Recovery-focused cognitive-behavioral therapy can delay and reduce relapses for patients with recent-onset bipolar disorder, Steven H. Jones, Ph.D., and his associates reported in a pilot study that compared 33 patients who received up to 18 hours of tailored CBT and 34 patients who received treatment as usual (TAU).
“This study highlights the potential benefits of taking a formulation-based approach to bipolar disorder, in which a range of evidence-informed techniques are available to the clinician but the relative emphasis given to each is determined on an individual client basis,” the researchers noted in the British Journal of Psychiatry ( doi:10.1192/bjp.bp.113.141259).
Dr. Jones of Lancaster (England) University and his colleagues studied participants who met the DSM-IV diagnosis of primary bipolar with onset within the past 5 years. The recovery-focused CBT approach included core items whose use was determined by individual patient needs. The recovery approach was explained, information was gathered about current and historical mood and functioning, the meaning and relevance of the diagnosis were discussed, recovery-informed therapy goals were identified, relationships between mood experiences and progress towards recovery goals were addressed, CBT techniques were identified and applied to facilitate positive coping, and wider functioning issues in relation to recovery were considered. The information was used to develop a recovery plan and lessons from therapy were shared with key stakeholders.
Unlike standard CBT for bipolar disorder, which focuses on preventing relapse, the tailored CBT approach elicited client-focused goals and the freedom to work within whatever model the client brings. The model could address functioning and comorbidity issues as well as mood problems, and emphasized supporting clients to move away from self-critical and stigmatizing language, especially around diagnosis and behavior in acute episodes.
The primary clinical outcomes were measured using the Bipolar Recovery Questionnaire (33-item version, 0-100 scale with higher score indicating higher personal recovery), time to bipolar relapse measured by the Structural Clinical Interview for DSM-IV (SCID)-LIFE, and mood symptoms as measured by the Hamilton Rating Scale for Depression and Bech-Rafaelsen Mania Scale.
After 12 months, the CBT group’s Bipolar Recovery Questionnaire mean score was 2,351 – a 30% improvement from baseline (1,797), while the TAU group’s mean score was 2,193 – an 8% improvement from baseline(1,935).
Both manic and depressive relapses were less common and took longer to occur in the CBT group. There were 11 depressive relapses in the CBT group, occurring after a median of 60 weeks. There were 19 relapses in the TAU group, occurring after a median of 18 weeks. There were 3 manic relapses in the CBT group, occurring after a median of 60 weeks, and 10 manic relapses in the TAU group occurring after a median of 33 weeks.
