Examining Stepped Care as an Innovation in the Delivery of Psychological Treatments for Bipolar Disorder: Perspectives From Members of the International Society of Bipolar Disorders Psychological Interventions Task Force

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Bipolar Disorders Pub Date : 2026-02-23 DOI:10.1111/bdi.70097

Louisa G. Sylvia, Alexandra K. Gold, Emma Morton, Katie M. Douglas, Harriet Birabwa-Oketcho, David J. Miklowitz, Anna Van Meter, Eric A.Youngstrom, Jennifer B. Levin, Esther Mesman, Maria Faurholt-Jepsen, Greg Murray

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引用次数: 0

Abstract

Background

Research demonstrates the effectiveness of evidence-based psychological treatment adjunctive to pharmacotherapy for reducing mood symptoms in bipolar disorder. However, access to these treatments is limited, and innovative strategies are needed to ensure that more patients with bipolar disorder receive the gold-standard treatments that may help them achieve wellness. “Stepped care” models of psychological service delivery represent one potential solution to this problem of treatment access. Under a stepped care model, patients are assigned the minimum necessary psychological treatment for symptom improvement. This typically means that patients who are experiencing more symptoms are assigned to a treatment of greater intensity (e.g., weekly individual therapy) whereas patients who are experiencing fewer symptoms are assigned to a treatment of relatively lesser intensity (e.g., biweekly group therapy). Stepped care models are dynamic, meaning that the level of treatment can be modified depending on the patient's response. Stepped care models have been explored in other clinical populations but require further exploration in bipolar disorder.

Methods

Members of the Psychological Interventions Task Force for the International Society of Bipolar Disorders conducted a narrative review of stepped care models and their application to bipolar disorder.

Results

We found evidence that stepped care models are useful approaches to delivering psychosocial treatments for bipolar disorder. We discuss several contextual factors in executing stepped care models in this population (i.e., cultural and pediatric applications), as well as share an example of a stepped care model—Focused Integrated Team-based Treatment for Bipolar Disorder (FITT-BD)—that is currently being evaluated in an academic medical center.

Conclusion

Further research is warranted to develop and assess robust stepped care models to determine whether they can improve access to treatment of bipolar disorder while not sacrificing outcomes.

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检查阶梯式护理作为双相情感障碍心理治疗的创新：来自国际双相情感障碍心理干预工作组成员的观点。

背景：研究证明了循证心理治疗辅助药物治疗对减轻双相情感障碍情绪症状的有效性。然而，获得这些治疗的途径是有限的，需要创新的策略来确保更多的双相情感障碍患者接受可能帮助他们实现健康的黄金标准治疗。心理服务提供的“阶梯式护理”模式是解决这一治疗机会问题的一个潜在解决方案。在阶梯式护理模式下，患者被分配到最低限度的必要心理治疗以改善症状。这通常意味着症状较多的患者被分配到强度较大的治疗（例如，每周一次的个体治疗），而症状较少的患者被分配到强度相对较小的治疗（例如，两周一次的团体治疗）。阶梯式护理模式是动态的，这意味着治疗水平可以根据患者的反应进行修改。阶梯式护理模式已经在其他临床人群中进行了探索，但在双相情感障碍中需要进一步探索。方法：国际双相情感障碍协会心理干预工作组成员对阶梯式护理模式及其在双相情感障碍中的应用进行了叙述性回顾。结果：我们发现阶梯式护理模式是提供双相情感障碍心理治疗的有效方法。我们讨论了在这一人群中实施阶梯式护理模式的几个背景因素（即文化和儿科应用），并分享了一个阶梯式护理模式的例子——以团队为基础的双相情感障碍综合治疗（FITT-BD）——目前正在一个学术医疗中心进行评估。结论：需要进一步的研究来开发和评估稳健的阶梯式护理模式，以确定它们是否可以在不牺牲结果的情况下改善双相情感障碍治疗的可及性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Bipolar Disorders 医学-精神病学

CiteScore

8.20

自引率

7.40%

发文量

审稿时长

6-12 weeks

期刊介绍： Bipolar Disorders is an international journal that publishes all research of relevance for the basic mechanisms, clinical aspects, or treatment of bipolar disorders and related illnesses. It intends to provide a single international outlet for new research in this area and covers research in the following areas: biochemistry physiology neuropsychopharmacology neuroanatomy neuropathology genetics brain imaging epidemiology phenomenology clinical aspects and therapeutics of bipolar disorders Bipolar Disorders also contains papers that form the development of new therapeutic strategies for these disorders as well as papers on the topics of schizoaffective disorders, and depressive disorders as these can be cyclic disorders with areas of overlap with bipolar disorders. The journal will consider for publication submissions within the domain of: Perspectives, Research Articles, Correspondence, Clinical Corner, and Reflections. Within these there are a number of types of articles: invited editorials, debates, review articles, original articles, commentaries, letters to the editors, clinical conundrums, clinical curiosities, clinical care, and musings.