Running Head: Family-Focused Treatment vs. Individual Treatment for Bipolar Disorder

Family-Focused Treatment vs. Individual Treatment for Bipolar Disorder
Amber Reddy
Ivy Tech Community College

Abstract Over a nine month period, recently hospitalized bipolar, manic patients were assigned at random to participate in family-focused psycho-educational therapy or individually focused patient treatment. Along with mood-stabilizing medications, all patients received concurrent treatment. During the two year study, one year period of active treatment and one year period of post treatment, organized follow-up assessments were conducted at three month intervals. Patients in family treatment were found to be less likely to be re-hospitalized and experienced fewer mood disorder relapses than those in the individual based treatment. Although between the two groups, there was no difference in the likelihood of a first relapse.

Family-Focused Treatment vs. Individual Treatment for Bipolar Disorder When it comes to bipolar disorder, is family-focused treatment better than individual treatment? According to the APA (American Psychological Association, it is. During a two year clinical trial using patients recruited from inpatient services from three large hospitals in the Los Angela’s area, fifty-three patients were chosen at random. Criteria for the study required patients to have been between the ages of 18- 45, diagnosed with the bipolar disorder, currently on mood-regulating medication, able to understand and give written consent, and the participation of at least one family member. If patients were found to have evidence of an organic nervous disorder or had chronic alcohol or substance abuse or dependency, they would have been ineligible to participate in the trial. Out of the fifty-three patients randomly chosen, 60% were Caucasian, 23% were African American, 9% were Asian American, and the remaining 9% were from other ethnic groups. While family participation was required, 34% of the patients had multiple relatives participate while 66% only had one family member participate. To determine that the two treatment groups were able to be compared, numerous demographics were assessed upon entry to the study which included gender, age, socioeconomic status, current marital status, and years of education. There were also clinical variables that included the age the illness was diagnosed, total duration of illness, premorbid social adjustment and the presence of previous episodes of illness. The only difference between the two groups were the age of at onset of illness and premorbid adjustment. Through the course of one year, all the patients received individual medication management sessions with a staff research psychiatrist, and were prescribed at least one prescription for mood-altering medication used for the treatment of bipolar disorder. During the one year trial, at any point, the two treatment groups received the same medication protocols. The patients had also been randomly assigned to either the family-focused control group or the individual based treatment. During the early stages of the trial, contact with the psychiatrist psychosocial intervention team took place weekly for the first three months, and then became less frequent as the patients were becoming more stable. For the second three months, contact took place every other week and during the remanding time, once a month. There were sessions held with Psychosocial Intervention team during the first nine months of the trial and for the remaining three months, the medication management sessions continued. “The family-focused treatment group (FFT), was modeled after the original structure of Fallon, Boyd, and McGill (1984) behavioral family management for patients with schizophrenia but substantially modified by Miklowitz and Goldstein (1997) for individuals with bipolar disorder and their families.” Each session for the FFT was an hour long each. During each hour long session, patients and their families received psychoeducation about bipolar disorder, problem-solving skills training, and communication enhancement training. Time spent with each training session depended on the family’s needs, prior knowledge of bipolar disorder, any family issues, and the patient’s clinical status. First, families received information about bipolar disorder, the causes, symptoms, treatment and the course it takes. Second, communication skills, such as active listening and giving structured positive and negative feedback were taught. Patients and their families were also given in-session role-playing along with some homework that required rehearsing in between sessions. Third, patients and their families were taught some problem-solving techniques. They were taught how to identify specific problems, brainstorming of solutions and how to implement self-selected solutions. “Although topics in the problem-solving component were geared towards each family’s specific concerns, all families completed a “relapse drill,” in which problem-solving focused on planning a family-wide response should the patients symptoms returned.” Also, on an as-needed basis, families were offered crisis intervention. During the individually-focused patient treatment condition, which consisted of 30 min sessions over a nine month period, the main focus was supportive, problem-focused and educational. The nine month sessions were held once a week for the first three month, biweekly for the second three months and once a month for the last three. During the first eight sessions, patients were taught about the illness and its symptoms. “Therapists acquainted patients with the importance of regular sleep patterns, medication effects and side effects, and the role of alcohol and street drugs in the precipitating symptom exacerbations.” During sessions 9-18, patients focused on making realistic short-term goals, problem-solving concerning current life stressors, and exploring the patient’s feelings regarding the illness. During the last few sessions, therapists focused mainly on disposition plans for the time period immediately following the study. There were two questions asked when determining the patients’ outcomes. Were there differences between the treatment groups in the probability of system relapse and re-hospitalization during the one year treatment period and the post treatment? Does participation in family treatment compared to the individual treatment improve compliance with medications? It was predicted that the FFT is associated with lower risk of re-hospitalization and relapse compared to the Individually Focused treatment group. It was also concluded that with family support, compared to individual treatment, the FFT was more consistent at their regularly taking medications.