INTEGRATED FAMILY/INDIVIDUAL THERAPY OF BIPOLAR DISORDER

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The development of new psychosocial treatments as adjuncts to pharmacotherapy is a central goal for the next decade of research on bipolar disorder, particularly for high-risk patients. We propose developing a new outpatient maintenance psychotherapy program (administered with pharmacotherapy ) that integrates the core ingredients of two promising psychotherapies for bipolar disorder:individual interpersonal/social rhythm therapy, and behavioral family management for bipolar disorder. This new program, titled "IFIT" (Integrated Family and individual Therapy for Bipolar Disorder), consists of individual and family sessions in alternating weeks over one year (50 sessions). The strength of this program will derive from the successful interdigitation of its two treatment components. In a Phase I Treatment Development and Standardization study (months 1-8), we will examine the feasibility of implementing IFIT in 12 recently episodic bipolar patients and family members. The goals of Phase I are to develop an IFIT treatment manual, therapist training procedures, and adherence and competence measures. We will select patients based on the presence of one or more high-risk factors: high expressed emotion in relatives; a recent history of episodes preceded by disruptions in social rhythms; and recent medication nonadherence. Experts in each modality will provide therapy supervision and adherence and competence ratings. Participating therapists have been previously certified in both treatment components. In a Phase II Treatment Piloting study (months 19-36), we will implement IFIT with 24 high-risk patients. We will determine rates of (and begin to identify correlates of) treatment completion, estimate effect sizes for IFIT in delaying recurrences of bipolar disorder, and develop a final treatment manual. The results of these development and pilot studies will inform the planning of a randomized, controlled efficacy study of IFIT for high-risk bipolar patients.