|Intensive Psychotherapy More Effective Than
Brief Therapy for Treating Bipolar Depression
Patients taking medications to treat bipolar disorder (http://www.nimh.nih.gov/healthinformation/bipolarmenu.cfm)
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). The results are published in the April
2007 issue of the Archives of General Psychiatry.
Bipolar disorder is a debilitating illness marked by severe mood
swings between depression and mania that 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 is routinely employed as a means to treat bipolar
illness in conjunction with medication, but the extent to which
psychotherapy is effective has been unclear. In addition, most
psychotherapeutic studies have been limited to a single site and
compared only one type of treatment to routine care. Thus, in addition
to examining the role of medication, STEP-BD set out to compare
several types of psychotherapy and pinpoint the most effective
treatments and treatment combinations.
With 293 participants, David Miklowitz, Ph.D., of the University
of Colorado and colleagues set out to test the effectiveness of
three types of standardized, 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 required the participation and
input of 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 sleep/wake
cycles, and solve key relationship problems.
All participants were already taking medication for their bipolar
disorder, and most were also enrolled in a STEP-BD medication study
reported in the New England Journal of Medicine on March
28, 2007 (http://www.nih.gov/news/pr/mar2007/nimh-28.htm).
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. Discontinuation rates among the groups were similar — 36
percent of those in the intensive programs discontinued and 31
percent of those in collaborative care discontinued. 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
Dr. Miklowitz. “It should be considered a vital part of the effort
to treat bipolar illness.”
The National Institute of Mental Health (NIMH) mission is to reduce
the burden of mental and behavioral disorders through research
on mind, brain, and behavior. More information is available at
the NIMH website, http://www.nimh.nih.gov.
The National Institutes of Health (NIH) — The Nation's
Medical Research Agency — includes 27 Institutes and
Centers and is a component of the U.S. Department of Health and
Human Services. It is the primary federal agency for conducting
and supporting basic, clinical and translational medical research,
and it investigates the causes, treatments, and cures for both
common and rare diseases. For more information about NIH and
its programs, visit www.nih.gov.