Evidence-Based Treatments for Bipolar Disorder

There are a variety of medications and therapies available to those suffering from bipolar disorder. Medications can help reduce symptoms and are recommended as the first-line treatment for bipolar disorder. People can also learn to manage their symptoms and improve their functioning with therapy and rehabilitation.

What is Evidence-Based Practice for Bipolar Disorder?

Research has shown that the treatments listed here are effective for people with bipolar disorder and are considered to be evidence-based. Evidence-based treatments for bipolar disorder include:

• Medication
• Psychoeducation
• Cognitive Behavioral Therapy (CBT)
• Interpersonal and Social Rhythm Therapy
• Family-Based Services
• Social Skills Training
• Illness Self-Management
• Assertive Community Treatment (ACT)
• Psychosocial Interventions for Alcohol and Substance Use Disorders
• Supported Employment
• Psychosocial Interventions for Weight Management

Medication

The post titled “Bipolar Disorder Medication: What You Should Know” provides information about mood stabilizing medications and their side effects. This is followed by information on antipsychotic and antidepressant medications, which are also frequently utilized in the treatment of bipolar disorder.

Psychoeducation

Psychoeducation educates patients about their illness and the most effective ways of treating symptoms and preventing relapse. Psychoeducation covers topics such as the nature and course of bipolar disorder, the importance of active involvement in treatment, the potential benefits and adverse effects of various treatment options, identification of early signs of relapse, and behavior changes that reduce the likelihood of relapse.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) aims to change a person’s way of thinking to be more adaptive and healthier. CBT is a blend of two therapies: cognitive therapy and behavioral therapy.

• Cognitive therapy focuses on a person’s thoughts and beliefs and how they influence a person’s mood and actions.
• Behavioral therapy focuses on a person’s actions and aims to change unhealthy behavior patterns.

CBT is used as an addition to medication and includes psychoeducation about the disorder as well as problem-solving techniques. Individuals learn to identify what triggers episodes of the illness, which can reduce the chance of relapse. This can help individuals with bipolar disorder minimize the types of stress that can lead to a hospitalization.

CBT also helps individuals learn how to identify maladaptive thoughts, logically challenge them, and replace them with more adaptive thoughts. CBT further targets depressive symptoms by encouraging patients to schedule pleasurable activities.

Individuals who receive both CBT and medication treatment have better outcomes than those who do not receive CBT as an additional treatment. CBT may be done one-on-one or in a group setting.

Interpersonal and Social Rhythm Therapy

In Interpersonal and Social Rhythm Therapy (IPSRT), patients first learn to recognize the relationship between their circadian rhythms and daily routines, as well as their mental health symptoms. IPSRT then focuses on stabilizing sleep/wake cycles, maintaining regular patterns of daily activities (i.e., sleeping, eating, exercise, and other stimulating activities), and addressing potential problems that may disrupt these routines.

This often involves resolving current interpersonal problems and developing strategies to prevent such problems from recurring in the future. When combined with medication, IPSRT can help individuals increase their targeted lifestyle routines and reduce both depressive and manic symptoms.

Family-Based Services

Mental illness affects the whole family. Family services teach families to work together towards recovery. In family-based services, the family and clinician meet to discuss problems the family is experiencing. Families then attend educational sessions where they will learn basic facts about mental illness, coping skills, communication skills, problem-solving skills, and ways to work with one another toward recovery.

Individuals with bipolar disorder who participate in family interventions along with taking medication have fewer relapses, longer time between relapses, better medication adherence, less severe mood symptoms, and increased positive communication between family members.

There is a range of family programs available to fit the specific needs of each family. Some families benefit from just a few sessions, while more intensive services are especially helpful for families that are experiencing high levels of stress and tension and for individuals with bipolar disorder who are chronically symptomatic or prone to relapse. Generally, these longer-term interventions last 6-9 months and can be conducted in single family or multi-family formats.

Social Skills Training

Many people with bipolar disorder have difficulties with social skills. Social skills training (SST) aims to correct these deficits by teaching skills to help express emotion and communicate more effectively so individuals are more likely to achieve their goals, develop relationships, and live independently. Social skills are taught in a very systematic way using behavioral techniques, such as modeling, role playing, positive reinforcement, and shaping.

Illness Self-Management

Components of illness self-management include psychoeducation, coping skills training, relapse prevention, and social skills training. Individuals learn about their psychiatric illness, their treatment choices, medication adherence strategies, and coping skills to deal with stress and symptoms.

Relapse prevention involves recognizing situations that might trigger symptoms, tracking warning signs and symptoms of relapse. They then develop a plan to cope with triggers and warning signs to prevent relapse. This treatment approach also teaches individuals social skills in order to improve the quality of their relationships with others.

Assertive Community Treatment

Assertive Community Treatment (ACT) is an approach that is most effective for individuals with the greatest service needs, such as those with a history of multiple hospitalizations or those who are homeless.

In ACT, the person receives treatment from an interdisciplinary team of usually 10 to 12 professionals, including case managers, a psychiatrist, several nurses and social workers, vocational specialists, substance abuse treatment specialists, and peer specialists.

The team provides coverage 24 hours a day, 7 days per week, and limits caseloads to ensure a high staff to client ratio, usually 1 staff member for every 10 clients.

Services provided in ACT include: case management, comprehensive treatment planning, crisis intervention, medication management, individual supportive therapy, substance abuse treatment, rehabilitation services (e.g., supported employment), and peer support.

Psychosocial Interventions for Alcohol and Substance Use Disorders

Many individuals with bipolar disorder also struggle with an alcohol or substance use disorder. Co-occurring disorders are best treated concurrently, meaning that treatment for bipolar disorder should be integrated with the treatment for the alcohol or drug problem.

Integrated treatment includes motivational enhancement and cognitive-behavioral interventions. Integrated treatments are effective at reducing substance use, preventing relapse, and keeping individuals in treatment longer. These interventions can be delivered one-on-one or in a group format.

Supported Employment

Research shows that about 70% of adults with severe mental illness want to work and about 60% can be successfully employed through Supported Employment.

Supported Employment is a program designed to help people with severe mental illness find and keep competitive employment. The approach is characterized by a focus on competitive work, a rapid job search without prevocational training, and continued support once a job is obtained.

Employment specialists work with individuals to identify their career goals and skills. Case managers and mental health providers work closely with employment specialist to provide support during the job seeking and keeping process.

Psychosocial Interventions for Weight Management

Weight gain is a significant and frustrating side effects of some medications used to treat the symptoms of bipolar disorder. Weight gain can lead to problems such as diabetes and hypertension, making it a serious health issue for many individuals.

Resources to support weight loss are available. Weight programs generally last 3 months or longer and include education about nutrition and portion control. Participants learn skills to monitor their daily food intake and activity levels, have regular weigh-ins, and set realistic and attainable personal wellness goals.

Participation in such a program can help prevent additional weight gain and lead to modest weight loss. The VA’s version of this program is called MOVE! It is offered in a supportive group setting.

Here are some additional articles you might find helpful:

• What Causes Bipolar Disorder and How Common Is It?
• Bipolar Disorder: The Symptoms
• Bipolar Disorder Medication: What You Should Know
• Family Support for Bipolar Disorder: How You Can Help