Psychosocial Interventions for Bipolar II Disorder
Abstract
Abstract
Objective:
Methods:
Results:
Conclusions:
Rationale for Psychotherapy in Bipolar II Disorder
Overview of Evidence Supporting Efficacy of Psychotherapy for Bipolar II Disorder
Methods
Results
Author | Treatment method | Treatment duration; follow-up | Sample | State at entry; other criteria | Overall outcome | |
---|---|---|---|---|---|---|
Individual and group psychoeducation | ||||||
Colom et al. (19, 21, 22)b | Group PE or support group | 21 sessions; 2 years, 5 years | 2003: N=120, BDII=20 (17%), BDI=100; 2009: N=99 | Euthymic | At 2 years, group PE associated with sig. lower relapse rates, lower hospitalization rates, and much less time acutely ill. At 5 years, group PE continued to be associated with sig. fewer recurrences and less time acutely ill in the BD II group. | |
Kallestad et al. (23)b | Individual PE or group PE | PE: 3 sessions, group: 18 to 20 sessions; 27 months, 8 years | N=85, BDII=45 (53%), BDI=40 | Any | Group PE associated with sig. longer time to hospitalization. Pre-randomization characteristics but not intervention group explained variance. Group PE participants without substance use had longest survival and had small but sig. reduction in hospital use. BD II had worse outcomes than BD I. | |
Morris et al. (24) | Group PE or peer support | 21 sessions, 2 years | N=304, BDII=61 (20%), BDI=243 | Euthymic | No sig. differences. | |
Parikh et al. (25)b | Group PE or individual CBT | PE: 6 sessions, CBT: 20 sessions; 72 weeks | N=204, BDII=57 (28%), BDI=147 | Full or partial remission | No sig. differences. BD I and II outcomes were not different. | |
Zaretsky et al. (26) | PE + CBT or PE alone | PE: 7 sessions, PE + CBT: Addition of 13 CBT sessions; 1 year | N=79, BDII=27 (34%), BDI=52 | Euthymic or minimally symptomatic | PE + CBT associated with sig. fewer days of depressed mood and fewer increases in antidepressant dosage. | |
Individual and group cognitive-behavioral therapy and cognitive therapy | ||||||
Gomes et al. (27) | Group CBT or TAU | 18 sessions; 2 years | N=50, BDII=12 (24%), BDI=38 | Euthymic | Group MBCT did not sig. increase time in remission or decrease number of episodes. Group CBT group had sig. longer median time to first relapse. | |
Jones et al. (28) | Group recovery-focused CBT (RCBT) or TAU | Up to 18 sessions; 1 year, small proportion up to 15 months | N=67, BDII=14 (21%), BDI=53 | Within 5 years of onset of BD | Group RCBT sig. improved personal recovery up to 12 months and increased time to relapse up to 15 months follow-up. | |
Meyer & Hautzinger (29)b | CBT or supportive therapy | 20 sessions; 2 years | N=76, BDII=16 (21%), BDI=38 | Current mood episode | CBT showed a non-sig. trend for preventing any affective episode. No differences in relapse rates were observed overall, but BD II group had worse outcomes than BD I. | |
Miklowitz et al. (30)b | CBT, FFT, IPSRT, or CC | CBT, FFT, and IPSRT: 30 sessions, CC: 3 sessions; 9 months, 12 months | N=293, BDII=90 (31%), BDI=197, NOS=5 | Current depressive episode | At 9 months, CBT, FFT, and IPSRT all associated with better total functioning, relationship functioning, and life satisfaction scores. No differences among CBT, FFT, and IPSRT. At 1 year, CBT, FFT, and IPSRT were associated with more rapid recovery and greater likelihood of being well during any study month. BD II and I outcomes were not different. | |
Perich et al. (31) | Group MBCT or TAU | 8 sessions; 1 year | N=95, BDII=35 (37%), BDI=59, NOS=1 | Euthymic or minimally symptomatic | No sig. difference. | |
Interpersonal and social rhythm therapy | ||||||
Inder et al. (32) | IPSRT or specialist supportive care | 12 weekly, then biweekly, and then monthly sessions, or as needed; 18 months, 3 years | N=100, BDII=17 (17%), BDI=78, NOS=5 | Any, ages 15 to 36 years | No sig. difference. | |
Swartz et al. (18)b | IPSRT or quetiapine pharmacotherapy | 12 sessions; 12 weeks | N=25, BDII=25 (100%) | Depressed | No sig. differences. | |
Swartz et al. (16)b | IPSRT + placebo pharmacotherapy or IPSRT + quetiapine pharmacotherapy | 20 sessions; 20 weeks | N=92, BDII=92 (100%) | Depressed | IPSRT + quetiapine yielded sig. faster depression and mania improvement. No sig. difference in response rates. Preference for psychotherapy was significantly associated with better outcomes with therapy alone. | |
Integrated care management | ||||||
Bauer et al. (33) | CC or TAU | 83 sessions; 3 years | N=306, BDII=41 (13%), BDI=265 | Current episode requiring acute psychiatric hospitalization; history of prior hospitalization | CC group had sig. fewer weeks in an affective episode, especially mania. CC associated with sig. improvements in some areas of functioning and quality of life. No sig. diff in symptomatic outcome and mean symptom levels. | |
Simon et al. (34) | SCM or TAU | Up to 48 sessions; 2 years | N=441, BDII=105 (24%), BDI=336 | Any | SCM group had sig. less severe mania and spent less time in a manic or hypomanic episode. No sig. intervention effect on severity or time in depression. | |
