Swartz H A, Frank E
Department of Psychiatry, University of Pittsburgh, Western Psychiatric Institute and Clinic, PA, USA.
Bipolar Disord. 2001 Feb;3(1):11-22. doi: 10.1034/j.1399-5618.2001.030102.x.
The depressive phase of bipolar disorder is particularly difficult to treat. Pharmacologic strategies for bipolar depression are often inadequate. We therefore review the literature on the role of psychotherapy as an adjunct to medication in the treatment of bipolar depression.
With one exception, there are no descriptions of psychotherapies employed specifically for the treatment of bipolar depression. We therefore reviewed published reports of psychotherapy for bipolar disorder in general and extracted from these reports relevant data or impressions about the specific effects of the therapies on the depressive phase of the disorder.
Described psychosocial approaches to bipolar disorder include psychoeducation, group therapy, cognitive-behavioral therapy, couples therapy, family therapy, and interpersonal psychotherapy. Only cognitive-behavioral therapy has been tested in a pilot study for the treatment of bipolar depression specifically. Results from randomized controlled trials of family therapy and interpersonal and social rhythm therapy suggest that these treatments may be more efficacious in the treatment and prevention of depression relative to mania.
A limited number of well-designed studies and preponderance of case reports limit definitive conclusions about the role of psychotherapy in the treatment of bipolar depression. However, converging reports suggest that cognitive-behavioral therapy, family therapy, and interpersonal and social rhythm therapy may be particularly useful for bipolar depression. We propose a novel approach to the treatment of bipolar disorder that includes the use of phase-specific sequenced psychotherapies delivered in variable patterns and linked to fluctuating mood states.
双相情感障碍的抑郁期尤其难以治疗。双相抑郁的药物治疗策略往往并不充分。因此，我们回顾了有关心理治疗作为药物治疗双相抑郁辅助手段作用的文献。
除一项研究外，没有专门针对双相抑郁治疗所采用心理治疗方法的描述。因此，我们回顾了关于双相情感障碍心理治疗的已发表报告，并从这些报告中提取了有关这些治疗方法对该障碍抑郁期具体影响的相关数据或观点。
所描述的双相情感障碍的心理社会治疗方法包括心理教育、团体治疗、认知行为疗法、夫妻治疗、家庭治疗和人际心理治疗。只有认知行为疗法在一项针对双相抑郁治疗的初步研究中进行了测试。家庭治疗以及人际和社会节律疗法的随机对照试验结果表明，相对于躁狂症，这些治疗方法在抑郁治疗和预防方面可能更有效。
设计良好的研究数量有限且病例报告占主导地位，这限制了对心理治疗在双相抑郁治疗中作用的确切结论。然而，越来越多的报告表明，认知行为疗法、家庭治疗以及人际和社会节律疗法可能对双相抑郁特别有用。我们提出一种治疗双相情感障碍的新方法，包括使用根据不同阶段顺序进行的心理治疗，以可变模式实施，并与情绪状态波动相关联。
