Psychosocial Approaches

Psychosocial therapy is used as an adjunct to drug treatment. Its purposes are to mollify the symptomatic course of the disorder, enhance patients' compliance with medications, enhance social and occupational functioning, and increase patients' ability to manage stressors that evoke symptoms. There are three treatments that have received some, albeit limited, empirical support. One is family or marital therapy, particularly psychoeducational approaches that focus on teaching patients and their family members about bipolar disorder and how to manage it and effective ways to communicate and solve family problems (Miklowitz & Goldstein, 1997; Miklowitz et al., 2000). Asecond is interpersonal and social rhythm therapy, an individual therapy that focuses on helping the patient understand and renegotiate the interpersonal context associated with mood disorder symptoms (Frank, Swartz, & Kupfer, 2000). Patients learn to stabilize sleep/wake rhythms and other daily routines, particularly in the face of environmental triggers for disruption. A third treatment is individual cognitive-behavioral therapy, in which patients learn to identify, evaluate, and restructure cognitive distortions, and develop illness management strategies such as behavioral activation, drug compliance monitoring, and the appropriate use of support systems (Cochran, 1984; Lam et al., in press; Otto, Reilly-Harrington, & Sachs, in press).

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