Medication isn’t the only effective treatment for bipolar disorder. Individuals with this disease may also benefit from psychosocial treatment, experts say.

“The first line of intervention for bipolar disorder is medication,” says Simon Rego, PsyD, chief psychologist at Montefiore Medical Center and associate professor of Psychiatry and Behavioral Sciences at Albert Einstein College of Medicine in New York City. “But some patients with bipolar disorder may have trouble complying with medication and/or dealing with the consequences of the disorder.” This is where psychosocial treatments can make a difference, he adds.

Psychosocial treatment doesn’t preclude the need for medication. Long-lasting injectable antipsychotic medications now are available that have some potential advantages for those who take them: early identification of non-adherence to medication, no need to remember to take medication every day, and reduced relapse frequency and rehospitalization rates. The indication for these medications (such as aripiprazole, olanzapine, paliperidone and risperidone) is for schizophrenia, however. Speak to your healthcare provider to learn more.

Psychosocial treatment can not only improve a patient’s adherence to medication but can increase their understanding of the illness, says David Roane, MD, chairman of the Department of Psychiatry at Lenox Hill Hospital in New York City. “A person with bipolar may lose their job or their relationships with other people,” Dr. Roane says. “Psychosocial treatments can help them readjust.”

Here is a rundown of some psychosocial treatments that can be beneficial.

Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT), which involves trying to change your patterns of thinking, is effective for bipolar disorder, according to the American Psychological Association. Strategies that are used in CBT include role-playing to get ready for interactions that could be problematic, facing fears directly rather than practicing avoidance, and learning techniques to calm and relax the mind and body.

Research suggests that adding cognitive-behavioral therapy to a treatment plan can improve the outcome of bipolar disorder, according to the American Psychological Association. 1

A good treatment outcome is one in which the mood episodes are stabilized and the patient is equipped with the cognitive and behavioral skills necessary to become more aware of triggers and how to manage them more effectively, Dr. Rego says. “In the case of Bipolar 1 Disorder, we may also measure a good outcome by a decrease in hospitalizations as well as a reengagement in work, better interpersonal relationships, and an overall improvement in the quality of life,” he explains.

“I believe that CBT is helpful,” says Scott Krakower, DO, assistant unit chief, psychiatry, Zucker Hillside Hospital in Glen Oaks, New York, “It’s effective with both adolescents and adults. There is a mindfulness component to this form of therapy that is also useful to patients.”

CBT can help a person with bipolar to recognize the warning signs of a mood change and can help them learn to change unhealthy patterns of behavior, Dr. Krakower explains.

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Interpersonal and Social Rhythm Therapy (IPSRT)

IPSRT, an adjunctive therapy for individuals with mood disorders, outlines techniques to improve medication adherence, manage stressful life events, and reduce disruptions in social rhythms. With this form of therapy, patients learn skills that can help them protect themselves against the development of future episodes.  Managing the patient’s symptoms and improving his interpersonal relations is the primary focus of IPSRT.

The efficacy of IPSRT for the treatment of bipolar mood episodes has been supported by two large clinical studies, Dr. Rego says. “It can be useful to avoid disruptions in social rhythm,” he says.   “The term, a disruption in social rhythm, sounds fancy, but it really just means any change to our regular daily routines, such as the time we wake up, the times we eat our meals, and the time we go to bed,” Dr. Rego explains.

“It helps individuals with bipolar disorder to understand what worsens and what triggers their illness,” says Stephen Ferrando, MD, director of psychiatry at Westchester Medical Center Health Network (WMCHealth) located in Valhalla, New York.

Individuals with bipolar disorder may not sleep well, and lack of sleep may trigger mania, he says. “Interpersonal and social rhythm therapy is a type of behavioral therapy used to treat the disruption in social circadian rhythms,” Dr. Ferrando explains. “It teaches people the skills that can protect them from other triggers. For instances, IPSRT teaches sleep management skills.”

IPSRT can help a person learn coping skills, Dr. Ferrando says. “The individual learns to manage conflict and thus avoid a manic episode that can do a lot of damage,” he explains.

Family-Focused Therapy

This can also be beneficial for those with bipolar disorder, according to the American Psychological Association.3 Family members are taught to recognize the warning signs of either a manic or a depressive episode, Dr. Roane says, and both family members and patients are taught better communication skills. “A family member can help to identify when a person with bipolar disorder is about to go into a new episode before it happens,” he says, “The family members can tell when a patient is not taking medication, so it’s critical for the family to be involved.”

Unfortunately, many patients with bipolar disorder tend to not involve their family in their treatment plan, Dr. Roane says. His advice? Bring the family into therapy when the person is doing well.  “This works better than when a relapse is happening,” he says.

A core component of family-focused therapy is psychoeducation, Dr. Roane explains. “This means educating people about the illness, the treatments available, and the risk of non-adherence to medication,” he explains.

Family-focused therapy is important because it can often help a patient get back on track with their family. “A lot of times, a patient will recover from a manic episode and tend to minimize or not remember how bad they were,” Dr. Ferrando says, “The family may have been traumatized by what happened. This form of therapy can help a family through this by emphasizing appropriate behavior on the part of the patient.”

Overall, most individuals with bipolar disorder will need treatment with antipsychotic or mood-stabilizing medications. But psychosocial treatments may be added in order to improve the individual’s functioning, according to the American Psychological Association.

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Last Updated: Mar 29, 2018