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Family-Focused Therapy for Bipolar Disorder

 

Family-Focused Therapy (FFT) is a psycho-educational treatment designed for individuals with bipolar disorder (BD). The primary goals of FFT are to alleviate mood symptoms, prevent relapse, and enhance overall psychosocial functioning. The treatment involves three core modules:

  1. Psychoeducation: The family learns about bipolar disorder, including its symptoms and triggers. They also develop coping strategies for managing symptoms and stressors and create a relapse prevention plan.

  2. Communication Enhancement Training: This module helps family members improve their communication skills, especially addressing maladaptive patterns that may contribute to conflict or stress.

  3. Problem-Solving Skills: The therapist teaches families specific techniques to address problems that may lead to conflict or exacerbate the patient's condition, promoting healthier interactions within the home.

The FFT protocol includes detailed session-by-session guidance for clinicians, with additional resources to address issues like suicidality, anxiety, ADHD, and other behavioral problems. FFT is adaptable for both adults and youth with bipolar disorder, as well as those at high risk for developing the condition. It is available in two versions: a 21-session model and a shorter 12-session model.

Research has shown that FFT is effective across various age groups. Studies have demonstrated its success in treating adults (Miklowitz, 2003a, 2003b; Rea et al., 2003), adolescents (Miklowitz, 2008), and high-risk youth (Miklowitz & Chang, 2008; 2010). Randomized controlled trials have shown that FFT leads to reduced depressive symptoms, a lower risk of recurrence, and improved psychosocial functioning and quality of life. Furthermore, FFT has been linked to reduced re-hospitalization rates over two years, as patients and their families learn to recognize and address early warning signs of relapse (Rea, 2003).

One of the key advantages of FFT is its family-based approach. Involving family members in the treatment process not only provides the patient with the necessary skills and support but also helps family members understand and cope with the challenges associated with bipolar disorder. This makes FFT a cost-effective treatment, as it benefits multiple members of the family, increasing access to care for those impacted by the disorder.

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-Miklowitz, D. J., George, E. L., Richards, J. A., Simoneau, T. L., & Suddath, R. L. (2003). A randomized study of family-focused psychoeducation and pharmacotherapy in the outpatient management of bipolar disorder. Arch Gen Psychiatry, 60(9), 904-912. https://doi.org/10.1001/archpsyc.60.9.904

-Rea, M. M., Tompson, M. C., Miklowitz, D. J., Goldstein, M. J., Hwang, S., & Mintz, J. (2003). Family-focused treatment versus individual treatment for bipolar disorder: results of a randomized clinical trial. J Consult Clin Psychol, 71(3), 482-492. https://doi.org/10.1037/0022-006x.71.3.482

-Miklowitz, D. J. (2008). Adjunctive psychotherapy for bipolar disorder: state of the evidence. Am J Psychiatry, 165(11), 1408-1419. https://doi.org/10.1176/appi.ajp.2008.08040488

​-Miklowitz, D. J., & Chang, K. D. (2008). Prevention of bipolar disorder in at-risk children: theoretical assumptions and empirical foundations. Dev Psychopathol, 20(3), 881-897. https://doi.org/10.1017/s0954579408000424

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Interpersonal and Social Rhythm Therapy for Bipolar Disorder

Interpersonal and social rhythm therapy (IPSRT) is a psychotherapy that helps people with bipolar disorder regulate their daily routines and social interactions to improve their mood and overall functioning: How it works IPSRT is based on the idea that circadian rhythm abnormalities contribute to bipolar disorder symptoms. The therapy helps patients develop more regular routines and social patterns to regulate these abnormalities. What it involves IPSRT combines behavioral techniques with interpersonal psychotherapy. It includes four phases: Initial phase: The clinician collects the patient's history, provides education, and identifies an interpersonal problem area. Intermediate phase: The therapist helps the patient implement strategies to stabilize their social rhythms and manage affective symptoms. Preventative phase: The patient works to consolidate their treatment gains and identify potential threats to their stability. Termination phase: The patient reviews their treatment successes and areas of vulnerability. What it can help with IPSRT can help patients: Reduce time to recovery from a depressive episode Decrease the likelihood of mood episodes recurring Improve psychosocial and occupational functioning Diminish interpersonal problems Adhere to medication regimens.

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Interpersonal and Social Rhythm Therapy (IPSRT) is a form of psychotherapy designed to assist individuals with bipolar disorder in regulating their daily routines and social interactions to improve mood stability and overall functioning.

How it Works

IPSRT is based on the concept that disruptions in circadian rhythms—our body's natural sleep-wake cycle—can play a significant role in triggering or exacerbating bipolar disorder symptoms. By helping patients establish more consistent daily schedules and social patterns, IPSRT aims to restore these rhythms and improve emotional regulation.

What it Involves

IPSRT blends elements of behavioral therapy and interpersonal psychotherapy, and it is typically structured into four phases:

  • Initial Phase: The therapist gathers the patient’s history, educates them about the treatment process, and identifies key interpersonal issues contributing to mood instability.

  • Intermediate Phase: The therapist works with the patient to implement strategies that stabilize social rhythms, improve daily routines, and manage emotional symptoms.

  • Preventive Phase: The patient consolidates gains made in treatment and learns how to identify and address potential threats to their stability.

  • Termination Phase: The patient reflects on their progress, celebrates successes, and discusses areas of vulnerability that could need ongoing attention.

What IPSRT Can Help With

IPSRT has been shown to help patients:

  • Reduce recovery time from depressive episodes

  • Lower the risk of mood episodes recurring

  • Enhance psychosocial and occupational functioning

  • Reduce interpersonal conflicts

  • Improve medication adherence

In short, IPSRT helps individuals with bipolar disorder build stability in their routines and relationships, fostering greater emotional balance and a better overall quality of life.

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-Steardo, L., Jr., Luciano, M., Sampogna, G., Zinno, F., Saviano, P., Staltari, F., Segura Garcia, C., De Fazio, P., & Fiorillo, A. (2020). Efficacy of the interpersonal and social rhythm therapy (IPSRT) in patients with bipolar disorder: results from a real-world, controlled trial. Ann Gen Psychiatry, 19, 15. https://doi.org/10.1186/s12991-020-00266-7

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