Intensive Psychotherapy More Effective Than Brief Therapy for Treating
Bipolar DepressionPatients taking medications to treat bipolar disorder
are more likely to get well faster and stay well if they receive
intensive psychotherapy, according to results from the Systematic
Treatment Enhancement Program for Bipolar Disorder (STEP-BD), funded by
the National Institutes of Health's (NIH) National Institute of Mental
Health (NIMH). The results are published in the April 2007 issue of the
Archives of General Psychiatry.
Bipolar disorder is a debilitating illness marked by severe mood swings
between depression and mania that affects 2.6 percent of Americans in
any given year. "We know that medication is an important component in
the treatment of bipolar illness. These new results suggest that adding
specific, targeted psychotherapy to medication may help give patients a
better shot at lasting recovery," said NIH Director Dr. Elias A.
"STEP-BD is helping us identify the best tools—both medications and
psychosocial treatments—that patients and their clinicians can use to
battle the symptoms of this illness," said NIMH Director Thomas R. Insel,
Psychotherapy is routinely employed as a means to treat bipolar illness
in conjunction with medication, but the extent to which psychotherapy is
effective has been unclear. In addition, most psychotherapeutic studies
have been limited to a single site and compared only one type of
treatment to routine care. Thus, in addition to examining the role of
medication, STEP-BD set out to compare several types of psychotherapy
and pinpoint the most effective treatments and treatment combinations.
With 293 participants, David Miklowitz, Ph.D., of the University of
Colorado and colleagues set out to test the effectiveness of three types
of standardized, intensive, nine-month-long psychotherapy compared to a
control group that received a three-session, psychoeducational program
called collaborative care. The intensive therapies were
family-focused therapy, which required the participation and input of
patients' family members and focused on enhancing family coping,
communication and problem-solving;
cognitive behavioral therapy, which focused on helping the patient
understand distortions in thinking and activity, and learn new ways of
coping with the illness; and
interpersonal and social rhythm therapy, which focused on helping the
patient stabilize his or her daily routines and sleep/wake cycles, and
solve key relationship problems.
All participants were already taking medication for their bipolar
disorder, and most were also enrolled in a STEP-BD medication study
reported in the New England Journal of Medicine on March 28, 2007. The
researchers compared patients' time to recovery and their stability over
Over the course of the year, 64 percent of those in the intensive
psychotherapy groups had become well, compared with 52 percent of those
in collaborative care therapy. Patients in intensive psychotherapy also
became well an average of 110 days faster than those in collaborative
care. In addition, patients who received intensive psychotherapy were
one and a half times more likely to be clinically well during any month
out of the study year than those who received collaborative care.
Discontinuation rates among the groups were similar—36 percent of those
in the intensive programs discontinued and 31 percent of those in
collaborative care discontinued. None of the three intensive
psychotherapies appeared to be significantly more effective than the
others, although rates of recovery were higher among those in
family-focused therapy compared to the other groups.
"Intensive psychotherapy, when used as an adjunctive treatment to
medication, can significantly enhance a person's chances for recovering
from depression and staying healthy over the long term," said Dr.
Miklowitz. "It should be considered a vital part of the effort to treat
The National Institute of Mental Health (NIMH) mission is to reduce the
burden of mental and behavioral disorders through research on mind,
brain, and behavior. More information is available at the NIMH website,
The National Institutes of Health (NIH) - The Nation's Medical Research
Agency - includes 27 Institutes and Centers and is a component of the U.
S. Department of Health and Human Services. It is the primary federal
agency for conducting and supporting basic, clinical, and translational
medical research, and it investigates the causes, treatments, and cures
for both common and rare diseases. For more information about NIH and
its programs, visit
Miklowitz D. et al. Psychosocial Treatments for Bipolar Depression.
Archives of General Psychiatry. Apr 2007; 164.