DISORDER pharmacologic agents available to them (Hirschfeld, Bowden,

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Last updated: August 18, 2019

DISORDER AND ADLERIAN PRINCIPLES                                                        2BipolarDisorder Symptoms and TreatmentwithAdlerian Therapy            Bipolardisorder is a serious mental illness that has a relatively high prevalence throughoutthe world. Statistical analysis by Kessler, Chiu, Demler, Merikangas, and Walters(2005) focused on the disorder in the United States and show the mood disorderaffecting 2.8% of the adult population in the United States when subtype I andII are combined and has a 4.4% lifetime prevalence.

In addition to a directhealthcare burden, bipolar disorder is also associated with a large indirectnon-healthcare related economic cost. In a study analyzing both direct and indirectcosts of bipolar disorder, Cloutier, Greene, Guerin, Touya, and Wu (2015) foundtotal costs associated with bipolar disorder exceeding $201 billion. Efficacystudies focusing on individual psychology versus placebo treatment are limited innature.

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Smith, and Glass (1980) identified no difference in effectiveness oftreatment in comparison with placebo treatment. They did however, note that “a typicaltherapy client is 75% better off than untreated individuals” (Smith et al1980).  The purpose of paper is to recognizecurrent psychotherapy approaches to bipolar disorder treatment, and reviewcurrent literature associated with bipolar disorder and treatment withtechniques commonly associated with Adlerian or Individual Psychology.  Epidemiologyof bipolar disorder            Bipolar disorder Iand bipolar disorder II are characterized by difference in patient characteristicsand symptoms.  The Diagnostic and Statistical Manual of MentalDisorders edition IV characterizes which also includes cyclothymic, and otherbipolar disorders not specified in their characterization, defines bipolar Idisorder as having one episode of mania, BIPOLAR DISORDER ANDADLERIAN PRINCIPLES                                                             3 while bipolar disorder IIis characterized by hypomanic and depressive episodes.

These patients have morepharmacologic agents available to them (Hirschfeld, Bowden, Gitlin2007) and can take part in psychotherapy interventions. With the average onsetof bipolar disorder I occurring with an average age of onset of 18 years ofage, and bipolar disorder II having an average age of onset of 22 years of age(Hilty, Leamon, Lim, Kelly, Hales 2006), patients seeking therapy could benefitfrom therapeutic intervention for the majority of their lives. Current psychological treatment of bipolar disorder            Adlerian therapy has been widely utilized for an array ofdisorders outlined by the Diagnostic and Statistical Manual of MentalDisorders. However, a meta-analysis by Miziou et al. 2015 revealed there have morestudies focusing on therapeutic benefit of other theories aside from IndividualPsychology. Specifically, this meta-analysis reported that when narrowing theirsearch to randomized trials, they found 14 studies examining efficacy inpsychosocial interventions utilizing CBT, 15 studies examining efficacy ofpsychosocial intervention utilizing family therapy, 4 studies focusing ofefficacy of intervention utilizing interpersonal and social rhythm therapy, and30 studies focusing on efficacy of psycho-education. The results of this meta-analysisrevealed limited usefulness for psychotherapies in treatment of patients withbipolar disorder as many studies only showed benefit in select sub-groups ofpatients with certain characteristics.In one randomizedprospective study conducted in 2012, Parikh et al.

found despite longer andindividual treatment, there was no significant benefit when compared to basicpsycho-education. In addition to this finding, the study revealed an economicimpact as well with the group part BIPOLAR DISORDER ANDADLERIAN PRINCIPLES                                                             4 taking in CBT having anassociated cost of $1200 per subject compared with $80 per subject forpsychoeducation. Another study by (Gomes et al. 2012) showed no difference in theCBT group versus treatment as usual group with time to recurrence, and totalnumber of episodes not differing from CBT to treatment as usual group.             The results of the meta-analysis for family focusedtherapy and particularly family intervention techniques showed benefits forfamily members, but the benefit for the patient themselves is still undetermined.One particular study by Miklowitz et al.

