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Treating the Highs & Lows of Bipolar Adults
Bipolar Adults continuing education addiction counselor CEUs

Section 16
Psychosocial Interventions with Bipolar Clients

CEU Question 16 | CE Test | Table of Contents | Bipolar
Psychologist CEs, Social Worker CEUs, Counselor CEUs, MFT CEUs

Medication compliance remains an area of concern for many patients and the professionals involved in their care and it is also one which education has sought to address. In a study carried out by Peet & Harvey (1991), 60 lithium clinic attendees were recruited to take part in a 6-week education program about lithium. Patients were randomly assigned to an education or a control group. Those in the education group showed substantial and significant increases in their knowledge about lithium together with a more favorable attitude towards lithium. However, work carried out some years earlier by Frank et al. (1985) found that a 1-day education workshop for patients and their families resulted in no cases of medication compliance.

Similar research in schizophrenia has shown that changes in attitude and knowledge does not necessarily lead to improved compliance and may well require the formal implementation of so called ‘compliance therapy’ (Kemp et al., 1996).

Family interventions
Miklowitz & Goldstein (1990) evaluated behavioral family management with a group of manic depressive patients recently hospitalized for an episode of mania. They found that of the nine family treatment cases only one relapsed (11 %) over a 9-month post-hospitalization period, compared to 14 out of 23 cases (61 %) from their naturalistic outcome study. Glick et al. (1994) carried out a cross national study of 24 in-patients with severe affective illness. Those patients who received individual and family psychoeducation demonstrated better coping with the episode, and their overall outcome was better 12-18 months after discharge. Clarkin et al. (1990) in a large-scale randomized controlled trial considered the outcome of 169 patients offered in-patient family intervention (IFI) 18 months after discharge. Of the 21 bipolar patients in this group, 12 were allocated IFI and nine to the control (usual inpatient treatment program). The results demonstrated that bipolar patients showed significantly improved social, family, work, leisure and role performance and improved family attitudes towards treatment were identified.

Psychological therapy
Jacobs (1982) reports the use of cognitive therapy techniques to reduce post-manic and post-depressive dysphoria. He reported that the application of cognitive therapy was ‘successful’ in both groups. Cochran (1984) studied the efficacy of a cognitive approach to medical non-compliance in out-patient lithium-treated patients. She used a modified cognitive--behavioral intervention (adapted from Beck et al., 1979) to challenge cognitions that impeded compliance. The results demonstrated an immediate improvement post treatment in the intervention group. This was maintained at a 6-month follow-up. Moreover, the intervention group were significantly less likely to have major compliance problems, to terminate lithium treatment against medical advice, or to be hospitalized.

Group therapy
There are a small number of uncontrolled studies of group therapy of various persuasions. Shakir et al. (1979) and Volkmar (1981) offered a therapy group to 15 bipolars who were also lithium responsive; many of these patients (10) had a poor history of compliance. The group, which was organized on the lines of that advocated by Yalom, ran for a number of years. Following a 2-year attendance at the group Shakir and colleagues reported significant changes in the patients’ level of functioning compared to the 2-years prior to attending the group. They also noted that following a 51-week attendance at the group, admission rates fell. Only three individuals were admitted to hospital over the period of 2 years and the average time spent in hospital fell to 3 weeks. Similar findings were reported from Kripke & Robinson (1985). Palmer & Williams (1995) in an exploratory study evaluated CBT in a group of Bipolars who were also receiving pharmacotherapy. The group was run weekly over a period of 17 weeks. The results indicated that for some, the intervention was successful in improving symptomatology and overall social adjustment, although the improvement varied across individuals.
- George, Sandra; Towards an Integrated Treatment Approach for Manic Depression; Journal of  Mental Health; Apr98, Vol. 7 Issue 2, p145.
The article above contains foundational information. Articles below contain optional updates.

Personal Reflection Exercise #2
The preceding section contained information about psychosocial interventions for bipolar clients.  Write three case study examples regarding how you might use the content of this section in your practice.

Online Continuing Education QUESTION 16
According to Cochran, what is the most effective form of therapy for increasing medication compliance in bipolar patients? Record the letter of the correct answer the CE Test.


CE Test for this course | Bipolar
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Table of Contents

The article above contains foundational information. Articles below contain optional updates.
The Most Effective Therapies for Treating Bipolar Disorder - May 24, 2019
You’ve been diagnosed with bipolar disorder, or maybe your loved one has. And you’re wondering, what’s the best treatment? What actually works? What the heck do I do? Because bipolar...
The post The Most Effective Therapies for Treating Bipolar Disorder first appeared on Psych Central.
My Life with Bipolar Affective Disorder - March 27, 2019
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The post My Life with Bipolar Affective Disorder first appeared on Psych Central.
Do Men and Women Experience Bipolar Disorder Differently? - March 02, 2019
Bipolar disorder affects men and women in equal numbers, and the symptoms are essentially identical. But some key differences do exist—differences that might be due to biological factors, and social...
The post Do Men and Women Experience Bipolar Disorder Differently? first appeared on Psych Central.
What Everyone Needs to Know About Bipolar Disorder - February 05, 2019
Nine years ago, Julie Kraft’s doctor uttered the words, “you have bipolar II disorder.” Immediately, images of unhinged film characters, sensationalist tabloid headlines and shocking news stories flooded her mind....
The post What Everyone Needs to Know About Bipolar Disorder first appeared on Psych Central.
Depression in Men: It Looks Different Than You Might Think - December 07, 2018
There is a big emphasis in our society on men being strong and tough. They should be able to handle anything and shouldn’t struggle with emotions and feelings. They just...
The post Depression in Men: It Looks Different Than You Might Think first appeared on Psych Central.

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