The role of cognitive behavioral psychotherapy in treatment of bipolar disorder

Abstract

Until recently bipolar disorder (BD) was regarded as a biological illness that should be treated biologically with pharmachotherapy. This view has changed in the recent years due to many reasons. This paper discusses some of the reasons why psychotherapy and particularly disorder specific cognitive behavioral psychotherapy should be combined with pharmacotherapy in treatment of BD. A combined approach is expected to improve treatment adherence, outcome and reduce cognitive vulnerabilites thereby preventing relapse.

Keywords

• bipolar disorder, cognitive behavioral therapy

İki uçlu bozuklukta bilişsel davranışçı terapilerin yeri ve önemi

Öz

Çok yakın bir geçmişe kadar iki uçlu bozukluk biyolojik bir hastalık olarak görülüyor ve bu nedenle tedavisinin de biyolojik olarak farmakoterapi ile yapılması gerektiği düşünülüyordu. Bu görüş günümüzde çeşitli nedenlerle değişikliğe uğramıştır. Bu yazıda psikoterapilerin ve özellikle hastalığa özgü geliştirilmiş bilişsel davranışçı psikoterapilerin iki uçlu bozukluk tedavisinde farmakoterapi ile kombine edilmesinin nedenleri ve yararları tartışılmıştır. Kombine bir yaklaşımın tedavi uyumunu ve sonuçlarını iyileştireceği ve bilişsel duyarlılıkları azaltarak nüksleri önlemekte daha yararlı olacağı umulmaktadır.

Anahtar Kelimeler

• iki uçlu bozukluk, bilişsel davranışçı terapi

Kaynakça

1. Scott J. Psychotherapy for bipolar disorder: An unmet need? British Journal of Psychiatry, 1995;167,581-8.
2. Keller MB. Chronic and recurrent affective disorders: incidence, course, and influencing factors: Adv Biochem Psychopharmacol. 1985;40:111-20.
3. Gitlin MJ, Swendsen J, Heller TL, Hammen C. Relapse and impairment in bipolar disorder: Am J Psychiatry. 1995;152:1635-40.
4. Dickson W, Kendall R. Does maintenance lithium therapy prevent recurrence of mania under ordinary clinical conditions. Psychological Medicine. 1986;16:521-30.
5. Scott J, Pope M. Nonadherence with mood stabilizers: Prevalence and predictors. Journal of Clinical Psychiatry. 2002;63,384-90.
6. Scott J, Stanton B, Garland A, Ferrier IN. Cognitive vulnerability in patients with bipolar disorder: Psychol Med. 2000;30:467-72.
7. Miklowitz DJ, Goldstein MJ, Nuechterlein KH et al. Family factors and the course of bipolar affective disorder. Archives of General Psychiatry. 1988;45:225-31.
8. Miklowitz DJ, Scott J. Psychosocial treatments for bipolar disorder: costeffectiveness, mediating mechanisms, and future directions. Bipolar Disord 2009;11:110-22.

9. Miklowitz DJ. Adjunctive psychotherapy for bipolar disorder: state of the evidence. Am J Psychiatry 2008;165:1408-19.
10. Scott J, Colom F, Vieta E. A meta-analysis of relapse rates with adjunctive psychological therapies compared to usual psychiatric treatment for bipolar disorders. Int J Neuropsychopharmacol 2007;10:123-9.
11. Scott J, Colom F. Gaps and limitations of psychological interventions for bipolar disorders. Psychother Psychosom 2008;77:4-11.
12. Scott J. Cognitive Therapy of Bipolar Disorder. In R. Leahy(Ed.) Contemporary Cognitive Therapy: Theory, Research and Practice 2004; The Guilford Press, NY.
13. Lam DH, Jones SH, Hayward P. 2010; Cognitive Therapy of Bipolar Disorder; John Wiley & Sons LTD, NY.
14. Newman CF. Cognitive therapy of bipolar disorder: In G. Simos (Ed.), Cognitive Behavior Therapy: A guide for the practicing clinician (pp. 71-96). East Sussex, UK: Brunner – Routledge. Altman ES, Rea MM, Mintz J, et al. Prodromal symptoms and signs of bipolar relapse: A report based on prospectively collected data. Psychiatry Research, 1992;41:1-8.
15. Molnar GJ, Feeney MG, and Fava GA. Duration and symptoms of bipolar prodomes. American Journal of Psychiatry: 1988;145:1576-8.
16. Smith JA and Tarrier N. Prodromal symptoms in manic depressive psychosis. Social Psychiatry and Psychiatric Epidemiology. 1992;27:245-8. Lam DH and Wong G. Prodromes, coping strategies, insight and social functioning in bipolar affective disorders. Psychological Medicine, 1997;27:1091-100.
17. Lam D, Wong G and Sham P. Prodromes, coping strategies and course of illness in bipolar affective disorder – a naturalistic study. Psychological Medicine, 2001;31:1397-402.