow him to prevent affective episodes that could arise in the future.

• You may be interested: "How to generate new healthy habits?"

5. systematic care

Once we have seen what the main psychological treatments for bipolar disorder are, we are going to get to know a modality in which encompasses various types of intervention (for example, crisis intervention teams, assertive community treatment, etc.).

This type of intervention has been developed for those patients with bipolar disorder who present various problems, such as a persistent symptomatology, functional problems at different levels and a high history of involuntary hospitalizations, for which they need systematic care in which they can rely on various assistive devices (for example, a day hospital, specialized care, etc.).

Assertive community treatment has shown very positive results in dealing with these patients, since it has been possible to find significant improvements in terms of psychopathology of patients, as well as in their level of functioning, greater adherence to medication and also an improvement in patient satisfaction due to an improvement in their quality of life.

Thus, These types of treatments help to significantly reduce the costs of health care, since they help reduce hospitalization rates in addition to improving patients' symptoms, as well as their levels of functionality.

In Spain, the first assertive community care program was established in the town of Avilés (Asturias), which has more than 20 years of experience.