# Evidence Based Psychotherapies for Adolescent Bipolar Disorder

* Medical disclaimer: This page is for educational and informational purposes only and may not be construed as medical advice. The information is not intended to replace medical advice offered by physicians. Please refer to the full text of the Wikiversity medical disclaimer.

### Bipolar Disorder

Bipolar disorder is characterized by cycles of either manic episodes alone or manic/hypomanic episodes and depressive episodes. Episodes of mania typically display feelings of high motivation, unrealistic achievement and extreme happiness, whereas depressive episodes typically display feelings of sadness, irritability, and changes in sleep and eating patterns.

### Psychotherapy

Psychotherapies are treatments that help people with a wide variety of mental health concerns. While different forms of psychotherapies for adolescent bipolar disorder aim to remedy different aspects of the disorder, all aim to alleviate symptoms and decrease functional impairment in the client.
Overview of Psychotherapies :
| Therapy | Key components | Duration | Results |
| Child- and Family-Focused Cognitive-Behavioral Therapy | Develop consistent routines Learn to regulate emotions Improve child's self-esteem and parent's self efficacy Reduce negativity Build social skills and networks Teach parents self-care Family-based problem solving and communication skill building | 12 weeks long 60-90 minute weekly sessions | Decrease intensity of manic episodes Decrease depressive symptoms in child Overall improvement in client's functioning |
| Interpersonal and Social Rhythm Therapy | Develop understanding of disruptions in routine and manic/depressive episodes Build skills for creating consistent routines, aka, social rhythms Build self-efficacy and phase out of therapy | Varies dependent on client need | Increases time between manic/depressive episodes |
| Mindfulness-Based Cognitive Therapy | Utilizes mindfulness-based practices such as mindfulness meditation Focus on awareness of client's thoughts, feelings and behaviors Learn to recognize how to monitor one's own thoughts Increase self-care practices | 8 weeks long 60-120 minute weekly sessions | Decrease in anxiety symptoms Decrease in depressive symptoms Increase mood regulation Increase attention ability |
| Multi-Family Psychoeducational Psychotherapy | Group therapy using treatment components from: Psychoeducation Family Systems therapy Cognitive-behavioral therapy | 8 weeks long 60-90 minute weekly sessions | Decrease in severity of mood symptoms Increase in caregiver understanding of child's disorder and how to seek mental health care Children report feeling more social support from caregivers |

## Child- and Family-Focused Cognitive-Behavioral Family (CFF-CBT)
#### Purpose

CFF-CBT was created to address the unique needs of bipolar disorder in children and adolescents with bipolar disorder, including rapid cycling, mixed mood states and comorbid disorders. This treatment has been tested to see if it will help address the high suicide attempt rate among children/adolescents with the disorder, and no significant effects were found. However CFF-CBT has been found to be effective for 7-13 year olds with both clients with and without non-suicidal self-injury behaviors. Mediators of this intervention include: parenting skills and coping, family flexibility, and family positive reframing.

#### Intended Population

Children aged 7-13 and adolescents aged 13-17

#### Length of Treatment

12 weekly sessions, with session time ranging from 60 to 90 minutes

#### Treatment Components

CFF-CBT focuses on 7 components comprising of the “RAINBOW” acronym:
R: Routine; developing consistency
A: Affective regulation; includes psychoeducation on feelings, coping skills, and mood monitoring
I: “I can do it!”; this aims to improve self-esteem in the child, as well as self-efficacy in the parent
N: “No Negative Thoughts/Live in the Now”
B: Be a good friend/balanced life style (building social skills and teaching parents self-care
O: Oh, how do we solve this problem? (family-based problem solving and communication skills building)
W: Ways to find support (building a network of support)

#### Treatment Outcomes

CFF-CBT has shown decreases in mania to a subclinical level, parent-reported youth depressive symptoms, increased involvement/fidelity to treatment, and improvements in the client’s overall, global functioning in comparison to psychotherapy as per usual.

## Interpersonal and Social Rhythm Therapy (IPSRT)
#### Purpose

IPSRT is based on the social zeitgeber hypothesis, which states that regularity in social routines and interpersonal relationships acts as a protective factor for mood disorders. Thus, this treatment focused on maintaining regularity in daily routines, quality of social relationships and social roles, and management of consequences of rhythm disruptions.

