Type of Psycho social Treatment
Psycho social theories and treatments of bipolar disorder follow fro man understanding that, although the disorder has pre dominantly genetic causes, its course is responsive to environmental stressors .As adjuncts to medication therapy, psycho social treatments aim to enhance medication compliance, and to increase resilience to stress.
Psychiatric Management and Supportive psycho therapy
Psychiatric Management and Supportive Psycho therapy is the standard in psychiatric office practice. The psychiatrist focuses on establishing a positive therapeutic relationship in the course of diagnosis and initiation of treatment of mood disorders. The psychiatrist is attentive to all signs and symptoms of the disorder with particular attention to suicidal ideation. The psychiatrist provides ongoing education, collaboration with the patient, and supportive feedback to the patient regarding ongoing response and prognosis.The supportive psycho therapeutic management of depression facilitates the ongoing pharmacologic response. Brief supportive psychotherapy in individuals with mild to moderate depression is indicated to improve medication compliance, to facilitate reduction of active signs and symptoms, and to provide education regarding relapse and recurrence of mood disorders.
Psycho therapy used with antidepressants can greatly enhance the results of medication. Individual or group psychotherapy can help the person gradually resume former responsibilities and adapt to the normal pressures of life, building on the improvement made by drug treatment. With interpersonal psychotherapy, the person receives supportive guidance for adjusting to changes in life roles.Cognitive therapy can help change a person’s hopeless and negative thinking. Psychotherapy alone may be just as effective as drug therapy for milder depressions.
Cognitive therapy is based on the premise that the negative emotions of depression are reactions to negative thinking derived from global dysfunctional negative attitudes. Patient and the rapist work together to identify automatic negative thoughts, correct the pervasive beliefs that generate these thoughts, and develop more realistic basic assumptions.
Treatment involves systematically monitoring negative cognitions whenever the patient feels depressed; recognizing the association between cognition, affect, and behaviour; generating data that support or refute the negative cognition; generating alternative hypotheses to explain the event that precipitated the negative cognition; and identifying the negative schemata predisposing to the emergence of global negative thinking when one side of an all-or-nothing assumption is disappointed.
An example of the cognitive therapy would be a man who feels depressed at the thought ‘no body loves me’ when his friend did not greet him enthusiastically. This thought might be seen to follow logically from the assumption ‘If my friend is not always happy to see me, he does not love me. Two kinds of alternative hypotheses could be generated in considering this cognition. First, the patient’s friend may have been preoccupied with something else or may have been happy to see him but did not demonstrate it in exactly the way he expected. Second, lack of enthusiasm at one particular moment is not necessarily a sign of generalized lack of love. Eventually the patient learns to correct the underlying all-or-nothing belief ‘People either are completely devoted tome or they do not care at all.
Cognitive therapy also focuses on the cognitive distortions of manic patients. For example, feelings of grandiosity are perpetuated by magnification of the positive and minimization of, or obliviousness to, negative feedback. Paranoid thinking in mania is reinforced by selective attention to evidence that confirms paranoid beliefs, along with dismissal of dis confirming evidence. These tendencies, as well as the patient’s desire to maintain a manic or hypo manic state, are addressed with standard cognitive therapy methods.
Interpersonal Therapy (IPT)
Interpersonal therapy is designed to improve depression by enhancing the quality of the patient’s interpersonal world. IPT involves a formal diagnostic assessment, inventory of important current and past relationships, and definition of the current problem area. In IPT, four areas of focus that could relate to depressive symptoms are:
2) interpersonal role disputes,
3) role transitions, and
4) inter personal deficits.
The treatment begins with an explanation of the diagnosis and treatment options. Through structured assignments, interpersonal therapy helps the patient to work toward explicit goals related to whichever of the four basic interpersonal problems (unresolved grief, role disputes, transitions to new roles, and social skills deficits) is believed to be present. Role play ingisused to help the patient acquirene winter personal skills, and structured conjoint meetings are used to help partners to clarify their expectations of each other.
Therapies for depression derived from principles of classic and operant conditioning, social learning theory, and learned helplessness include social learning approaches, self control therapy, social skills training, and structured problem-solving therapy. Behaviour therapies utilize education, guided practice, homework assignments, and social reinforcement of successive approximations in a time-limited format, typically over 8-16weeks. Depressive behaviours such as self-blame, passivity, and negativism are ignored, where as behaviours that are inconsistent with depression, such as activity, experiencing pleasure, and solving problems, are rewarded. Rewards can include anything that the patient seems to seek out – from attention, to praise, to being permitted to withdraw or complain, to money. Learned helplessness is combated by the therapist’s giving patients small, discrete tasks that very gradually become more demanding. For example, a person who is hopeless about finding a suitable job, is first of all asked to buya newspaper; then go through the newspaper and list all the available jobs; then he is asked to choose one and make an application and the like. Each positive experience reinforces a feeling of accomplishment that makes the next task easier. Social skills training teach self-reinforcement, assertive behaviour, and the use of social re-inforcers such as eye contact and compliments.
Interpersonal psychotherapy of depression addresses four areas of current interpersonal
1. Interpersonal loss or grieving;
2. Role transitions;
3. Interpersonal disputes;
4. Social deficits.
This type of treatment, like other psychotherapies for depression, also involves education
about the nature of depression and the relationship between symptoms of depressive disorder and current interpersonal difficulties.
Cognitive–behavioral therapy for mood disorders is a form of treatment aimed at symptom reduction through the identification and correction of cognitive distortions. Behavioral interventions are used to limit self-stimulating behaviors. Activities that have a high potential for dangerous consequences or which might serve to exacerbate the episode are identified early on, and the therapist helps to plan strategies for avoiding or limiting these activities.
Cognitive–behavioral therapy is less effective than medication treatment in moderate to severe depressional though some have suggested a relatively equal response to cognitive– behavioral therapy and medication in more severely depressed outpatients.
Brief Dynamic Psychotherapy
Brief dynamic psychotherapy addresses current conflicts as manifestations of difficulty in early attachment and disruption of early object relationships. Brief dynamic psycho therapy was not specifically designed for treatment of depression and is currently the subject of ongoing studies as well as controlled clinical trials in comparison with medication treatment.The results of these trials will allow us to address the appropriate role of brief dynamic psychotherapy in outpatients with mild to moderate depression.
In addition, it will be important to understand whether dynamic psychotherapy may address demoralization or response to traumatic circumstances.
Marital and Family Therapy
Marital distress is a major event associated with the development of a depressive episode. Marital discord will often persist after the remission of depression and subsequent relapses are frequently associated with disruptions of marital relationships.