Involving parents in therapy boosts mental wellness among children and teens at risk for bipolar disorder, according to a new study published recently in JAMA Psychiatry. The large, multi-site randomized controlled trial supports a family-focused therapeutic approach for building stress-management and emotion-regulation skills in these youth.
Bipolar disorder frequently runs in families, and when parents with the condition recognize early symptoms in their children, they often wonder how to help, said Stanford child and adolescent psychiatrist Manpreet Singh, MD, one of the study's coauthors.
"These parents begin to worry: 'Is my kid going to be OK? How can I support their development, knowing that I have this?'" Singh said.
In the brain-based condition, people experience large shifts in mood and energy levels. Also known as manic depression, bipolar is often not diagnosed until someone has had symptoms for several years. Experts want to figure out how to respond proactively to early signs of the disorder. Singh worked with collaborators from Stanford, UCLA and the University of Colorado to test a family-based method for building resilience in high-risk kids who have a parent with bipolar disorder.
"If you live with someone who has this condition -- these mood swings -- that in and of itself is very stressful," Singh said. "We wanted to foster knowledge of the symptoms, more adaptive communication, and problem solving between parents and kids, so there would be less stress."
The study participants were 127 children and teens aged 9 to 17 and their families, including at least one parent, sometimes both, and sometimes siblings as well. All 127 youth had begun to exhibit signs of major depressive disorder or abnormally elevated moods.
The participants were randomly assigned to a control treatment or family-focused therapy. The control treatment included three one-hour sessions of education about bipolar disorder, and three individual psychotherapy sessions for the youth alone, focused on mood management.
In the family-focused intervention, families attended 12 one-hour therapy sessions where they learned about bipolar disorder, and also worked together on healthy communication skills and methods for problem solving.
They learned to comment on a behavior rather than a person, saying "It bothers me when you do that" instead of "I hate you," for instance. They learned to create more opportunities for positive interactions, too.
"I would sometimes write on my prescription pad 'Go to a movie together,'" Singh said, adding that the families in the study had sometimes not had positive experiences with each other in a long time. Phrasing it as a doctor's prescription helped families take seriously the need to enjoy each other's company.
The researchers checked in on the participants for one to four years after treatment ended. Youth who had participated in family-focused therapy had fewer mental-health symptoms and longer periods without symptoms than those in the control treatment.
"Adolescents at high risk for developing bipolar stay healthier for longer periods when their families are involved in their psychotherapy sessions," Singh said.
Although the participants were not followed long enough to say whether bipolar disorder had been prevented, Singh says the results are an important step in the right direction for at-risk kids. "Longer days well is very clinically meaningful," she said. "Wellness begets wellness."
Photo by Kevin Delvecchio