Skip to main content
×
×
Home

Recovery-focused cognitive–behavioural therapy for recent-onset bipolar disorder: Randomised controlled pilot trial

  • Steven H. Jones (a1), Gina Smith (a2), Lee D. Mulligan (a3), Fiona Lobban (a4), Heather Law (a5), Graham Dunn (a6), Mary Welford (a7), James Kelly (a8), John Mulligan (a9) and Anthony P. Morrison (a10)...
Abstract
Background

Despite evidence for the effectiveness of structured psychological therapies for bipolar disorder no psychological interventions have been specifically designed to enhance personal recovery for individuals with recent-onset bipolar disorder.

Aims

A pilot study to assess the feasibility and effectiveness of a new intervention, recovery-focused cognitive–behavioural therapy (CBT), designed in collaboration with individuals with recent-onset bipolar disorder intended to improve clinical and personal recovery outcomes.

Method

A single, blind randomised controlled trial compared treatment as usual (TAU) with recovery-focused CBT plus TAU (n = 67).

Results

Recruitment and follow-up rates within 10% of pre-planned targets to 12-month follow-up were achieved. An average of 14.15 h (s.d. = 4.21) of recovery-focused CBT were attended out of a potential maximum of 18 h. Compared with TAU, recovery-focused CBT significantly improved personal recovery up to 12-month follow-up (Bipolar Recovery Questionnaire mean score 310.87, 95% CI 75.00–546.74 (s.e. = 120.34), P = 0.010, d=0.62) and increased time to any mood relapse during up to 15 months follow-up (χ2 = 7.64, P<0.006, estimated hazard ratio (HR) = 0.38, 95% CI 0.18–0.78). Groups did not differ with respect to medication adherence.

Conclusions

Recovery-focused CBT seems promising with respect to feasibility and potential clinical effectiveness. Clinical- and cost-effectiveness now need to be reliably estimated in a definitive trial.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Recovery-focused cognitive–behavioural therapy for recent-onset bipolar disorder: Randomised controlled pilot trial
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Recovery-focused cognitive–behavioural therapy for recent-onset bipolar disorder: Randomised controlled pilot trial
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Recovery-focused cognitive–behavioural therapy for recent-onset bipolar disorder: Randomised controlled pilot trial
      Available formats
      ×
Copyright
Corresponding author
Steven H. Jones, Spectrum Centre for Mental Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, UK. Email: s.jones7@lancaster.ac.uk
Footnotes
Hide All

National Institute for Health Research, England. This report presents independent research commissioned by the National Institute for Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-0606-1086). Further support was received from primary care trusts, mental health trusts, the Mental Health Research Network and Comprehensive Local Research Networks in North West England. The views expressed in this publication are those of the authors and not necessarily those of the NHS, the NIHR or the Department of Health.

Declaration of interest

None.

