Back in the day, when you could struggle to stay awake during a seminar when people read their process notes to their supervisors, and watch brachiosaurids frolic outside the window, intensive therapy was at least twice weekly. More like thrice weekly.
Gone are the sauropods. Now, you are likely to see hitherto-unknown strange creatures with spiked hair and iPods race by on their Razor scooters. And "intensive" treatment is less than one session per week.
Intensive Psychosocial Intervention Enhances Functioning in Patients With Bipolar Depression: Results From a 9-Month Randomized Controlled Trial
Am J Psychiatry 164:1340-1347, September 2007
doi: 10.1176/appi.ajp.2007.07020311
© 2007 American Psychiatric Association
OBJECTIVE: Psychosocial interventions are effective adjuncts to pharmacotherapy in delaying recurrences of bipolar disorder; however, to date their effects on life functioning have been given little attention. In a randomized trial, the authors examined the impact of intensive psychosocial treatment plus pharmacotherapy on the functional outcomes of patients with bipolar disorder over the 9 months following a depressive episode. METHOD: Participants were 152 depressed outpatients with bipolar I or bipolar II disorder in the multisite Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) study. All patients received pharmacotherapy. Eighty-four patients were randomly assigned to intensive psychosocial intervention (30 sessions over 9 months of interpersonal and social rhythm therapy, cognitive behavior therapy [CBT], or family-focused therapy), and 68 patients were randomly assigned to collaborative care (a 3-session psychoeducational treatment). Independent evaluators rated the four subscales of the Longitudinal Interval Follow-Up Evaluation-Range of Impaired Functioning Tool (LIFE-RIFT) (relationships, satisfaction with activities, work/role functioning, and recreational activities) through structured interviews given at baseline and every 3 months over a 9-month period. RESULTS: Patients in intensive psychotherapy had better total functioning, relationship functioning, and life satisfaction scores over 9 months than patients in collaborative care, even after pretreatment functioning and concurrent depression scores were covaried. No effects of psychosocial intervention were observed on work/role functioning or recreation scores during this 9-month period. CONCLUSIONS: Intensive psychosocial treatment enhances relationship functioning and life satisfaction among patients with bipolar disorder. Alternate interventions focused on the specific cognitive deficits of individuals with bipolar disorder may be necessary to enhance vocational functioning after a depressive episode.
The problem with this study is that, these days, it is very difficult to get 30 sessions of psychotherapy in some places. Leading HMOs (yes, I'm talking to you, Duane and Bruce) give maybe ten sessions. Twenty if you are lucky.
One thing I notice about this study, also, is their curious statement: "Alternate interventions focused on the specific cognitive deficits of individuals..."
Since when is a focus on the specific individual considered to be an "alternate" intervention? Imagine that! Paying attention to the individual, and tailoring the treatment to that person's needs!
On a more serious note, it is good to see that people are trying to figure out how best to restore functioning in persons with bipolar disorder. It is clear from reading it that the authors are very much aware of the need to treat people, not diseases. It's just unfortunate that treatment at a level of intensity that used to be routine, is now considered exceptional.
Medicine & Health
Comments
I have to say that I don't think a psychoanalyst would consider this to be "intensive".
Posted by: Alex | September 9, 2007 6:39 AM
Oe of the issues of the current patchwork of health care is that a few people get weekly services over an extended time (3 months or more), most get the 10 or 15 initial sessions, and few get whatever is provided through emergency rooms.
As for the cognitive issue, there's not been a lot of attention paid to cognitive deficits (memory, attention, planning) and specific cognitive remediation & strategies in this population until the last few years. It's starting now, but despite the emphasis on biological psychiatry, concern about the cognitive consequences between acute episodes hasn't been high.
Posted by: stewart | September 9, 2007 10:22 AM
"It's just unfortunate that treatment at a level of intensity that used to be routine, is now considered exceptional. "
The more so since so many patients are now on medications they may end up taking for years. 20 sessions and out seems a bit counterproductive in lifelong diseases like bipolar disorder.
Posted by: Dirkh | September 11, 2007 9:13 AM