Group functional remediation | ||||||
Solé et al. (35)b Torrent et al. (36) | Group FR, group PE, or TAU | 21 sessions; 6 months | N=53 of 239, BDII=53 (100%) | Subsample of Torrent et al., 2013, BDII diagnosis; euthymic at study entry | No sig. group differences. Changes in global psychosocial functioning trended similarly to original study; may be insufficiently powered. Unlike the original study, FR was associated with sig. decrease in depressive symptoms in the BD II subgroup. | |
Technology-assisted interventions | ||||||
Barnes et al. (37) | Online PE + CBT or Internet control condition | 20 sessions over 12 months; 1 year | N=233, BDII=29 (12%), BDI=204 | No acute mania | No sig. difference. | |
Bilderbeck et al. (38) | Electronic mood monitoring and in-person therapist-administered PE or electronic mood monitoring and self-directed PE | 5 in-person sessions over 12 weeks with electronic mood monitoring; 1 year | N=121, BDII=42 (35%), BDI=79 | Euthymic | No sig. difference. | |
Depp et al. (39) | In-person PE + electronic mood monitoring with feedback loop or in-person PE + paper-and-pencil mood monitoring | 4 PE sessions then 10 weeks of daily mood monitoring; 6 months | N=82, BDII=10 (12%), BDI=72 | No severe depressive or manic symptoms | PRISM was associated with sig. greater reduction in depressive symptoms at 6 and 12 weeks but not 24 weeks; no impact on manic symptoms or functional impairment. | |
Faurholt-Jepsen et al. (40) | In-person TAU and electronic mood monitoring with feedback loop or placebo smartphone without the app | Daily; 6 months | N=67, BDII=22 (33%), BDI=45 | No severe depressive or manic symptoms | No significant effect on depressive or manic symptoms. MONARCA associated with more sustained depressive symptoms. | |
Hidalgo-Mazzei et al. (41, 42) | Online pre- and post-personalized electronic psychoeducation | 3 months; 3 months | N=51 (2 excluded), BDII=13 (27%), BDI=33, NOS=3 | Euthymic | Completing SIMPLe was associated with sig. improved biological rhythm regularity, sleep, social rhythms, eating patterns, predominant rhythm. There was no sig. effect on activities. | |
Lauder et al. (43) | Online MoodSwings or online MoodSwings Plus | 1 module every 2 weeks for 10 weeks, then 3 booster sessions; 12 months | N=130, BDII=63 (49%), BDI=67 | Any | There were no sig. differences for mania or depression relapse rates. MoodSwings Plus group had lower levels of mania. | |
Todd et al. (44) | Online recovery-focused PE + CBT or in-person TAU | 10 modules, 6 months of access; 6 months | N=122, BDII=30 (25%), BDI=86 | Any | PE + CBT associated with greater improvement in psychological and physical domains of quality of life, well-being, and recovery. | |
Other individual and group interventions | ||||||
Fagiolini et al. (45) | SCBD + ECI or ECI only | SCBD + ECI: 12 weekly, 8 biweekly, then monthly sessions; 2 years | N=463, BDII=87 (19%), BDI=313, other=63 | Current mood episode | SCBD + ECI associated with sig. greater improvement in quality of life. | |
Castle et al. (46) | Collaborative therapy program: MAPS (CTP) or phone calls | 15 sessions; 1 year | N=84, BDII=21 (25%), BDI=62, NOS=1 | No acute episode of mania or depression | CTP associated with longer time to relapse and less time unwell. No sig. differences in post-treatment symptoms. | |
Van Dijk et al. (47) | DBTS-M or wait list | 12 sessions; 6 months | N=24, BDII=14 (58%), BDI=10 | Euthymic, depressed or hypomanic | DBTS-M was associated with a trend toward fewer depressive symptoms and fewer hospitalizations and emergency visits. | |
Weiss et al. (48) | IGT or group drug counseling | 20 sessions; 3 months | N=62, BDII=10 (16%), BDI=50, NOS=2 | Any, diagnosis of substance dependence other than nicotine | IGT group had better substance use outcomes but more depression and mania symptoms. No sig. difference for number of weeks ill. |
Psychoeducation
CBT
IPSRT
Integrated Care Management
Functional Remediation
Technology-Assisted Interventions
Other Individual and Group Interventions
Common Factors and Clinical Recommendations
Psychoeducation should be tailored to address the nuances of the bipolar II illness subtype.
Regular mood monitoring is important for those with bipolar II disorder, with a focus on identifying subthreshold depressive symptoms.
Depression-specific strategies should be enhanced for bipolar II disorder.
Psychoeducation about medications and medication side effects is especially complex in bipolar II disorder because there is uncertainty about appropriate pharmacologic management.
Illness recognition and understanding can be problematic for family members, especially when diagnosis has been incorrect or delayed for years or even decades.
Comorbidities such as substance use, anxiety disorders, and personality disorders should be evaluated and addressed.
Discussion
Conclusions
References
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