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Intensive Psychotherapy is more effective than brief therapy for treating bipolar disorder

Patients taking medications to treat bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy, according to results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH).

Bipolar disorder, a debilitating illness marked by severe mood swings between depression and mania, affects 2.6 percent of Americans in any given year. “We know that medication is an important component in the treatment of bipolar illness. These new results suggest that adding specific, targeted psychotherapy to medication may help give patients a better shot at lasting recovery,” said NIH Director Dr. Elias A. Zerhouni.

“STEP-BD is helping us identify the best tools—both medications and psychosocial treatments—that patients and their clinicians can use to battle the symptoms of this illness,” said NIMH Director Thomas R. Insel, M.D.

Psychotherapy together with medication is often used to treat bipolar illness. In addition to examining the role of medication, STEP-BD compared several types of psychotherapy to pinpoint the most effective treatments and treatment combinations.

In a study of 293 participants already taking medication for their bipolar disorder, researchers at the University of Colorado tested the effectiveness of three types of intensive, nine-month-long psychotherapy compared to a control group that received a three-session, psychoeducational program called collaborative care. The intensive therapies were

  • family-focused therapy, which involved patients’ family members and focused on enhancing family coping, communication and problem-solving;
  • cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness; and
  • interpersonal and social rhythm therapy, which focused on helping the patient stabilize his or her daily routines and sleeping cycles, and solve key relationship problems.

The researchers compared patients’ time to recovery and their stability over one year.

Over the course of the year, 64 percent of those in the intensive psychotherapy groups had become well, compared with 52 percent of those in collaborative care therapy. Patients in intensive psychotherapy also became well an average of 110 days faster than those in collaborative care. In addition, patients who received intensive psychotherapy were one and a half times more likely to be clinically well during any month out of the study year than those who received collaborative care. About a third of those in each group dropped out of the study.
None of the three intensive psychotherapies appeared to be significantly more effective than the others, although rates of recovery were higher among those in family-focused therapy compared to the other groups.

“Intensive psychotherapy, when used as an adjunctive treatment to medication, can significantly enhance a person’s chances for recovering from depression and staying healthy over the long term,” said David Miklowitz, Ph.D., of the University of Colorado. “It should be considered a vital part of the effort to treat bipolar illness.”

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