Recovery-focused CBT aids bipolar patients

By Eleanor McDermid, Senior medwireNews Reporter

Cognitive behavioural therapy (CBT) that is focused broadly on patients’ recovery may be an effective intervention for patients with recent-onset bipolar disorder, a pilot randomised trial indicates.

Compared with standard CBT, the intervention used in the trial has “less of a focus on relapse prevention and symptom reduction”, explain lead study author Steven Jones (Lancaster University, UK) and co-workers.

Instead, treatment is tailored around patients’ stated goals, bringing evidence-based approaches to bear on functioning and comorbidity problems, as well as mood issues.

In the study, which involved 67 patients, CBT was delivered either in mental health facilities or patients’ homes, and consisted of initial weekly sessions, later decreasing to fortnightly, across a 6-month period.

Of the 33 patients assigned to receive the recovery-focused CBT, 32 attended at least six sessions, with these patients receiving an average of 14 hours of therapy. Over the 12 months from baseline, average scores on the Bipolar Recovery Questionnaire were a significant 310.87 points higher among patients in the CBT group than those 34 patients who received treatment as usual.

During up to 15 months of follow-up, 12 patients in the CBT group had a manic or depressive mood relapse, compared with 20 patients in the usual treatment group. The median times to recurrence were 56 versus 18 weeks, respectively, equating to a significant difference in favour of recovery-focused CBT.

The reduced relapse risk associated with CBT was significant for both depressive and manic relapses considered individually, although manic relapses were less common than depressive ones, occurring in just three patients in the CBT group and 10 in the usual treatment group.

CBT was associated with nonsignificant trends towards improved social functioning, self-reported mood symptoms and quality of life, with the effect being “marginally stronger on functional than on symptomatic measures”, the team observes in the British Journal of Psychiatry.

“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”, say Jones et al.

However, they note that all patients in their study were at a fairly early stage in their bipolar disorder, having been diagnosed within the preceding 2 to 3 years.

“It would also be of interest to evaluate the extent to which this approach can be adapted for individuals with an established course of bipolar disorder”, they say.

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