Dissemination of a Brief Psychoeducational Intervention for Bipolar Disorder in Community Mental Health Settings
DOI:
https://doi.org/10.12970/2310-8231.2014.02.02.2Keywords:
Life Goals Program, Collaborative Care, Psychosocial Treatment, Evidence-based Treatments, Psychological Treatment, Mood Disorders.Abstract
Various efficacious psychosocial interventions for Bipolar Disorder (BD) share common elements, with psychoeducation being a main component. Recent treatment guidelines for BD recommend psychoeducation, especially when delivered in brief, cost-effective formats. Its format has several implications for the feasibility of its dissemination in the health care system. The Life Goals Program (LGP) is an evidence-based, cost-effective psychoeducational treatment for BD. Despite its demonstrated benefits for patients and the healthcare system, most patients do not have access to this type of treatment. The goal of this study is to examine the dissemination of the LGP and its effectiveness in three community mental health care centers in Quebec, Canada. A sample of 15 healthcare service providers received thorough training in the delivery of the LGP and delivered the treatment to 73 patients with BD. The treatment consisted of six 90-minute sessions described in the treatment manual with session six being repeated with a family member attending. Treatment integrity and clinical effectiveness were assessed with objective measures. The intervention was successfully implemented, with high rates of treatment fidelity and positive impacts on clinical outcomes. Patients demonstrated marked gains in knowledge about BD, increased acceptance of the illness, reductions in depressive symptoms and improvements in medication behaviors. Treatment effect sizes were moderate to large. Results show that the LGP can be successfully implemented in routine mental health settings given the brief format of the intervention, its proven cost effectiveness, and its less extensive training requirements.
References
Schaffer A, Cairney J, Cheung A, Veldhuizen S, Levitt A. Community survey of bipolar disorder in Canada: lifetime prevalence and illness characteristics. Can J Psychiatry 2006a; 51: 9-16.
Schaffer A, Cairney J, Cheung AH, Veldhuizer S, Levitt AJ. Use of treatment services and pharmacotherapy for bipolar disorder in a general population-based mental health survey. J Clin Psychiatry 2006b; 67: 386-93. http://dx.doi.org/10.4088/JCP.v67n0308
Benazzi F. Inter-episode mood lability in mood disorders: residual symptom or natural course of illness? Psychiatry Clin Neurosci 2004; 58: 480-6. http://dx.doi.org/10.1111/j.1440-1819.2004.01289.x
Paykel ES, Abbott R, Morriss R, Hayhurst H, Scott J. Sub-syndromal and syndromal symptoms in the longitudinal course of bipolar disorder. Br J Psychiatry 2006; 189: 118-23. http://dx.doi.org/10.1192/bjp.bp.105.013870
Hawke LD, Provencher MD, Parikh SV, Zagorski B. Comorbid anxiety disorders in Canadians with bipolar disorder: clinical characteristics and service use. Can J Psychiatry 2013a; 58: 393-401.