#### Intended Population

IPSRT is intended for all individuals with bipolar disorder, and has been found to be effective in adolescents.

#### Length of Treatment

Length of treatment varies dependent on client needs.

#### Treatment Components

IPSRT is structured in three phases:
* Initial phase: Explores the clients history in order to explore links between disruptions in routines to affective episodes. This stage also includes education on the rationale of the treatment
* Intermediate phase: Focused on reorganizing the client's social rhythms, reinforcing new social rhythms and building confidence in using techniques that are taught in the treatment
* Final phase: Reduction in frequency of visits in order to work towards termination of therapy and self-efficacy

#### Treatment Outcomes

If applied early in the acute phase of bipolar disorder, IPSRT may prolong time to relapse in depressive/manic episodes.

## Mindfulness-Based Cognitive Therapy (MBCT)
#### Purpose

Mindfulness approaches aim to enhance one’s ability to focus their attention on the present moment in a non-judgmental manor. In treatment for Bipolar Disorder, mindfulness approaches may focus on awareness of the client’s patterns of thoughts, feelings and bodily sensations both specific and non-specific to their experiences related to the disorder. Moreover, when comorbid with anxiety, bipolar disorder has higher risk of suicide attempts, therefore MBCT aims to decrease these anxiety symptoms.

#### Intended Population

MBCT is intended for all populations with bipolar disorder.

#### Length of Treatment

MPCT is typically offered in 1-2 hour weekly sessions over an 8-week period in a group setting (Perich et al 2012; Weber et al 2010). Participants are also assigned homework, including varying lengths of meditation practice.

#### Treatment Components

MPCT combines aspects of classical CBT and mindfulness-based stress reduction therapies. The themes addressed in each session are:
Session 1: Automatic pilot
Session 2: Dealing with barriers
Session 3: Mindfulness of the breath
Session 4: Staying present
Session 5: Allowing and letting be
Session 6: Thoughts are not facts
Session 7: How can I best take care of myself
Session 8: Using what has been learned to deal with future moods

#### Treatment Outcomes

Treatment outcomes include decreases in anxiety and depressive symptoms and mood regulation in patients with bipolar disorder, but there has been no evidence in prevention of recurrences. MBCT has also been found to improve attentional readiness, and attenuated activation of non-relevant information processing during attentional readiness, which are usually decreased in individuals with Bipolar Disorder compared to those without.

## Multi-Family Psychoeducational Psychotherapy (MF-PEP)
#### Purpose

MF-PEP is a group-based evidence based treatment for children with bipolar disorder, which is meant to increase the ability for the treatment to be readily implemented into the community. While MF-PEP creates a support system within the family for the child through being a family-based intervention, it also serves to increase social support for care givers through being a group-based therapy.

#### Intended Population

MF-PEP is intended for children with depressive and bipolar disorders and their caretakers.

#### Length of Treatment

MF-PEP is an 8-session long treatment, with sessions typically ranging from 60-90 minutes.

#### Treatment Components

MF-PEP combines psychoeducation, family systems, and cognitive behavior therapy techniques, aiming to target depressive and bipolar disorder symptoms and how these symptoms cause impairment. In MF-PEP, sessions are delivered in a combination of settings, including all children and parents together, as well as separating all children and caregivers into their own respective groups.

#### Treatment Outcomes

Treatment outcomes for MG-PEP include an increase in caregiver's understanding of the child's disorder, and a decrease in mood symptom severity within the children which has been seen to be maintained through an 18-month follow-up. Additionally, MF-PEP has been found to have a positive effect on parent's help-seeking behaviors for mental health care, leading to access to higher-quality services. Lastly, children report feeling a stronger sense of social support from their caregivers after participating in the intervention.

## See also:

* ICD-10 Diagnostic Criteria
* Evidence-Based Assessment for Bipolar Disorder
* Bipolar disorder in children
* The International Society for Bipolar Disorders Task Force report on pediatric bipolar disorder: Knowledge to date and directions for future research
* Treatment of bipolar disorder