Footnotes
References
Hide All
1 Barnard, PJ. Bridging between basic theory and clinical practice. Behav Res Ther 2004; 42: 9771000.
2 Jones, S. Circadian rhythms, multilevel models of emotion and bipolar disorder – an initial step towards integration? Clin Psychol Rev 2001; 21: 1193–209.
3 Post, RM. Transduction of psychosocial stress into the neurobiology of recurrent affective disorder. Am J Psychiatry 1992; 149: 9991010.
4 Scott, J, Paykel, E, Morriss, R, Bentall, R, Kinderman, P, Johnson, T, et al. Cognitive-behavioural therapy for severe and recurrent bipolar disorders: randomised controlled trial. Br J Psychiatry 2006; 188: 313–20.
5 Lish, JD, Dime-Meenan, S, Whybrow, PC, Price, RA, Hirschfeld, RM. The national depressive and manic-depressive association (DMDA) survey of bipolar members. J Affect Disord 1994; 31: 281–94.
6 Baldessarini, RJ, Tondo, L, Vazquez, GH, Undurraga, J, Bolzani, L, Yildiz, A, et al. Age at onset versus family history and clinical outcomes in 1,665 international bipolar-I disorder patients. World Psychiatry 2012; 11: 40–6.
7 Mead, S, Copeland, ME. What recovery means to us. Comm Ment Health J 2000; 36: 315–28.
8 Department of Health: New Horizons: A Shared Vision for Mental Health. Department of Health, 2009.
9 Department of Health: No Health Without Mental Health: A Cross-Government Mental Health Outcomes Strategy. Department of Health, 2011.
10 Jones, SH, Mulligan, LD, Law, H, Dunn, G, Welford, M, Smith, G, et al. A randomised controlled trial of recovery focused CBT for individuals with early bipolar disorder. BMC Psychiatry 2012; 12: 204.
11 Hamilton, M. A rating scale for depression. J Neurol Psychiatry 1960; 23: 5962.
12 Bech, P, Rafaelsen, OJ, Kramp, P, Bolwig, TG. The mania rating scale: scale construction and inter-observer agreement. Neuropharmacology 1978; 17: 430–1.
13 Goldberg, JF, Perlis, RH, Bowden, CL, Thase, ME, Miklowitz, DJ, Marangell, LB, et al. Manic symptoms during depressive episodes in 1,380 patients with bipolar disorder: findings from the STEP-BD. Am J Psychiatry 2009; 166: 173–81.
14 Perlis, RH, Ostacher, MJ, Patel, JK, Marangell, LB, Zhang, H, Wisniewski, SR, et al. Predictors of recurrence in bipolar disorder: primary outcomes from the systematic treatment enhancement program for bipolar disorder (STEP-BD). Am J Psychiatry 2006; 163: 217–24.
15 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorder (4th edn) (DSM-IV). APA, 1994.
16 First, MB, Gibbon, M, Spitzer, RL, Williams, JBW, Benjamin, LS. Structured Clinical Interview for DSM-IV Axis I Disorders, Research Version, Patient Edition. American Psychiatric Press, 1997.
17 Keller, MB, Lavori, PW, Friedman, B, Nielsen, E, Endicott, J, McDonald-Scott, P, et al. The longitudinal interval follow-up evaluation. a comprehensive method for assessing outcome in prospective longitudinal studies. Arch Gen Psychiatry 1987; 44: 540–8.
18 Jones, S, Mulligan, LD, Higginson, S, Dunn, G, Morrison, A. The bipolar recovery questionnaire: psychometric properties of a quantitative measure of recovery experiences in bipolar disorder. J Affect Disord, 2013; 147: 3443.
19 Michalak, EE, Murray, G, Crest, BD. Development of the QoL.BD: a disorder-specific scale to assess quality of life in bipolar disorder. Bipolar Disord 2010; 12: 727–40.
20 Morosini, P, Magliano, L, Brambilla, L, Ugolini, S, Pioli, R. Development, reliability and acceptability of a new version of the DSMIV social and occupational functioning assessment scale (SOFAS) to assess routine social funtioning. Acta Psychiatr Scand 2000; 101: 323–9.
21 Beck, AT. Cognitive models of depression. J Cogn Psychother 1987; 1: 537.
22 Bauer, MS, Crits-Christoph, P, Ball, WA, Dewees, E, McAllister, T, Alahi, P, et al. Independent assessment of manic and depressive symptoms by self-rating. Scale characteristics and implications for the study of mania. Arch Gen Psychiatry 1991; 48: 807–12.
