EBP Exchange - UMB School of Social Work

I just found this in the IASWR newsletter this week and thought users of this exchange might find it of interest.  

INTENSIVE PSYCHOTHERAPY MORE EFFECTIVE THAN BRIEF THERAPY FOR TREATING BIPOLAR DEPRESSION

http://www.nih.gov/news/pr/apr2007/nimh-02.htm http://www.nimh.nih.gov/healthinformation/bipolarmenu.cfm

Patients taking medications to treat  bipolar disorder are more likely to get well faster and stay well if they receive intensive psychotherapy, according to results from the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), funded by the National Institutes of Health’s (NIH) National Institute of Mental Health (NIMH). The results are published in the April 2007 issue of the “Archives of General Psychiatry”. Psychotherapy is routinely employed as a means to treat bipolar illness in conjunction with medication, but the extent to which psychotherapy is effective has been unclear. In addition, most psychotherapeutic studies have been limited to a single site and compared only one type of treatment to routine care. Thus, in addition to examining the role of medication, STEP-BD set out to compare several types of psychotherapy and pinpoint the most effective treatments and treatment combinations. With 293 participants, David Miklowitz, Ph.D., of the University of Colorado and colleagues set out to test the effectiveness of three types of standardized, intensive, nine-month-long psychotherapy compared to a control group that received a three-session, psychoeducational program called collaborative care. The intensive therapies were

– family-focused therapy, which required the participation and input of patients’ family members and focused on enhancing family coping, communication and problem-solving;

– cognitive behavioral therapy, which focused on helping the patient understand distortions in thinking and activity, and learn new ways of coping with the illness; and

– interpersonal and social rhythm therapy, which focused on helping the patient stabilize his or her daily routines and sleep/wake cycles, and solve key relationship problems. All participants were already taking medication for their bipolar disorder, and most were also enrolled in a STEP-BD medication study reported in the “New England Journal of Medicine” on March 28, 2007 The researchers compared patients’ time to recovery and their stability over one year. Over the course of the year, 64 percent of those in the intensive psychotherapy groups had become well, compared with 52 percent of those in collaborative care therapy. Patients in intensive psychotherapy also became well an average of 110 days faster than those in collaborative care. In addition, patients who received intensive psychotherapy were one and a half times more likely to be clinically well during any month out of the study year than those who received collaborative care. Discontinuation rates among the groups were similar — 36 percent of those in the intensive programs discontinued and 31 percent of those in collaborative care discontinued. None of the three intensive psychotherapies appeared to be significantly more effective than the others, although rates of recovery were higher among those in family-focused therapy compared to the other groups.  (Miklowitz D. et al. Psychosocial Treatments for Bipolar Depression. “Archives of General Psychiatry”. Apr 2007; 164.)

A SAMHSA suupported implementation resource kit is avaialble for Assertive Community Treatment–arguably the best established and most widely disseminated evidence based practice in mental health.  I expect that this effort will help shape the future of dissemination of other ESIs

http://mentalhealth.samhsa.gov/cmhs/communitysupport/toolkits/community/