2010 showed the family focused therapyhaving a positive impact on number of depressive symptoms, however there was nochange in number or time to manic episodes. Adlerian influences            Adler’s influence on these therapies should not beundermined as principles of Adlerian therapy are heavily observed in modernpsychology. In a study looking at overlapping tenets of cognitive behavioral therapyand individual psychology (Watts, Ergüner-Tekinalp2017) it was noted that many modern psychotherapies share common approaches dueto the contributions of Adler.  Some ofthese commonalities have led to uses of Adlerian techniques in the treatment ofbipolar disorder without recognition. An example of this phenomenon can beobserved with the use of Adler’s emphasis on subjective perception of theirlife, or schema (Watts, Ergüner-Tekinalp 2017). This principle in assessment ofthe patient can be observed in many cognitive behavioral approaches, and is akey component of Aaron Beck’s, and Albert Ellis’ approach to accessing andchallenging irrational or maladaptive thoughts that often accompany mooddisorders (Longmore, Worrell, 2008).

BIPOLAR DISORDER ANDADLERIAN PRINCIPLES                                                             5            In another example of Adlerian principles being utilizedin modern day applied psychology is observed through its contributions torational emotive therapy developed by Albert Ellis. Due to the high comorbidityrate among patients with bipolar disorder, >60% in a study looking atpatients meeting DSM-VI criteria for another axis-I comorbid (McElroy et al.2006), it is important to acknowledge Adler’s contribution to this early formof cognitive behavior therapy that can be utilized with these patients. Inrational emotive therapy, there is a strong commonality to Adlerian principlesthrough an emphasis on self-rating and anxiety. Adler’s work similarly pointedout feelings of inferiority and the nature human nature of striving forsuperiority (Watts, Critteli 2006). Another example of RET relying on Adlerianprinciples has to do with its holistic approach that emphasizes patient’svalues, goals, and social interests (Watts, Critelli, 2006).

Whilecontemporary cognitive behavioral therapy techniques have moved to theforefront of treatment of many mood disorders including bipolar syndrome(Freeman, Urschel 1997), Adlerian concepts have been taking an active role withinthese theories. The case for Adlerian therapy in treating bipolarpatientsAs mentioned in the sectioncovering current psychological treatments of bipolar disorder, efficacyconcerns remain regarding long term benefits identified from techniquesemployed using cognitive behavioral therapies, relational emotive therapies, orfamily therapy (Oud et al. 2016). Adlerian therapy providesstructure for treating patients through the four main phases that are incorporatedinto therapeutic practice; forming the therapeutic relationship, lifestyleanalysis and BIPOLAR DISORDER ANDADLERIAN PRINCIPLES                                                            6 assessment, interpretationand insight, and reorientation (Dreikurs, 1962). It places a strong emphasis onsocial context, and therefore can be utilized for patients with varyingcultural backgrounds (Flanagan, Flanagan, 2006).  Adler’s emphasis on social equality makesindividual psychology particularly valuable forwomen in a society that may encounter prejudice.

 This emphasis, in addition to the counselorsfocus on the tasks of life, work or occupation, social relationships, love andmarriage, self, spirituality, parenting and family being met, it gives manyplatforms for the counselor to work off after assessment to create mutuallyagreed upon goals to start striving towards reorientation (Flanagan, Flanagan,2006). Conclusion While there is limited dataregarding the efficacy of Adlerian therapy in the treatment of patients withbipolar disorder, there is data examining the efficacy of contemporary behavioraltherapies that utilize Adlerian principles (Oud et al. 2016). There is a needfor more studies and literature regarding the potential benefits of individualpsychology in the treatment of patients with bipolar disorder. The data thatwas present regarding psychoeducation showed similar efficacy to many of thelonger, CBT based randomized trials. The current literature and data comparingAdlerian principles being utilized by other theories was summed upappropriately by the Richard Watts book published in 2004, Adlerian, Cognitive, and ConstructivistTherapies: An Integrative Dialogue when they stated that “Perhaps Cognitive-Behavioral Psychology’s strongarray of treatment and research strategies could be joined with the theoreticalconcepts of Adlerian Psychology to the benefit of both of these systems”.

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