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Thesis

Adjunctive psychosocial treatment for Bipolar Disorder: A meta-analytic review

26 July 2004

Abstract

Bipolar disorder is a chronic mental illness marked by erratic and extreme shifts in mood, resulting in significant cognitive and behavioral impairments. Since the introduction of lithium carbonate as an effective mood stabilizer, medication is considered the mainstay of treatment. However, despite medication compliance, relapse rates, residual symptoms, and psychosocial deficits persist. Consequently, researchers are investigating adjunctive psychotherapeutic interventions as a means to mitigate the impact of this illness. Although numerous descriptive studies exist detailing psychosocial treatment of bipolar disorder, only 29 present quantitative data. This meta-analytic study is the first attempt to summarize the effectiveness of the researched interventions to date. Lack of consistent outcome data limited this analysis to 17 studies. Summary analyses of the treatment conditions revealed a small to medium effect size of .39 on measures of depression, a negligible effect size of .13 on mania measures, and a small to medium effect size of .44 for overall functional improvements. Compared to medication management alone, psychosocial interventions produced a modest but significant benefit, yielding a between group effect size of .39 for overall improvement. There were no significant differences in the effect sizes for overall functioning between cognitive therapies, family therapies, interpersonal therapies and psycho education. Individual and group treatments performed equally well. Treatments involving 15 sessions or more showed an effect size of .54, a significant difference compared to .29 for fewer than 15 sessions. Implication of results and suggestions for future research are discussed.


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