DISORDER pharmacologic agents available to them (Hirschfeld, Bowden,

DISORDER AND ADLERIAN PRINCIPLES                                                        2

Bipolar
Disorder Symptoms and Treatment

with
Adlerian Therapy

            Bipolar
disorder is a serious mental illness that has a relatively high prevalence throughout
the world. Statistical analysis by Kessler, Chiu, Demler, Merikangas, and Walters
(2005) focused on the disorder in the United States and show the mood disorder
affecting 2.8% of the adult population in the United States when subtype I and
II are combined and has a 4.4% lifetime prevalence. In addition to a direct
healthcare burden, bipolar disorder is also associated with a large indirect
non-healthcare related economic cost. In a study analyzing both direct and indirect
costs of bipolar disorder, Cloutier, Greene, Guerin, Touya, and Wu (2015) found
total costs associated with bipolar disorder exceeding $201 billion. Efficacy
studies focusing on individual psychology versus placebo treatment are limited in
nature. Smith, and Glass (1980) identified no difference in effectiveness of
treatment in comparison with placebo treatment. They did however, note that “a typical
therapy client is 75% better off than untreated individuals” (Smith et al
1980).  The purpose of paper is to recognize
current psychotherapy approaches to bipolar disorder treatment, and review
current literature associated with bipolar disorder and treatment with
techniques commonly associated with Adlerian or Individual Psychology.  

Epidemiology
of bipolar disorder

            Bipolar disorder I
and bipolar disorder II are characterized by difference in patient characteristics
and symptoms.  The Diagnostic and Statistical Manual of Mental
Disorders edition IV characterizes which also includes cyclothymic, and other
bipolar disorders not specified in their characterization, defines bipolar I
disorder as having one episode of mania,

BIPOLAR DISORDER AND
ADLERIAN PRINCIPLES                                                             3

while bipolar disorder II
is characterized by hypomanic and depressive episodes. These patients have more
pharmacologic agents available to them (Hirschfeld, Bowden, Gitlin
2007) and can take part in psychotherapy interventions. With the average onset
of bipolar disorder I occurring with an average age of onset of 18 years of
age, 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 benefit
from therapeutic intervention for the majority of their lives.

Current psychological treatment of bipolar disorder

            Adlerian therapy has been widely utilized for an array of
disorders outlined by the Diagnostic and Statistical Manual of Mental
Disorders. However, a meta-analysis by Miziou et al. 2015 revealed there have more
studies focusing on therapeutic benefit of other theories aside from Individual
Psychology. Specifically, this meta-analysis reported that when narrowing their
search to randomized trials, they found 14 studies examining efficacy in
psychosocial interventions utilizing CBT, 15 studies examining efficacy of
psychosocial intervention utilizing family therapy, 4 studies focusing of
efficacy of intervention utilizing interpersonal and social rhythm therapy, and
30 studies focusing on efficacy of psycho-education. The results of this meta-analysis
revealed limited usefulness for psychotherapies in treatment of patients with
bipolar disorder as many studies only showed benefit in select sub-groups of
patients with certain characteristics.

In one randomized
prospective study conducted in 2012, Parikh et al. found despite longer and
individual treatment, there was no significant benefit when compared to basic
psycho-education. In addition to this finding, the study revealed an economic
impact as well with the group part

BIPOLAR DISORDER AND
ADLERIAN PRINCIPLES                                                             4

taking in CBT having an
associated cost of $1200 per subject compared with $80 per subject for
psychoeducation. Another study by (Gomes et al. 2012) showed no difference in the
CBT group versus treatment as usual group with time to recurrence, and total
number of episodes not differing from CBT to treatment as usual group.

            The results of the meta-analysis for family focused
therapy and particularly family intervention techniques showed benefits for
family members, but the benefit for the patient themselves is still undetermined.
One particular study by Miklowitz et al. 2010 showed the family focused therapy
having a positive impact on number of depressive symptoms, however there was no
change in number or time to manic episodes.

Adlerian influences

            Adler’s influence on these therapies should not be
undermined as principles of Adlerian therapy are heavily observed in modern
psychology. In a study looking at overlapping tenets of cognitive behavioral therapy
and individual psychology (Watts, Ergüner-Tekinalp
2017) it was noted that many modern psychotherapies share common approaches due
to the contributions of Adler.  Some of
these commonalities have led to uses of Adlerian techniques in the treatment of
bipolar disorder without recognition. An example of this phenomenon can be
observed with the use of Adler’s emphasis on subjective perception of their
life, or schema (Watts, Ergüner-Tekinalp 2017). This principle in assessment of
the patient can be observed in many cognitive behavioral approaches, and is a
key component of Aaron Beck’s, and Albert Ellis’ approach to accessing and
challenging irrational or maladaptive thoughts that often accompany mood
disorders (Longmore, Worrell, 2008).

BIPOLAR DISORDER AND
ADLERIAN PRINCIPLES                                                             5

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

While
contemporary cognitive behavioral therapy techniques have moved to the
forefront of treatment of many mood disorders including bipolar syndrome
(Freeman, Urschel 1997), Adlerian concepts have been taking an active role within
these theories.

The case for Adlerian therapy in treating bipolar
patients

As mentioned in the section
covering current psychological treatments of bipolar disorder, efficacy
concerns remain regarding long term benefits identified from techniques
employed using cognitive behavioral therapies, relational emotive therapies, or
family therapy (Oud et al. 2016).

Adlerian therapy provides
structure for treating patients through the four main phases that are incorporated
into therapeutic practice; forming the therapeutic relationship, lifestyle
analysis and

BIPOLAR DISORDER AND
ADLERIAN PRINCIPLES                                                            6

 

assessment, interpretation
and insight, and reorientation (Dreikurs, 1962). It places a strong emphasis on
social context, and therefore can be utilized for patients with varying
cultural backgrounds (Flanagan, Flanagan, 2006).  Adler’s emphasis on social equality makes
individual psychology

particularly valuable for
women in a society that may encounter prejudice.  This emphasis, in addition to the counselors
focus on the tasks of life, work or occupation, social relationships, love and
marriage, self, spirituality, parenting and family being met, it gives many
platforms for the counselor to work off after assessment to create mutually
agreed upon goals to start striving towards reorientation (Flanagan, Flanagan,
2006).

Conclusion

While there is limited data
regarding the efficacy of Adlerian therapy in the treatment of patients with
bipolar disorder, there is data examining the efficacy of contemporary behavioral
therapies that utilize Adlerian principles (Oud et al. 2016). There is a need
for more studies and literature regarding the potential benefits of individual
psychology in the treatment of patients with bipolar disorder. The data that
was present regarding psychoeducation showed similar efficacy to many of the
longer, CBT based randomized trials. The current literature and data comparing
Adlerian principles being utilized by other theories was summed up
appropriately by the Richard Watts book published in 2004, Adlerian, Cognitive, and Constructivist
Therapies: An Integrative Dialogue when they stated that “Perhaps Cognitive-Behavioral Psychology’s strong
array of treatment and research strategies could be joined with the theoretical
concepts of Adlerian Psychology to the benefit of both of these systems”.

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