230 CHAPTER 6
2006; Brondolo & Mas, 2001; Frank et al., 2005; Miklowitz, 2008; Miklowitz
et al., 2007).Targeting Social Factors: Interacting with Others
Treatments that target social factors are designed to help patients minimize
disruptions in their social patterns and develop strategies for better social inter-
actions (Lam et al., 2000). One such treatment interpersonal and social rhythm
therapy(IPSRT), was adapted from interpersonal therapy specifi cally for peo-
ple with bipolar disorders (Frank et al., 1999) to address social factors that
contribute toward relapse of mania. As in IPT, IPSRT sessions focus on iden-
tifying themes of social stressors, such as a relationship confl ict (a role dispute
in IPT; see Chapter 4) that arises because the partners have different expecta-
tions of the relationship. Treatment can then focus on developing effective ways
for the patient to minimize such social stressors. In addition, IPSRT focuses on
the timing of events (such as arranging weekend activities so that the patient
wakes up at the same time each morning and goes to sleep at the same time
each night—weekend and weekday), on increasing overall regularity in daily life
(such as having meals at relatively fi xed times during the day; see Figure 6.6),
and helping the patient want to maintain regularity. IPSRT plus medication is
more effective than medication alone (Frank et al., 1999; Miklowitz, 2008;
Miklowitz et al., 2007).
Other treatments that target social factors focus on the family, educating fam-
ily members about bipolar disorder and providing emergency counseling during
crises (Miklowitz et al., 2000, 2003, 2007). Also, family therapy that reduces
the critical behavior of family members can reduce relapses (Honig et al., 1997).
Another treatment with a social focus is group therapy or a self-help group, either
of which can decrease the sense of isolation or shame that people with bipolar
disorders may experience; group members support each other as they try to make
positive changes.FEEDBACK LOOPS IN TREATMENT: Bipolar Disorder
Both Jamison and her psychiatrist understood that treatment could affect multiple
factors:
No pill can help me deal with the problem of not wanting to take pills; likewise, no
amount of psychotherapy alone can prevent my manias and depressions. I need both.
It is an odd thing, owing life to pills, one’s own quirks and tenacities, and this unique,
strange, and ultimately profound relationship called psychotherapy.
(1995, p. 89)
We have seen that successful treatments for bipolar disorders can address mul-
tiple factors—for example, CBT can result in more consistent medication use
and IPSRT can reduce triggers of relapse. Successful treatment can also affect
interpersonal relationships. As patients begin to recover from a bipolar disor-
der, they interact differently with others, develop a more regular schedule, and
come to view themselves differently. They change the attributions they make
about events and even change how reliably they take medication for the dis-
order. Figure 6.7 summarizes the feedback loops involved in the treatment of
bipolar disorders.
Jamison’s treatment involved interactions among the factors: Her ther-
apy helped her to recognize and accept her illness and encouraged her to take
care of herself more appropriately (psychological and social factors), includ-
ing sticking with a daily regimen of lithium (neurological factor). Furthermore,
the successful lithium treatment allowed her to have better relationships with
others (social factor), which led to a positive change in how she saw herself
(psychological factor).P SN