A Randomized Controlled Trial of Cognitive Therapy for Bipolar Disorder: Focus on Long-Term Change.[CME]
J Clin Psychiatry 2006;67:277-286
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Background: This study reports the
outcome of a randomized controlled trial of
cognitive therapy (CT) for bipolar disorder. The
treatment protocol differed from other published forms
of CT for bipolar disorder through the addition of emotive techniques.
Method: Fifty-two patients with DSM-IV
bipolar I or II disorder were randomly allocated to
a 6-month trial of either CT or treatment as
usual, with both treatment groups also receiving
mood stabilizers. Outcome measures included
relapse rates, dysfunctional attitudes, psychosocial
functioning, hopelessness, self-control, and
medication adherence. Patients were assessed
during treatment by independent raters blind to the
patients' group status.
Results: At posttreatment, patients allocated
to CT had experienced less severe depression
scores (Beck Depression Inventory and Montgomery-Asberg Depression Rating Scale) and less
dysfunctional attitudes. After controlling for the
presence of major depressive episode at baseline, there was a statistical trend toward a greater
time to depressive relapse (p = .06) for the CT group.
At 12-month follow-up, the CT group showed a trend toward lower Young Mania Rating
Scale scores and improved behavioral self-control.
The Clinical Global Impressions-Improvement scale, comparing the 18 months prior to treatment to
the severity of illness status at follow-up, showed
a substantial difference between groups in favor
Conclusion: Our findings corroborate
previous bipolar disorder research in demonstrating
the value of CT, particularly immediately
posttreatment, and indicate some continuation (albeit
diminishing) of benefits in the succeeding 12 months. These findings suggest that
psychological booster sessions may be crucial for
maintaining the beneficial effects of cognitive therapy.