|
November – December 2019
Guest column from Kenneth L. Salzman, Ph.D., licensed psychologist
Pairing psychotherapy with medications can reduce symptoms of bipolar disorder
.jpg) Research into the treatment of bipolar disorder indicates that medication alone doesn’t produce the best outcomes for patients.
Psychotherapy, when added to medication for the treatment of bipolar disorder, consistently shows advantages over medication alone. Why is this and, more importantly, how can psychotherapy help improve outcomes?
Process of psychotherapy
Every patient comes to psychotherapy with a specific set of skills and abilities, strengths as well as weaknesses. The process of psychotherapy helps increase a patient’s understanding of their situation and clarify which aspects are within their control to some degree.
Psychotherapy might explore the motivating factors — historical, social and physical — that contribute to their condition and symptoms. The behavioral health specialist’s skill set allows for an exploration of these factors to facilitate a better understanding of the role they play in bipolar disorder. This, in turn, can help resolve conflicts that interfere with the patient’s effective functioning and provide skill development, allowing the patient to achieve increased levels of control over their condition.
About bipolar disorder
Bipolar disorder, also known as manic-depressive illness, is a brain disorder that causes unusual shifts in mood, energy, activity levels and the ability to carry out day-to-day tasks. The exact cause of bipolar disorder isn’t known, but a combination of genetics, environment and altered brain structure and chemistry may play a role.
Manic episodes may include symptoms such as high energy, reduced need for sleep and loss of touch with reality. Depressive episodes may include symptoms such as low energy, low motivation and loss of interest in daily activities. Mood episodes can last days to months at a time.
Effects of depression, mania
When a patient experiences alternating periods of depression and mania, it creates a perception of powerlessness, often generating a sense of hopelessness and suicidal ideation. Medication may mitigate many of the symptoms, but the underlying sense of disorder persists. This can be especially problematic if:
- The efficacy of the medication begins to fade.
- The patient experiences adverse side effects to the medication.
- The patient doesn’t comply with his or her medication regimen.
Ongoing episodes of depression and mania also can generate a sense of fear and dread, exacerbating the symptoms of the episodes. Psychotherapy sessions with a behavioral health specialist provide the time and a suitable environment where the patient can become more aware of the pattern of their disorder. They glean a better understanding of the warning signs that precede an episode and become more adept at implementing actions that mitigate the symptoms.
To the extent that patients perceive themselves as able to mitigate their symptoms, their sense of powerlessness decreases and is replaced with a developing sense of confidence. As the confidence in their own ability to control symptoms increases, their fear of an upcoming episode decreases. This, in itself, can reduce the severity of an episode’s symptoms.
I encourage physicians to consider the tools in a psychotherapist’s skill set when treating a patient with bipolar disorder. These tools can make a big difference in reducing the severity of a patient’s symptoms and the risk of relapse.
Kenneth L. Salzman is a licensed psychologist in independent private practice in Lansing. He currently serves on the Insurance Committee of the Michigan Psychological Association and has worked with Blue Cross and other health care plans to help facilitate the integration of behavioral services with medical systems.
|
