Dialectical behavior therapy (DBT) shows promise for the treatment of bipolar disorder, findings from a pilot study show.
"Because all of the DBT skills in some way target emotion dysregulation, it seems logical that DBT would be effective in treating BD [bipolar disorder], in which one of the primary symptoms is mood instability," say Sheri Van Dijk, from Southlake Regional Health Centre in Ontario, Canada, and colleagues.
"The DBT Core Mindfulness Skills teach clients to be more aware of their emotions, thoughts and behaviors, and therefore result in an increase in client's degree of self-control and ability to manage distressing thoughts and emotions," they explain.
The researchers therefore believe that DBT may make a suitable adjunctive psychotherapy to psychopharmacologic treatment, which "remains the cornerstone of managing BD."
The study involved 26 adults with bipolar I or II disorder who were randomly assigned to DBT or a wait-list control group. The participants had multiple psychiatric diagnoses, most commonly anxiety and personality disorders.
The DBT comprised 12 sessions of 90 minutes, which provided education about bipolar disorder, the medications to treat it, and the importance of self-care, as well as teaching distress tolerance skills, emotion regulation skills, and interpersonal effectiveness skills.
The intervention showed a trend toward reducing depressive symptoms, as measured on the Beck Depression Inventory.
Before treatment, most patients in both the DBT (75%) and control (93%) groups had minimal or mild depression, as categorized by respective scores of 0 to 3 and 14 to 19 on the Beck Depression Inventory.
After 12 weeks of treatment, the percentage of patients receiving DBT categorized as having minimal or mild depression increased to 92%, whereas it decreased to 42% among the control group, with 58% categorized as having moderate-to-severe depression, reflecting a significant difference between the two groups.
The researchers note that mean scores on the Beck Depression Inventory at baseline were slightly higher in the control group than the intervention group, but analysis indicated that the average reduction in post-test scores was greater for patients receiving intervention, at 16.7 points versus 10.3 points, although the difference was nonsignificant.
The results, published in the Journal of Affective Disorders, also showed that DBT was associated with significant improvement in scores on the mindfulness based self-efficacy scale, particularly for greater mindful awareness and less fear toward and more control of emotional states.
Overall satisfaction with DBT was good, with 75% of patients giving an overall impression rating of "excellent" and 24% a rating of "good."
The team concludes that "further trials evaluating the efficacy of using DBT skills to treat BD are needed, especially given the small sample in this study."
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