The latest TTWS reader fabulousness comes from Joe G., who is responding to an article I linked to about bipolar treatment with psychotherapy. Says Joe:

It is always worthwhile to take a look at the original article ("Intensive psychotherapy benefits bipolar patients"). The reader will note that broad groups including the estimated 30 to 60 percent of persons suffering from both bi-polar disorder and alcohol or substance abuse were excluded. This was not mentioned in the Reuters article. How might their inclusion and that of other groups representative of the greater community impacted the reported outcomes? "Patients were excluded only if they required immediate treatment for a current DSM-IV substance or alcohol abuse or dependence disorder (excluding nicotine); were pregnant or planning pregnancy in the next year; had a history of intolerance, nonresponse, or medical contraindication to paroxetine or bupropion; or required initiation of or dose changes in antipsychotic medications." The study also excluded persons who could not speak English.

Then there is the issue of fidelity to evidenced based practices. For example, how many of us can actually access CBT from a well trained practitioner "supervised by nationally recognized experts" where, "Individual CBT sessions consisted of (1) psychoeducation regarding the course of bipolar disorder, medication adherence, and stress management; (2) life events scheduling for alleviating inactivity or reducing overstimulation; (3) cognitive restructuring; (4) problem-solving training; (5) strategies for early detection of and intervention for mood episodes; and (6) selected interventions for comorbidities, if relevant. Early sessions focused on monitoring activity and challenging negative thoughts; later sessions focused on challenging dysfunctional beliefs."

I could go on.

While clinical studies are always interesting and worthwhile, what is more interesting is how they influence the care actually provided in the community in which we live and seek treatment. Frequently, the treatment we receive is represented as "evidenced based, culturally competent care in accordance with the principles of wellness and recovery," yet in practice it is often anything we can access.

[I don't know who did this illustration. I apologize to the artist.]