23 Stephenson, BJ, Rowe, BH, Haynes, RB, Macharia, WM, Leon, G. The rational clinical examination. Is this patient taking the treatment as prescribed? JAMA 1993; 269: 2779–81.
24 Tracey, TJ, Kokotovic, AM. Factor structure of the working alliance inventory. Psychol Assess 1989; 1: 207–10.
25 Blackburn, IM, James, IA, Milne, DL, Baker, C, Standart, S, Garland, A, Reichelt, FK. The revised cognitive therapy scale (CTS-R): psychometric properties. Behav Cogn Psychother 2001; 29: 431–46.
26 Miklowitz, D, Goodwin, GM, Bauer, MS, Geddes, JR. Common and specific elements of psychosocial treatments for bipolar disorder: a survey of clinicians participating in randomized trials. J Psychiatr Pract 2008; 14: 7785.
27 Jones, S, Burrell-Hodgson, G. Cognitive behavioural treatment of first diagnosis bipolar disorder. Clin Psychol Psychother 2008; 15: 367–77.
28 Dunn, G, Maracy, M, Dowrick, C, Ayuso-Mateos, JL, Dalgard, OS, Page, H, et al. Estimating psychological treatment effects from a randomised controlled trial with both non-compliance and loss to follow-up. Br J Psychiatry 2003; 183: 323–31.
29 Loeys, T, Goetghebeur, E. A causal proportional hazards estimator for the effect of treatment actually received in a randomized trial with all-or-nothing compliance. Biometrics 2003; 59: 100–5.
30 Frangakis, CE, Rubin, DB. Addressing complications of intention-to-treat analysis in the combined presence of all-or-none treatment-noncompliance and subsequent missing outcomes. Biometrika 1999; 86: 365–79.
31 Busseri, MA, Tyler, JD. Interchangeability of the Working Alliance Inventory and Working Alliance Inventory, Short Form. Psychol Assess 2003; 15: 193–7.
32 Davidson, K, Norrie, J, Tyrer, P, Gumley, A, Tata, P, Murray, H, et al. The effectiveness of cognitive behavior therapy for borderline personality disorder: Results from the Borderline Personality Disorder Study of Cognitive Therapy (BOSCOT) trial. J Pers Disord 2006; 20: 450–65.
33 Keen, AJ, Freeston, MH. Assessing competence in cognitive-behavioural therapy. Br J Psychiatry 2008; 193: 60–4.
34 Mental Health Research Network. Service User Involvement in the UK Mental Health Research Network. MHRN, 2005.
35 Lam, DH, Watkins, ER, Hayward, P, Bright, J, Wright, K, Kerr, N, et al. A randomized controlled study of cognitive therapy for relapse prevention for bipolar affective disorder. Arch Gen Psychiatry 2003; 60: 145–52.
36 Fowler, D, Hodgekins, J, Painter, M, Reilly, T, Crane, C, MacMillan, I, et al. Cognitive behaviour therapy for improving social recovery in psychosis: a report for the ISREP MRC trial platform study (Improving social recovery in early psychosis). Psychol Med 2009; 39: 1627–36.
37 Ball, JR, Mitchell, PB, Corry, JC, Skillecorn, A, Smith, M, Malhi, GS. A randomized controlled trial of cognitive therapy for bipolar disorder: Focus of long-term change. J Clin Psychiatry 2006; 67: 277–86.
38 Meyer, TD, Hautzinger, M. Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Psychol Med 2012; 42: 1429–39.
39 Zaretsky, A, Lancee, W, Miller, C, Harris, A, Parikh, SV. Is cognitive-behavioural therapy more effective than psychoeducation in bipolar disorder? Can J Psychiatry 2008; 53: 441–88.
40 Lobban, F, Taylor, L, Chandler, E, Tyler, E, Kinderman, P, Kolamunnage-Donna, R, et al. Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial. Br J Psychiatry 2010; 196: 5963.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
PDF
Supplementary materials

Jones et al. supplementary material
Supplementary Table S1

 PDF (78 KB)
78 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Recovery-focused cognitive–behavioural therapy for recent-onset bipolar disorder: Randomised controlled pilot trial

  • Steven H. Jones (a1), Gina Smith (a2), Lee D. Mulligan (a3), Fiona Lobban (a4), Heather Law (a5), Graham Dunn (a6), Mary Welford (a7), James Kelly (a8), John Mulligan (a9) and Anthony P. Morrison (a10)...
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *