Dialectical Behavior Therapy Effective for Adolescents with Bipolar Disorder

October 29, 2010 · Posted in Current Treatments 

As we posted yesterday, therapeutic approaches appear necessary for childhood-onset bipolar disorder.  In a poster at the Pediatric Bipolar Conference in Cambridge, Massachusetts in March, Tina Goldstein of Western Psychiatric Institute in Pittsburgh presented an open study indicating that dialectical behavior therapy (DBT) was effective for adolescents with bipolar disorder. This is the second study that has produced these results. In DBT, patients are taught coping skills and mindfulness in order to break the cycle of responding to dysregulated emotions with problematic behaviors.

The DBT approach has proven efficacy in those with borderline personality disorder, which shares a number of symptom targets with those of bipolar disorder. These include emotional dysregulation, suicidal behavior, self-injurious behavior, interpersonal deficits, and poor treatment adherence.

In Dr Goldstein’s study, suicidal ideation decreased very substantially over one year of DBT, as did emotional dysregulation. There were also substantial improvements in other treatment endpoints, including an increase in the duration of time well. The acute treatment period consisted of one to six months of semimonthly one-hour sessions of DBT for the patient and separate family skills training sessions, after which there were monthly visits with one-hour individual sessions for the patient and for other family members.

EDITOR’S NOTE:  This form of therapy appears to be an excellent approach for adolescents with bipolar disorder who are often difficult to treat with just pharmacological agents. Other psychotherapeutic approaches have also resulted in positive data, leading to the conclusion that some form of individual or family psychotherapy or psychoeducation is necessary for the adequate management of this difficult-to-treat illness.

Children with illnesses such as diabetes get information, guidance, counseling, and illness education from a host of sources, including doctors, nurses, social workers, dietitians, and caseworkers.  A similar model of treatment and education could be just as useful for those with bipolar illness, but it is not always available, even to the well-insured.

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