Sublette ME, Carballo JJ, Moreno C, et al.Substance use disorders and suicide attempts in bipolar subtypes. J Psychiatr Res 2009; 43: 230-8. http://dx.doi.org/10.1016/j.jpsychires.2008.05.001
Judd LL, Akiskal HS. The prevalence and disability of bipolar spectrum disorders in the US population: re-analysis of the ECA database taking into account subthreshold cases. J Affect Disord 2003; 73: 123-31. http://dx.doi.org/10.1016/S0165-0327(02)00332-4
Das Gupta R, Guest JF. Annual cost of bipolar disorder to UK society. Br J Psychiatry 2002; 180: 227-33. http://dx.doi.org/10.1192/bjp.180.3.227
Stensland MD, Jacobson JG, Nyhuis A. Service utilization and associated direct costs for bipolar disorder in 2004: an analysis in managed care. J Affect Disord 2007; 101: 187-93. http://dx.doi.org/10.1016/j.jad.2006.11.019
Brissos S, Dias VV, Carita AI, Martinez-Arán A. Quality of life in bipolar type I disorder and schizophrenia in remission: clinical and neurocognitive correlates. Psychiatry Res 2008; 160: 55-62. http://dx.doi.org/10.1016/j.psychres.2007.04.010
Rivas-Vazquez RA, Johnson SL, Rey GJ, Blais MA, Rivas-Vazquez A. Current treatments for bipolar disorder: a review and update for psychologists. Prof Psychol Res Pr 2002; 33: 212-23. http://dx.doi.org/10.1037/0735-7028.33.2.212
Judd LL, Schettler PJ, Akiskal HS, et al. Long-term symptomatic status of bipolar I vs. bipolar II disorders. Int J Neuropsychopharmacol 2003; 6: 127-37. http://dx.doi.org/10.1017/S1461145703003341
Miklowitz DJ, Goodwin GM, Bauer MS, Geddes JR. Common and specific elements of psychosocial treatments for bipolar disorder: a survey of clinicians participating in randomized trials. J Psychiatr Pract 2008; 14: 77-85. http://dx.doi.org/10.1097/01.pra.0000314314.94791.c9
Weber Rouget B, Aubry JM. Efficacy of psychoeducational approaches on bipolar disorders: a review of the literature. J Affect Disord 2007; 98: 11-27. http://dx.doi.org/10.1016/j.jad.2006.07.016
Sperry L. Psychopharmacology and psychotherapy: strategies for maximizing treatment outcomes. New York: Brunner/Mazel; 1995.
Huxley NA, Parikh SV, Baldessarini RJ. Effectiveness of psychosocial treatments in bipolar disorder: state of the evidence. Harv Rev Psychiatry 2000; 8: 126-40. http://dx.doi.org/10.1080/hrp_8.3.126
Yatham LN, Kennedy SH, Parikh SV, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar Disord 2013; 15: 1-44. http://dx.doi.org/10.1111/bdi.12025
Perry A, Tarrier N, Morriss R, McCarthy E, Limb K. Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. BMJ 1999; 318: 149-53. http://dx.doi.org/10.1136/bmj.318.7177.149
Colom F, Vieta E, Martínez-Arán A, et al. A randomized trial on the efficacy of group psychoeducation in the prophylaxis of recurrences in bipolar patients whose disease is in remission. Arch Gen Psychiatry 2003; 60: 402-7. http://dx.doi.org/10.1001/archpsyc.60.4.402
Colom F, Vieta E. Psychoeducation manual for bipolar disorder. New York: Cambridge University Press; 2006.
Bauer MS, McBride L. Structured group psychotherapy for bipolar disorder: the life goals program. 2nd ed. New York: Springer; 2003.
Bauer MS, McBride L, Williford WO, et al., and Coauthors for the cooperative studies program 430 study. Collaborative care for bipolar disorder: part II. Impact on clinical outcome, function, and costs. Psych Serv 2006; 57: 937-45. http://dx.doi.org/10.1176/appi.ps.57.7.937
Simon GE, Ludman EJ, Bauer MS, Unützer J, Operskalski B. Long-term effectiveness and cost of a systematic care program for bipolar disorder. Arch Gen Psychiatry 2006; 63: 500-8. http://dx.doi.org/10.1001/archpsyc.63.5.500
Bauer MS, McBride L, Chase C, Sachs G, Shea N. Manual-based group psychotherapy for bipolar disorder: a feasibility study. J Clin Psychiatry 1998; 59: 449-55. http://dx.doi.org/10.4088/JCP.v59n0902
de Andrés RD, Aillon N, Bardiot MC, et al. Impact of the life goals group therapy program for bipolar patients: an open study. J Affect Disord 2006; 93: 253-7. http://dx.doi.org/10.1016/j.jad.2006.03.014
Provencher MD, Baruch P, Tremblay J, St-Amand J. A feasibility study of group psychoeducation for bipolar disorder in Quebec City. Bipolar Disord 2007; 9 (Suppl 1): 87. doi:10.1111/j.1399-5618.2007.00511.x.
