Bipolar Patients Need More Talk Therapy

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Psychological therapy can greatly boost the effectiveness of drugs in treating bipolar disorder, but these specialized talk therapies aren't as widely available as they should be, experts say.

"There are probably several dozen places in the country where you can get these treatments," said Dr. Holly Swartz, an assistant professor of psychiatry at the University of Pittsburgh. "It's not available in the majority of the country."

Much of the problem is lack of training in the specialized techniques for psychologists, psychiatrists and social workers, said David Miklowitz, a professor of psychology and psychiatry at the University of Colorado at Boulder. The techniques should become part of the regular curriculum for them, he said.

And just as drug companies trumpet the effectiveness of their drugs, advocates for talk therapy have to advertise the impact of their techniques, Miklowitz said.

"There's a lot of work that needs to be done to get these treatments into day-to-day use in community practice," he said.

Basically, the talk therapies work by helping patients deal with stress, function socially and stick with their medications, he said.

They come in three styles:

  • Family-focused therapy includes the patient's family and deals with their relationships. Goals include improving communication and problem-solving and providing for family intervention at the earliest signs of relapse.

  • Cognitive-behavioral therapy is done with the patient alone. It helps patients change harmful thinking patterns of depression and mania, and teaches them to recognize their early warning signs of relapse to either extreme of the illness.

  • Interpersonal and social rhythm therapy addresses ways to deal with interpersonal issues like marriage problems, and promotes a regular daily schedule of sleeping, waking, eating and other activities. Sticking to a regular schedule is thought to help stabilize and prevent bipolar symptoms.

    Miklowitz is studying whether family-focused therapy can delay the first appearance of bipolar disorder or reduce its severity in children at risk. Those children have suggestive symptoms and a family history of bipolar disorder but do not yet have the full-blown condition.
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