The various psychoeducation programs (bipolarity)

The various psychoeducation programs

Psychoeducation

Different approaches to psychoeducational measures exist

General Information on Bipolar Disorder and its Treatments

Information is the indispensable prerequisite for all psychoeducational approaches.

It is a legal obligation, defined by the law of March 2002, that the patient be informed of his disorder, its consequences, treatments and effects.

This information is increasingly accessible to patients, thanks to the publication of popular books and thanks to the Internet.

Behavioral and Cognitive Therapies (CBT)

Cognitive-behavioral therapy consists in identifying negative thoughts and maladaptive behaviors in order to replace them with thoughts and reactions that are in line with reality.

The two main models in behavioral and cognitive therapies for bipolar disorders are the individual program of M. R. Basco and A. J. Rush and the group therapy of D. H. Lam et al.

The individual program of Mr. R. Basco and A. J. Rush (1996)

They were the first to combine educational and therapeutic tools into a program. It consists of 20 individual sessions, divided into 4 phases:

educational phase
phase of learning behavioral and cognitive techniques: makes it possible to identify the patient's thoughts that endanger pharmacological treatment and the cognitive disturbances created by mania and depression
psychosocial problem management phase: assessment of the psychosocial consequences of the disorder and management of difficulties
consolidation phase

LACK

Session description
Effectiveness study

D. H. Lam Group Therapy et al. (1999).

This program is based on the stress vulnerability model. It is followed in groups of about ten people and includes twenty sessions, spread over 3 months. The therapy consists of 3 phases:

the educational phase (6 sessions): presentation of the cognitive model of interactions between thoughts, emotions and behaviors. Each patient builds a list of problems to be solved
the cognitive phase (10 sessions): focuses on the daily self-recording of mood to identify its fluctuations.
the consolidation phase (4 sessions): allows you to check the understanding and use of the CBT techniques learned

The effectiveness of this method has been proven through several studies, including “Relapse Prevention in Patients With Bipolar Disorder: Cognitive therapy Outcome after 2 Years” in 2005. 103 type 1 bipolar patients who are often victims of relapses were divided into two groups: the 1st group followed the therapy and the

What do these two programs have in common?

The use of TCCs makes it possible to ensure:

an improvement in medication adherence
early detection of symptoms
better stress management
management of comorbidities and bipolar depressions.

Interpersonal psychotherapy and the study of social rhythms (IPSRT)

Along with the application of behavioral and cognitive therapy and psychoeducation, another major intervention specific to bipolar disorder emerged in the 90s: interpersonal therapy, supplemented a few years later by social rhythm therapy (Frank). et al., 2000).

The basics of this therapy

As seen in one of the previous articles on the inheritance of bipolarity, the disease causes a genetic vulnerability with complex transmission whose genes are not yet clearly identified. However, it is certain that the neuromediators involved in bipolar disorders (serotonin, dopamine, noradrenaline, GABA) are also involved in chronobiological systems (= biological clocks) and the circadian system.

It is therefore important for any bipolar person to understand their rhythms and to monitor them to limit relapses.

The goals of this therapy

provide psychoeducation on bipolar disorder and its treatments
manage the patient's social rhythms

connect life events, daily rhythms and mood swings
Measuring daily rhythms
regulate daily rhythms
Balancing the types of activities between rest and stimulation

accept the disease or “grieve for an unscathed future”
solve interpersonal problems

The course of this therapy

This form of therapy focuses on the patient's interpersonal difficulties and chronobiological rhythms, in order to regulate them. It lasts about 24 sessions and should ideally start during the acute episode.

It has 3 phases:

the initial phase (8 sessions):

development of psychoeducation: by studying the evolution of the disorder and the reactions to treatments, symptoms, and life events
evaluation of social rhythms: time of sunrise, first contact, start of activity, dinner, bedtime,...
assessment of personal dysfunctions: inventory of all relationships in which the patient feels emotionally involved, classified by “proximity”

the intermediate phase (12 sessions):

acceptance of bipolarity: acceptance of the diagnosis, learning about the limitations associated with the disease and positive aspects (sensitivity, creativity,...)
work on the organization of rhythms: identification of unstable rhythms, establishment of paths for change, warning about desynchronizers (long trips, vacations, etc.)
resolving interpersonal problems: working with conflicts, bereavements, role changes or isolation

the final phase (4 sessions) : evaluating the effectiveness of therapy, empowering and developing prevention strategies

Personal goals program

This program, developed by M. Bauer and L. McBride in 1996, is a structured group therapy designed for bipolar patients, based on cognitive and behavioral theories and problem-solving techniques.

The program is composed of two phases:

5 weekly informative sessions on bipolar disease, its causes and treatments, on the various aspects of depressions and states of manic arousal.
The identification of personal goals. The principle is to recognize obstacles and overcome them using cognitive and interpersonal techniques.

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We work with a great association: La Maison Perché
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Psychoeducational measures focused on the family

Bipolar disorder affects not only those who suffer from it, but also those around them. However, family dysfunctions (conflicts and communication difficulties) can be relapsing factors for bipolar patients. That is why it is necessary for the family environment to be involved in psychoeducation programs.

This approach was mainly developed by Miklowitz. It integrates psychoeducational and cognitive-behavioral techniques (problem solving, training in better communication, etc.) and is aimed at the various members of the family.

The positive results relate in particular to depressive episodes. The explanation provided by the authors would be that mania is a phenomenon mainly determined by biological factors with relapses most often attributed to poor adherence to treatment, a reduction in sleep time, breaks in routines (social rhythms) and a situation of overwork. In contrast, social and family support seems to better protect against the occurrence of bipolar and unipolar depressive episodes. It is possible that the framework provided by the family helps to regulate social rhythms through lifestyle rules and a structured schedule. Conflict resolution and better communication contribute to thymic stability and protect against the occurrence of episodes of arousal.

In France, there are also other organizations: here is the list here.