Sajatovic M, Davies MA, Ganocy SJ, et al. A comparison of the Life Goals Program and treatment as usual for individuals with bipolar disorder. Psych Serv 2009; 60: 1182-9. http://dx.doi.org/10.1176/appi.ps.60.9.1182
Aubry J-M, Charmillot A, Aillon N, et al. Long-term impact of the life goals group therapy program for bipolar patients. J Affect Disord 2012; 136: 889-94. http://dx.doi.org/10.1016/j.jad.2011.09.013
Parikh SV, Zaretsky A, Beaulieu S, et al. A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: a Canadian Network for Mood and Anxiety Treatments (CANMAT) study. J Clin Psychiatry 2012; 73: 803-10. http://dx.doi.org/10.4088/JCP.11m07343
U.S. Department of Health and Human Services. Mental health: a report of the Surgeon General-Executive Summary. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Mental Health Services, National Institutes of Health; 1999.
Candini V, Buizza C, Ferrari C, et al. Is structured group psychoeducation for bipolar patients effective in ordinary mental health services? A controlled trial in Italy. J Affect Disord 2013; 151: 149-55. http://dx.doi.org/10.1016/j.jad.2013.05.069
Bauer MS, McBride L. Thérapie de groupe pour le trouble bipolaire: une approche structurée. Paris: Médecine & Hygiène; 2001.
Thompson K, Kulkarni J, Sergejew AA. Reliability and validity of a new Medication Adherence Rating Scale (MARS) for the psychoses. Schizophr Res 2000; 42: 241-7. http://dx.doi.org/10.1016/S0920-9964(99)00130-9
Hogan TP, Awad AG, Eastwood R. A self-report scale predictive of drug compliance in schizophrenics: reliability and discriminative validity. Psychol Med 1983; 13: 177-83. http://dx.doi.org/10.1017/S0033291700050182
Morisky DE, Green LW, Levine DM. Concurrent and predictive validity of a self-reported measure of medication adherence. Med Care 1986; 24: 67-74. http://dx.doi.org/10.1097/00005650-198601000-00007
Büssing A, Matthiessen PF, Mundle G. Emotional and rational disease acceptance in patients with depression and alcohol addiction. Health Qual Life Out 2008; 6: 4. http://dx.doi.org/10.1186/1477-7525-6-4
Altman EG, Hedeker D, Peterson JL, Davis JM. The Altman Self-Rating Mania Scale. Biol Psychiatry 1997; 42: 948-55. http://dx.doi.org/10.1016/S0006-3223(96)00548-3
Altman EG, Hedeker D, Peterson JL, Davis JM. A comparative evaluation of three self-ratingscales for acute mania. Biol Psychiatry 2001; 50: 468-71. http://dx.doi.org/10.1016/S0006-3223(01)01065-4
Beck AT, Steer RA, Brown GK. Manual for the Beck Depression Inventory-II. San Antonio,TX: Psychological Corporation; 1996.
Sabourin S, Gendreau P. Assessing client satisfaction with mental health treatment among French-Canadians. Appl PsycholInt Rev 1988; 37: 327-35. http://dx.doi.org/10.1111/j.1464-0597.1988.tb01146.x
Hawke LD, Parikh SV, Michalak EE. Stigma in bipolar disorder: a review of the literature. J Affect Disord 2013b; 150: 181-191. http://dx.doi.org/10.1016/j.jad.2013.05.030
Herschell AD, Kolko DJ, Baumann BL, Davis AC. The role of therapist training in the implementation of psychosocial treatments: a review and critique with recommendations. Clin Psychol Rev 2010; 30: 448-66. http://dx.doi.org/10.1016/j.cpr.2010.02.005
