Manual-Based Group Psychotherapy for Bipolar Disorder: A Feasibility Study

Background: The Life Goals Program is a structured, manual-based grouppsychotherapy program for bipolar disorder that seeks to improve patient participation inmedical model treatment (phase 1) and assist patients in meeting functional status goals(phase 2). The goals of this initial study were (a) to determine whether the procedurescould be exported from the authors to other therapists and (b) to quantify tolerabilityand impact of procedures on patients.

Method: Four therapists across 2 sites and 29 patients from the VeteransAffairs (VA) Medical Center were studied in an open feasibility study. Therapists weretrained, and subsequent compliance with manual procedures was quantified. Several processindices measuring tolerability and impact on patients were analyzed.

Results: Therapists covered 90% to 96% of phase 1 psychoeducationalcontent, indicating excellent fidelity to manual procedures. Sixty-nine percent ofpatients completed phase 1, and participation scores were in the good to excellent rangefor 56%. Completion of phase 1 was associated with significant increase in knowledge aboutbipolar disorder. Fourteen (70%) of 20 patients enrolled in phase 2 reached theirself-identified, behaviorally based goal (48% of the total sample who began phase 1 of theprogram). Mean±SD time to goal completion was 8.7±5.3 months (median [95% confidenceinterval] =7 [5.1-12.3 months]; range, 2-17 months).

Conclusion: The manual-based intervention can be exported with fidelityto other therapists and sites (for phase 1). Data indicate reasonable tolerability andgood achievement of process (for phases 1 and 2) for those who accept this group modality.Comparison with other manual-based psychotherapies indicates remarkable consistencyregarding content for psychotherapy for bipolar disorder; major differences among thepsychotherapies include mode of delivery and relative emphasis of specific components.