Psychosocial therapies such as CBT can provide a clinical adjunct to pharmacological therapy. CBT aims to generate links between patterns of thoughts, feelings and behaviours using cognitive restructuring to facilitate the understanding and management of these patterns. A variety of interventions can be labelled as CBT, but the primary approaches focus on coping strategies and problem solving skills.

What is the evidence for CBT for bipolar disorder?

Moderate quality evidence suggests CBT accompanied by medication for bipolar disorder can improve depression symptoms and functioning. Moderate to low quality evidence finds CBT can also improve mania symptoms and reduce relapses.

November 2021

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Bipolar disorder is one of the leading causes of disability due to having a mental illness. A range of pharmacological and psychological interventions are effective in the management and prevention of acute episodes of bipolar disorder. However, these incur considerable costs, as well as productivity losses due to time off work. This topic presents the economic cost-effectiveness of psychosocial treatments in Purchasing Power Parity – International dollar (PPP-INT$), which is comparable to what the US dollar would buy in the United States.

What is the evidence for psychosocial treatment costs?

Moderate to low quality evidence finds the cost of the Bipolar Disorders Program is around PPP-INT$3,879 per person, a group structured psychoeducation is around PPP-INT$1,727 per person, a hospital-based psychosocial care plus lithium or valproic acid is around PPP-INT$1,091 to PPP-INT$9,627 per person, a community-based psychosocial care plus lithium or valproic acid is around PPP-INT$719 to PPP-INT$5,599 per person, a Joint Crisis Plan is around PPP-INT$2,286 per person, a specialized out-patient clinic of pharmacological, psychotherapy, and group psychoeducation costs around PPP-INT$4,036 per person, cognitive behavioural therapy costs around PPP-INT$2,881 per person, structured psychoeducation costs around PPP-INT$5,626 per person, and a multicomponent psychoeducation and support intervention costs around PPP-INT$1,846 per person. All of these interventions were cheaper in the long-term compared to standard care as they reduced hospitalisation costs.

November 2021

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People with severe mental illnesses such as bipolar disorder may be in need of emergency care at some stage in their illness. Crisis planning interventions focus on patients being involved in identifying preferences and planning for their future care during a mental health crisis. Crisis planning can help to prevent relapse by promoting better self-management and by prompting help-seeking.

What is the evidence for crisis planning interventions?

Moderate to high quality evidence suggests a small effect of reduced compulsory hospitalisation but not voluntary hospitalisation, for patients receiving crisis planning interventions for 12-24 months compared to standard care.

November 2021

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Educational therapies for psychiatric illnesses (psychoeducation) are targeted towards increasing a person’s knowledge about their disorder. Educational therapies aim to improve insight and understanding, promote coping and reduce stigma, increase medication adherence, enable behavioural change, and ultimately prevent relapse. Educational sessions can take place individually or in groups, with other patients or with family, and are usually incorporated into an ongoing treatment regimen in both hospital and community settings.

What is the evidence for educational therapies?

Moderate to low quality evidence suggests a medium-sized effect of fewer relapses to mania or depression with group psychoeducation, but not with individual psychoeducation, when compared to treatment as usual. It may also increase treatment adherence.

Psychoeducation plus cognitive behavioural therapy (CBT) may improve mania symptoms and functioning. Psychoeducation plus Personalized Real-time Intervention for Stabilizing Mood (PRISM) may improve depressive symptoms.

Moderate to high quality evidence suggests reduced internalised stigma with psychoeducation.

November 2021

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Family intervention involves the introduction of a patient’s immediate family into a psychosocial treatment setting. Its goals involve preventing relapse, improving the family’s relationships and understanding of the disorder as well as improving their own mental health, should that be compromised. Family interventions have a focus on psychoeducation which provides information on the disorder, medication, and treatment adherence. They can also employ cognitive and behavioural strategies to improve problem solving, communication skills, and coping, and to reduce high expressed emotion in the family unit.

What is the evidence for family intervention?

Moderate quality evidence finds family therapy plus medication can reduce relapses and improve depression and mania compared to standard care (mostly medication alone). Moderate to low quality evidence finds carer focused therapy may also reduce relapses in patients.

November 2021

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Group therapy refers to any psychosocial therapy that is administered in a group setting. It can include specific cognitive or behavioural therapies and is often utilised in inpatient settings. The usefulness of group therapy has been examined in the context of improving illness outcomes such as symptom severity and quality of life, medication compliance, and particularly social interaction and anxiety.

What is the evidence for group therapy?

Moderate to low quality evidence finds medium to large effects of fewer relapses and improved symptoms and functioning following group therapies. Group therapies consisted of psychoeducation, cognitive behavioural therapy, family-focused treatment, functional remediation, and interpersonal and social rhythm therapy. There were also fewer relapses with group mindfulness therapy, social cognition and interaction training, and dialectical behaviour therapy.

November 2021

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Integrated care refers to the association of multiple treatment paradigms to produce a single unified program. The idea is to deliver seamless care to the patient to ensure high treatment continuity and improve patient satisfaction. Integrated programs typically involve multi-element psychosocial therapies for mental illness. For example, integrated psychological therapy may involve a combination of cognitive training, social skills training, problem-solving training and cognitive remediation. Integrated care can also refer to the formal liaison of typically distinct services such as medical practitioners and dedicated mental health teams, or the incorporation of mental health and substance use treatments into a single program.

What is the evidence for integrated care?

Moderate to high quality evidence suggests there a small, reduced risk of hospitalisation with collaborative care. There were no significant effects on relapse rates, depression or anxiety post-treatment. Low quality evidence is unable to determine the longer-term effects on symptoms or for physical health or functioning.

November 2021

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The social environment can exert influence on synchronisation of circadian rhythms by entraining neurohormonal events such as cortisol and melatonin secretion. These are key components of circadian physiology, and disruptions to them can influence mood. Interpersonal and social rhythm therapy aims to improve interpersonal problem solving and social rhythm regularization. It involves psychoeducation about regulating routines and discussion around strategies for solving current interpersonal problems and preventing them in the future.

What is the evidence for social rhythms interventions?

Moderate to high quality evidence finds improved occupational, social, and general functioning following IPSRT compared to various control conditions. However, there were no consistent improvements in symptoms.
Control conditions included clinical status and symptom review treatment, intensive clinical management, specialist supportive care, and collaborative care. One included study incorporated family-focused therapy and cognitive-behavioural therapy with IPSRT.

November 2021

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Mindfulness involves intentional and non-judgmental focus of one’s attention on emotions, thoughts and sensations that are occurring in the present moment. The aim is to open awareness to present experiences, whether positive or negative, allowing thoughts to come and go without reacting, and accepting oneself and the experience.

What is the evidence for mindfulness?

Moderate quality evidence finds medium-sized improvements in depression and anxiety, but no consistent improvements in mania symptoms with mindfulness-based interventions in pre-post treatment assessments. There may also be improvements in mindfulness ability, stress, and emotion regulation following treatment. However, moderate to low quality evidence finds no differences in symptoms when mindfulness-based interventions were compared to usual treatment.

November 2021

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Pending enough primary studies, we invite reviews on this topic to be conducted. Alternatively, we will endeavour to conduct our own review to fill this gap in the Library.

November 2021

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