International Journal of Behavioral Sciences

International Journal of Behavioral Sciences

The Effectiveness of Family-Focused Therapy on Family Functioning in Individuals with Bipolar Disorder: A Randomized Controlled Trial

Document Type : Original Article

Authors
Nasimeh Nikbakht 1
Bahram Mirzaian 1
Ghodratollah Abbasi 1
Seyed Mohammad Mousavi 2
1 Department of Psychology, Sar.C., Islamic Azad University, Sari, Iran
2 Mazandaran University of Medical Sciences, Sari, Iran
10.30491/ijbs.2026.567282.2296
Abstract
Introduction: Bipolar disorder profoundly disrupts interpersonal relationships and family cohesion. This study aimed to evaluate the effectiveness of Family-Focused Therapy in improving family functioning among individuals with bipolar disorder.
Method: A randomized clinical trial with a pretest-posttest control group design and a three-month follow-up was conducted. The study population consisted of individuals aged 25–45 years diagnosed with bipolar disorder in Sari during 2025. Thirty participants, along with one self-selected family member, were recruited through convenience sampling and randomly assigned to experimental and control groups (n=15 per group). The experimental group underwent ten 90-minute sessions of an abbreviated adaptation of Family-Focused Therapy, while the control group received no additional psychosocial intervention (treatment as usual, consisting of pharmacotherapy only) during this period. Data were collected using the Family Assessment Device, which was completed by both the patient and one family member to reflect a family perspective (scores were averaged or jointly reported as appropriate). Data were analyzed via repeated measures analysis of variance in SPSS version 26.
Results: The experimental group showed significant reductions in Family Assessment Device scores (indicating improved family functioning, since higher scores reflect poorer functioning) from pretest to posttest and at the three-month follow-up (P<0.01). These improvements were sustained, with no significant differences between posttest and follow-up scores.
Conclusion: Family-focused therapy was associated with improvements in family functioning in individuals with bipolar disorder in this sample. This modality can be considered as an adjunctive psychosocial intervention to promote familial outcomes and systemic stability.
Keywords
Bipolar Disorder
Family Therapy
Family Relations
Treatment Outcome
Psychotherapy
1.      Oliva V, Fico G, De Prisco M, Gonda X, Rosa AR, Vieta E. Bipolar disorders: an update on critical aspects. The Lancet Regional Health - Europe. 2025;48:101135. https://doi.org/10.1016/j.lanepe.2024.101135
2.      Durdurak BB, Morales-Muñoz I, de Cates AN, Wiseman C, Broome MR, Marwaha S. Underlying biological mechanisms of emotion dysregulation in bipolar disorder. Front Psychiatry. 2025;16:1552992. https://doi.org/10.3389/fpsyt.2025.1552992
3.      Rostami S, Borjali A, Eskandari H, Rostami R, Northoff G. Novel Approach to Mind Wandering in Major Depressive Disorder and Bipolar Disorder Patients: Does the Direction of Thoughts Matter? International Journal of Behavioral Sciences. 2021;15(1):66–72. https://doi.org/10.30491/ijbs.2021.250747.1383
4.      Hunt GE, Malhi GS, Cleary M, Lai HMX, Sitharthan T. Prevalence of comorbid bipolar and substance use disorders in clinical settings, 1990–2015: Systematic review and meta-analysis. Journal of Affective Disorders. 2016;206:331–49. https://doi.org/10.1016/j.jad.2016.07.011
5.      Sabbah A, Mottaghi S, Moradi A, Bahrami M. A Comparison of Problem Solving, Working Memory, and Selective Attention Executive Functions in Patients with Bipolar II Disorder, Borderline Personality Disorder, and Non-clinical Samples. International Journal of Behavioral Sciences. 2022;16(2):118–24. https://doi.org/10.30491/ijbs.2022.339371.1794
6.      Dou W, Yu X, Fang H, Lu D, Cai L, Zhu C, et al. Family and Psychosocial Functioning in Bipolar Disorder: The Mediating Effects of Social Support, Resilience and Suicidal Ideation. Front Psychol. 2021;12:807546. https://doi.org/10.3389/fpsyg.2021.807546
7.      Hasani H, Goudarzi M, Karimisani P. The Effectiveness of Metacognitive Therapy on Family Functioning in Parents with A Child Diagnosed with Bipolar II Disorder. J Clin Res Paramed Sci. 2025;14(1):e159910. https://doi.org/10.5812/jcrps-159910
8.      Hosseinpour S, Alizadeh M, Homaei R. The Mediating Role of Drug Attitude in the Relationship between Differentiation of Self and Family Functioning with Addiction Potential in Adolescents. International Journal of Behavioral Sciences. 2022;16(2):82–8. https://doi.org/10.30491/ijbs.2022.322257.1734
