Conclusions

This chapter highlights the fact that psychological factors may be associated with the onset and the outcome of BP episodes and that the instability model of relapse allows clinicians to recognize the potential mechanisms by which psychological therapies may improve the prognosis of those at risk of persistent symptoms or frequent relapse. The three core brief manualized therapies (IPSRT, CT and FFT) have all developed specific models for use in BP. As such, the choice between the three specific individual approaches is more likely to be dictated by client choice or the availability of a trained therapist. The group psychoeducation model (Colom et al., 2003) appears to be a hybrid therapy incorporating a number of key elements from each of the specific individual approaches but it has the additional advantage of allowing individuals to share their views of BP with others and to learn adaptive coping strategies from other group members. Individuals who need help with more circumscribed problems such as adapting to the disorder, adhering to medication or identifying and self-managing early warning signs and symptoms of relapse may benefit from more targeted interventions. Adherence therapy, relapse prevention training or brief group psycho-education may be helpful in these circumstances. The fundamental difference between these technique-driven interventions and the specific models is that the former are briefer than the specific therapies (about six to nine sessions compared to about 20 sessions) and usually offer a generic, fixed treatment package rather than an individualized, more flexible formulation-based approach. However, these simpler and briefer interventions appear to be potentially very useful in day-to-day clinical practice in general adult psychiatry settings and so further randomized trials should be encouraged (Scott & Tacchi, 2002).

The use of psychological therapy as an adjunct to medication is likely to be clinically effective and cost effective as well as contributing to a significant improvement in the quality of life of individuals with BP and, indirectly, their significant others. As such, brief evidence-based therapies represent an important component of good clinical practice in the management of BP. Studies of a comprehensive 'whole-system' approach to the collaborative psychobiosocial management of BP (described in Bauer et al., 1997) are also being undertaken in the US. If these improve the quality and continuity of care for individuals with BP it will have implications for the future organization of health services. The number and variety of trials of psychological interventions is exciting for researchers and clinicians interested in BP. However, for individuals with BP and their significant others, this work is long overdue (Jamison, Gardner & Goodwin, 1979).

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