Manual-Based Group Psychotherapy for Bipolar Disorder

BACKGROUND: The Life Goals Program is a structured, manual-based group psychotherapy program for bipolar disorder that seeks to improve patient participation in medical model treatment (phase 1) and assist patients in meeting functional status goals (phase 2). The goals of this initial study were (a) to determine whether the procedures could be exported from the authors to other therapists and (b) to quantify tolerability and impact of procedures on patients. METHOD: Four therapists across 2 sites and 29 patients from the Veterans Affairs (VA) Medical Center were studied in an open feasibility study. Therapists were trained, and subsequent compliance with manual procedures was quantified. Several process indices measuring tolerability and impact on patients were analyzed. RESULTS: Therapists covered 90% to 96% of phase 1 psychoeducational content, indicating excellent fidelity to manual procedures. Sixty-nine percent of patients completed phase 1, and participation scores were in the good to excellent range for 56%. Completion of phase 1 was associated with significant increase in knowledge about bipolar disorder. Fourteen (70%) of 20 patients enrolled in phase 2 reached their self-identified, behaviorally based goal (48% of the total sample who began phase 1 of the program). Mean +/- SD time to goal completion was 8.7 +/- 5.3 months (median 95% confidence interval = 7 5.1-12.3 months; range, 2-17 months). CONCLUSION: The manual-based intervention can be exported with fidelity to other therapists and sites (for phase 1). Data indicate reasonable tolerability and good achievement of process (for phases 1 and 2) for those who accept this group modality. Comparison with other manual-based psychotherapies indicates remarkable consistency regarding content for psychotherapy for bipolar disorder; major differences among the psychotherapies include mode of delivery and relative emphasis of specific components.