9.      Munuera C, Compagnone P, Husky MM, Lebourleux P, Petit F, M’bailara K. Improving the Assessment Process of Family Functioning in Adult Bipolar Disorders: A PRISMA Systematic Review. Journal of Clinical Medicine. 2022;11(3):841. https://doi.org/10.3390/jcm11030841
10.   Yosefi Tabas M, Momeni F, Bakhshani N, Pourshahbaz A, Rezaei O. Effectiveness of Family-Focused Therapy in Bipolar Disorder: A Randomized Controlled Trial. Iran J Psychiatry Behav Sci. 2023;17(4):e138878. https://doi.org/10.5812/ijpbs-138878
11.   Miller IW, Keitner GI, Ryan CE, Uebelacker LA, Johnson SL, Solomon DA. Family treatment for bipolar disorder: family impairment by treatment interactions. J Clin Psychiatry. 2008;69(5):732–40. https://doi.org/10.4088/JCP.v69n0506
12.   Padmavathi N, Gandhi S, Manjula M, Viswanath B, Jain S. Family Focused Therapy for Family Members of Patients with Bipolar Disorder: Case Reports of Its Impact on Expressed Emotions. Indian J Psychol Med. 2021;43(3):261–4. https://doi.org/10.1177/0253717620950253
13.   Weintraub MJ, Schneck CD, Posta F, Merranko JA, Singh MK, Chang KD, et al. Effects of family intervention on psychosocial functioning and mood symptoms of youth at high risk for bipolar disorder. J Consult Clin Psychol. 2022;90(2):161–71. https://doi.org/10.1037/ccp0000708
14.   Simon GE. Family focused psychoeducational therapy decreases relapse and rehospitalisation in people with a manic episode and bipolar disorder. Evid Based Ment Health. 2003;6(4):114. https://doi.org/10.1136/ebmh.6.4.114
15.   Waraan L, Siqveland J, Hanssen-Bauer K, Czjakowski NO, Axelsdóttir B, Mehlum L, et al. Family therapy for adolescents with depression and suicidal ideation: A systematic review and meta-analysis. Clin Child Psychol Psychiatry. 2023;28(2):831–49. https://doi.org/10.1177/13591045221125005
16.   Yosefi Tabas M, Momeni F, Bakhshani N, Pourshahbaz A, Rezaei O, et al. Comparison of the Effectiveness of Family-Focused Therapy and Social Cognition and Interaction Training in Preventing Relapse in Bipolar Disorder and Enhancing Patients' Social Functioning and Interpersonal Relationships. Health Scope. 2024;13(3):e138425. https://doi.org/10.5812/healthscope-138425
17.   Epstein NB, Baldwin LM, Bishop DS. THE McMaster Family Assessment Device. Journal of Marital and Family Therapy. 1983;9(2):171–80. https://doi.org/10.1111/j.1752-0606.1983.tb01497.x
18.   Mansfield AK, Keitner GI, Dealy J. The Family Assessment Device: An Update. Family Process. 2015;54(1):82–93. https://doi.org/10.1111/famp.12080
19.   Mehmannavazan M, Hosseini M, Hejazi SS, Vartanoosian J, Matbouei M, Nasiri M. Psychometric evaluation of the Persian version of Family Management Measure. Health Educ Health Promot. 2021;9(4):351. https://hehp.modares.ac.ir/article-5-51291-en.html
20.   Miklowitz DJ, Chung B. Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Fam Process. 2016;55(3):483–99. https://doi.org/10.1111/famp.12237
21.   Mirhosseini S, Parsa FI, Gharehbaghi M, Minaei-Moghadam S, Basirinezhad MH, Ebrahimi H. Care burden and associated factors among caregivers of patients with bipolar type I disorder. BMC Primary Care. 2024;25(1):321. https://doi.org/10.1186/s12875-024-02583-2
22.   Miklowitz DJ, Chung B. Family-Focused Therapy for Bipolar Disorder: Reflections on 30 Years of Research. Fam Process. 2016;55(3):483–99. https://doi.org/10.1111/famp.12237
23.   Miklowitz DJ, Axelson DA, Birmaher B, George EL, Taylor DO, Schneck CD, et al. Family-focused treatment for adolescents with bipolar disorder: results of a 2-year randomized trial. Arch Gen Psychiatry. 2008;65(9):1053–61. https://doi.org/10.1001/archpsyc.65.9.1053
24.   Fackina KA. Family Focused Therapy for Bipolar Disorder. In: Lebow JL, Chambers AL, Breunlin DC, editors. Encyclopedia of Couple and Family Therapy. Cham: Springer International Publishing; 2019. p. 1051–9. https://doi.org/10.1007/978-3-319-49425-8_169
25.   Becqué YN, van der Wel M, Aktan-Arslan M, Driel AGv, Rietjens JAC, van der Heide A, et al. Supportive interventions for family caregivers of patients with advanced cancer: A systematic review. Psycho-Oncology. 2023;32(5):663–81. https://doi.org/10.1002/pon.6126
26.   Khalid N, Razali A, Sajali Zaidi NS, Razak NAA, Muhamad AS, Ahmad N, et al. Family-based interventions in improving caregivers' psychological-related outcomes: A systematic literature review. Chronic Illness. 2025;21(3):337–60. https://doi.org/10.1177/17423953251334123
27.   Varghese M, Kirpekar V, Loganathan S. Family Interventions: Basic Principles and Techniques. Indian J Psychiatry. 2020;62(Suppl 2):S192–s200. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_770_19
 
International Journal of Behavioral Sciences
Volume 19, Issue 4
Winter 2026
Pages 239-245