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Abstract

The broad acceptance of evidence-based psychosocial interventions as adjuncts to pharmacotherapy for bipolar disorder has been inhibited by the extensive training, supervision, and fidelity requirements of these approaches. Interventions that emphasize evidence-based strategies drawn from these modalities—rather than the full manualized protocols—may broaden the availability of psychotherapy for patients with bipolar disorder. In this article, psychosocial risk factors relevant to the course of bipolar disorder (stressful life events that disrupt social rhythms, lack of social support, family criticism and conflict, and lack of illness awareness or literacy) are reviewed, along with evidence-based psychosocial interventions (e.g., interpersonal and social rhythm therapy, cognitive-behavioral therapy, family-focused therapy, and group psychoeducation) to address these risk factors. The results of a component network meta-analysis of randomized psychotherapy trials in bipolar disorder are discussed. Manualized psychoeducation protocols—especially those that encourage active skill practice and mood monitoring in a family or group format—were found to be more effective, compared with individual psychoeducation or routine care, in reducing 1-year recurrence rates. Cognitive restructuring, regulation of daily and nightly routines, and communication skills training were core components associated with stabilization of depressive symptoms. The authors describe a novel psychoeducational approach—practical psychosocial management (PPM)—that integrates these core strategies into the personalized care of patients with bipolar disorder to reduce recurrences and enhance mood stability. PPM is designed to be implemented, without time-intensive training and oversight, by physician or nonphysician clinicians. Evaluating the efficacy and coverage of PPM will require implementation trials in community settings.

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Information

Published In

Go to American Journal of Psychotherapy
Go to American Journal of Psychotherapy
American Journal of Psychotherapy
PubMed: 39582312

History

Received: 15 May 2024
Revision received: 28 June 2024
Revision received: 27 July 2024
Accepted: 28 August 2024
Published online: 25 November 2024

Keywords

  1. Bipolar Disorder
  2. Psychotherapy
  3. Psychosocial Interventions
  4. Psychoeducation
  5. Evidence-Based Therapy
  6. Component Network Meta-Analysis

Authors

Details

Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.
Department of Psychiatry and Biobehavioral Sciences, Jane and Terry Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles.

Notes

Send correspondence to Dr. Miklowitz ([email protected]).

Competing Interests

Dr. Miklowitz receives research support from the Attias Family Foundation, Baszucki Brain Research Fund, Max Gray Fund for Treatment of Mood Disorders, Milken Family Foundation, and NIMH; he receives book royalties from Guilford Press and John Wiley and Sons. Dr. Gitlin receives book royalties from Guilford Press and Springer.

Funding Information

Supported by the NIMH (R01-MH-093676, R34-MH117200, and R01-MH-123575) and by the Baszucki Brain Research Fund.

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