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., 1997, 1999).I.W.Miller and his colleagues, in a small pilotstudy, added family therapy to a drug regimen and reported a significant increase inthe percentage of patients with bipolar disorder who fully recovered (56%) over thosewho had drug treatment alone (20%).During a 2-year follow-up, patients whoreceived psychological treatment and medication had less than half the recidivism ofthose who had drug treatment alone (Miller, Keitner, Epstein, Bishop, & Ryan, 1991).David Miklowitz and his colleagues found that family tension is associated withrelapse in bipolar disorder.Preliminary studies indicate that treatments, directed athelping families understand symptoms and develop new coping skills and Durand 6-111communication styles, change communication styles(Simoneau, Miklowitz, Richards,Saleem, & George, 1999) and prevent relapse (Miklowitz, 2001;Miklowitz &Goldstein, 1997; Miklowitz, Simoneau, Sachs-Ericsson, Warner, & Suddath, 1996).More recently, Miklowitz, George, Richards, Simoneau and Suddath (2003)demonstrated that their family-focused treatment combined with medication results insignificantly less relapse 1 year following initiation of treatment than patientsreceiving crisis management and medication over the same period of time (see Figure6.9).Specifically, only 35% of patients receiving family therapy plus medicationrelapsed compared with 54% in the comparison group.Similarly, family therapypatients averaged over a year and a half (73.5 weeks) before relapsing, significantlylonger than the comparison group.Rea, Tompson, and Miklowitz (2003) comparedthis approach with an individualized psychotherapy, in which patients received thesame number of sessions over the same time period, and continued to find anadvantage for the family therapy after 2 years.In another important study, Lam et al.(2003) showed that patients with bipolar disorders treated with cognitive therapy plusmedication relapsed significantly less over 1 year than a control group receiving justmedication, replicating, in part, earlier results from Perry, Tarrier, Morriss, McCarthy,and Limb (1999).[Figures 6.9 goes here]Let us now return to Katie, who, you will remember, had made a serious suicideattempt in the midst of a major depressive episode.KatieThe Triumph of the SelfLike the overwhelming majority of people with serious psychological disorders,Katie had never received an adequate course of treatment, although she was Durand 6-112evaluated from time to time by various mental health professionals.She lived in arural area where competent professional help was not readily available.Her lifeebbed and flowed with her struggle to subdue anxiety and depression.When shecould manage her emotions sufficiently, she took an occasional course in the highschool independent study program.Katie discovered that she was fascinated bylearning.She enrolled in a local community college at the age of 19 and didextremely well, despite the fact that she had not progressed beyond her freshmanyear in high school.At the college she earned a high school equivalency degree.Shewent to work in a local factory.But she continued to drink heavily and to takeValium; on occasion, anxiety and depression would return and disrupt her life.Finally, Katie left home, attended college full time, and fell in love.But theromance was one-sided, and she was rejected.One night after a phone conversation with him, I nearly drank myself to death.Ilived in a single room alone in the dorm.I drank as much vodka as quickly as Icould.I fell asleep.When I awoke, I was covered in vomit and couldn t recallfalling asleep or being sick.I was drunk for much of the next day.When I awokethe following morning, I realized I could have killed myself by choking on my ownvomit.More importantly, I wasn t sure if I fully wanted to die.That was the last ofmy drinking.Katie decided to make some changes.Taking advantage of what she had learnedin the little treatment she had received, she began looking at life and herselfdifferently.Instead of dwelling on how inadequate and evil she was, she began topay attention to her strengths. But I now realized that I needed to accept myself asis, and work with any stumbling blocks that I faced.I needed to get myself throughthe world as happily and as comfortably as I could.I had a right to that. Other Durand 6-113lessons learned in treatment now became valuable, and Katie became more aware ofher mood swings:I learned to objectify periods of depression as [simply] periods of feeling. Theyare a part of who I am, but not the whole.I recognize when I feel that way, and Icheck my perceptions with someone that I trust when I feel uncertain of them.I tryto hold on to the belief that these periods are only temporary.Katie developed other strategies for coping successfully with life:I try to stay focused on my goals and what is important to me.I have learned thatif one strategy to achieve some goal doesn t work there are other strategies thatprobably will.My endurance is one of my blessings.Patience, dedication, anddiscipline are also important.None of the changes that I have been throughoccurred instantly or automatically.Most of what I have achieved has requiredtime, effort, and persistence.Katie dreamed that if she worked hard enough she could help other people whohad problems similar to her own.Katie pursued that dream and earned her Ph.D.inpsychology.Concept Check 6.4Indicate which type of treatment for mood disorders is being described in eachstatement.1.The controversial but somewhat successful treatment involving the production ofseizures through electrical shock to the brain._______2.This teaches clients to carefully examine their thought process and recognize depressive errors in thinking._______ Durand 6-1143.These come in three main types (tricyclics, MAO inhibitors, and SSRIs), areoften prescribed, but have numerous side effects._______4.This antidepressant must be carefully regulated to avoid illness but has theadvantage of affecting manic episodes._______5.It is crucial to focus on resolving problems in existing relationships and learn toform new interpersonal relationships.6.This is an effort to prevent relapse or recurrence over the long run._______SuicideDescribe the relationship between suicide and mood disorders, including knownrisk factors and approaches to suicide prevention and treatment
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