The 5 Psychological Treatments for Bipolar Disorder

An overview of the treatments and forms of psychological therapy used in bipolar disorder.

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

Psychological treatments for bipolar disorder have been developed in order to address mainly the depressive symptoms and also to improve the patient's adherence to pharmacological treatment, which aims to treat manic episodes, because at the moment there is not enough scientific evidence to be able to treat them with psychological treatment in a unique way.

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

The most commonly used psychological treatments for bipolar disorder.

This is a brief classification of the 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 of treatment is psychoeducational intervention in individual format; It is also often carried out in group and family format..

Psychoeducational intervention involves providing information about bipolar disorder so that people diagnosed with bipolar disorder will be able to the best possible way to cope with it, as well as the possible consequences of bipolar disorder..

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

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

It should be noted that the studies made with respect to the results regarding the effectiveness of psychoeducational intervention point out that it is more effective if it is applied in group format over several monthsThe intervention should begin as soon as 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 stage of the disorder, psychoeducational intervention would not be the most suitable treatment, so other psychological treatments for bipolar disorder that are appropriate in this case would have to be used.

The Barcelona Group has developed a psychoeducational intervention approach that presents positive scientific guarantees in addressing the symptoms of bipolar disorder. This intervention is implemented over 21 sessions in group format, in which the modules listed earlier in this section are worked on. In this regard, a clinical trial showed that psychoeducational intervention in group format significantly reduced relapses and hospitalizations in patients with bipolar disorder.

It is worth mentioning that the most recent studies recommend the use of psychoeducational intervention in combination with psychopharmacological treatment.. On the other hand, this intervention is recommended for the treatment of depressive symptoms; on the other hand, it does not have sufficient evidence when addressing manic symptoms. However, psychoeducation is a good alternative because of its low cost compared to other psychological treatments for bipolar disorder (e.g., cognitive-behavioral therapy).

2. Cognitive-behavioral therapy

Cognitive-behavioral therapy (CBT), when framed within the 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 that thoughts directly influence the way they act and feel..

Therefore, the objective 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 for a limited period of time. can be used both individually and in groups and for a limited period of time.. Some of the most commonly used techniques in this treatment are problem solving, modification of maladaptive coping styles or cognitive restructuring. Likewise, there are specific manuals that explain the approach to bipolar disorder from cognitive-behavioral therapy, among which the manual by Lam and collaborators stands out, which divides 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 reinforce the effects of both psychological treatments for bipolar disorder, the main benefits being the following: early detection and coping with prodromal symptoms of the disorder, stabilization of the sleep routine, improved adherence to medication, and helping the patient to identify possible triggering signs of an affective episode.

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

3. Family therapy

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

These interventions are based on the hypothesis that there are high levels of hostility, critical attitude or over-involvement in the family. there are high levels of hostility, critical attitude or over-involvement at the emotional level of the family members of the patient with a bipolar disorderThese interventions are based on the hypothesis that there are high levels of hostility, critical attitude or over-involvement at the emotional level of the relatives of the patient with bipolar disorder, which 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 providing support to the patient and his or her family members. to provide support to the patient and family members, in order to increase their understanding of bipolar disorder and its treatment.The main components of this kind of psychological treatment for bipolar disorder are the following: family psychoeducational intervention, communication skills training and, finally, problem-solving training.

The main components of this kind of psychological treatments for bipolar disorder are the following: family psychoeducational intervention, communication skills training and, finally, problem-solving training.

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

Most treatment guidelines recommend combining family psychological intervention with pharmacological treatment.

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 also to stabilize the patient's social and Biological rhythms. to stabilize the patient's social and biological rhythms..

Therefore, the aim of the intervention is that the patient learns to develop and maintain stable sleep routines, train a series of skills that allow the patient to reduce in quantity and severity the social stressors, which would improve the quality of their interpersonal relationships and, on the other hand, help the patient to develop new habits and skills that allow them to prevent affective episodes that may arise in the future.

5. Systematic care

Now that we have seen what the main psychological treatments for bipolar disorder are, we will move on to a modality that encompasses various types of intervention (e.g. crisis intervention teams, assertive community treatment, etc.).

These types of interventions have been developed for patients with bipolar disorder who present with a variety of problems, such as persistent symptomatology, problems with functioning at various levels and a high history of involuntary hospitalizations, and therefore require systematic care in which need systematic care in which they can be supported by a variety of care facilities (e.g., a day hospital). (e.g. day hospital, specialized care, etc.).

Assertive community treatment has shown very positive results in the approach to these patients, since it has been possible to find significant improvements in terms of the patients' psychopathology, 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.

Therefore, this type of treatment helps to reduce these types of treatments help to significantly reduce health care costs, as they help to reduce theIn addition, they help to reduce hospitalization rates and improve 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.