Numerous studies have pointed to the failure of prophylaxis with pharmacotherapy alone in the treatment of bipolar I disorder. Recent investigations have demonstrated benefits from the addition of psychoeducation or psychotherapy to pharmacotherapy in this population.
To compare 2 psychosocial interventions: interpersonal and social rhythm therapy (IPSRT) and an intensive clinical management (ICM) approach in the treatment of bipolar I disorder.
Randomized controlled trial involving 4 treatment strategies: acute and maintenance IPSRT (IPSRT/IPSRT), acute and maintenance ICM (ICM/ICM), acute IPSRT followed by maintenance ICM (IPSRT/ICM), or acute ICM followed by maintenance IPSRT (ICM/IPSRT). The preventive maintenance phase lasted 2 years.
Research clinic in a university medical center.
One hundred seventy-five acutely ill individuals with bipolar I disorder recruited from inpatient and outpatient settings, clinical referral, public presentations about bipolar disorder, and other public information activities.
Interpersonal and social rhythm therapy, an adaptation of Klerman and Weissman's interpersonal psychotherapy to which a social rhythm regulation component has been added, and ICM.
Time to stabilization in the acute phase and time to recurrence in the maintenance phase.
We observed no difference between the treatment strategies in time to stabilization. After controlling for covariates of survival time, we found that participants assigned to IPSRT in the acute treatment phase survived longer without a new affective episode (P = .01), irrespective of maintenance treatment assignment. Participants in the IPSRT group had higher regularity of social rhythms at the end of acute treatment (P<.001). Ability to increase regularity of social rhythms during acute treatment was associated with reduced likelihood of recurrence during the maintenance phase (P = .05).
Interpersonal and social rhythm therapy appears to add to the clinical armamentarium for the management of bipolar I disorder, particularly with respect to prophylaxis of new episodes.
"2012 ) . We failed to find significant differences between treatments in any of the analyses examining the alliance - outcome association . The lack of significant difference between treatments is consistent with previous studies that found no significant general differences between these treatments ( Barber et al . , 2012 ; Elkin et al . , 1989 ; Frank et al . , 2005 ; Imber et al . , 1990 ) and with studies in which alliance was identified as a common factor across different treat - ment orientations ( Horvath et al . , 2011 ) . The findings are also consistent with previous findings specifically demonstrating the important role of alliance for therapeutic change in case manage - ment ( Zilcha - Ma"
[Show abstract][Hide abstract] ABSTRACT: Most of the literature on the alliance-outcome association is based exclusively on differences between patient reports on alliance. Much less is known about the unique contribution of the therapist's report to this association across treatment, that is, the association between therapist-reported alliance and outcome over the course of treatment, after controlling for the patient's contribution. The present study is the first to examine the unique contribution of the therapist-reported alliance to outcome, accounting for reverse causation (symptomatic levels predicting alliance), at several time points in the course of treatment. Of 156 patients randomized to dynamic supportive-expressive psychotherapy, antidepressant medication with clinical management, and placebo with clinical management, 149 were included in the present study. Alliance was assessed from the perspective of both the patient and the therapist. Outcome measures included the patients' self-reported and diagnostician-rated depressive symptoms. Overall, the findings demonstrate that the therapists' contribution to the alliance-outcome association was explained mainly by prior symptomatic levels. However, when a time lag of several sessions was introduced between alliance and symptoms, a positive association emerged between alliance at 1 time point and symptomatic distress assessed several sessions later in the treatment, controlling for previous symptomatic level. The findings were similar whether or not we controlled for the patient's perspective on the alliance. Taken together, the findings attest to the importance of improving therapists' ability to detect deterioration in the alliance. (PsycINFO Database Record
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Journal of Counseling Psychology 08/2015; DOI:10.1037/cou0000106 · 3.23 Impact Factor
"Literature remains scarce regarding the observation of biological rhythm as an improvement marker resulting from a psychotherapeutic intervention. Frank et al. (2005), in a study with Interpersonal and Social Rhythm Therapy (IPSRT), showed that psychotherapy improved social/circadian rhythms in patients with bipolar disorders. To our knowledge, there is no study showing whether psychotherapy positively affects biological rhythms regulation in depressed patients over a twelve-month follow-up period. "
"A systematic review of manic and depressive prodromes revealed that sleep disturbance is by far the most robust early symptom of mania (median prevalence of 77%; Jackson et al., 2003), and it has been found that especially those life events which disturb sleep-wake-regulation can trigger or aggravate (hypo)manic syndromes (Barbini et al., 1996; Plante and Winkelman, 2008; Wehr, 1991). -While sleep deficits can trigger mania, stabilisation of sleepwake rhythm has become an established and important element in behavioural therapies for BD (Frank et al., 2005; Leibenluft and Suppes, 1999; Riemann et al., 2002). Also, extended bed rest and darkness as an add-on to the usual treatment of acute mania resulted in a faster decrease in Young Mania Rating Scale (YMRS; Young et al., 1978) in those patients with a recent (within 2 weeks) onset of mania (Barbini et al., 2005). "
[Show abstract][Hide abstract] ABSTRACT: According to the recently proposed vigilance model of affective disorders (vigilance in the sense of "brain arousal"), manic behaviour is partly interpreted as an autoregulatory attempt to stabilise vigilance by creating a stimulating environment, and the sensation avoidance and withdrawal in Major Depressive Disorder (MDD) is seen as an autoregulatory reaction to tonically increased vigilance. Indeed, using a newly developed EEG-based algorithm, hyperstable vigilance was found in MDD, and the contrary, with rapid drops to sleep stages, in mania. Furthermore, destabilising vigilance (e.g. by sleep deprivation) triggers (hypo)mania and improves depression, whereas stabilising vigilance, e.g. by prolonged sleep, improves mania. ADHD and mania have common symptoms, and the unstable vigilance might be a common pathophysiology. There is even evidence that psychostimulants might ameliorate both ADHD and mania. Hyperactivity of the noradrenergic system could explain both the high vigilance level in MDD and, as recently argued, anhedonia and behavioural inhibition. Interestingly, antidepressants and electroconvulsions decrease the firing rate of neurons in the noradrenergic locus coeruleus, whereas many antimanic drugs have opposite effects.
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