Cognitive Therapy (CT) for Bipolar Disorder

Status: Modest Research Support for depression* and Modest Research Support for mania

Description

It is important to note that there are many manuals of cognitive therapy for bipolar disorder, including group and individual approaches. Of these, the findings based on the manual by D. Lam and others have been particularly positive, as have those from the one-year report of the Systematic Treatment Enhancement Program for bipolar disorder (STEP; Miklowitz et al., 2007). Findings from other manuals have not achieved strong research support to date (Patelis-Siotis et al., 2001; Scott et al., 2006). All cognitive therapy manuals include a psychoeducational component regarding the biological basis of the illness, the need for medications, and the early warning signs of symptoms. They also include a focus on identifying maladaptively negative thoughts about the self, and teaching clients skills to challenge these overly negative thoughts. Many also include ideas about how to target the overly positive thoughts that might be present during mania. The Lam manual is distinguished by an integration of cognitive interventions with more extensive focus on promoting regular sleep and regulating extreme goal striving. The Lam manual is designed for 12 to 18 individual weekly sessions, followed by 2 booster sessions over the next 6 months, and only the randomized controlled trials that used this particular manual have shown effects in diminishing manic symptoms over time.

Key References (in reverse chronological order)

• Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Kogan, J. N., Sachs, G. S., et al. (2007). Intensive psychosocial intervention enhances functioning in patients with bipolar depression: Results from a 9-month randomized controlled trial. American Journal of Psychiatry, 164, 1340-1347.
• Scott, J., Paykel, E., Morriss, R., Bental, R., Kinderman, P., Johnson, T. et al. (2006). Cognitive behavioural therapy for severe and recurrent bipolar disorders: A randomised controlled trial. British Journal of Psychiatry, 188, 313-320.
• Lam, D. H., McCrone, P., Wright, K., & Kerr. N. (2005). Cost-effectiveness of relapse-prevention cognitive therapy for bipolar disorder: 30-month study. British Journal of Psychiatry, 186, 400-506.
• Lam, D. H., Hayward, P., Watkins, E. R., Wright, K., & Sham, P. (2005). Relapse prevention in patients with bipolar disorder: Cognitive therapy outcome after 2 years.American Journal of Psychiatry, 162, 324-329.
• Lam, D. H., Watkins, E. R., Hayward, P., Bright, J., Wright, K., Kerr, N., et al. (2003). A randomized controlled study of cognitive therapy of relapse prevention for bipolar affective disorder: Outcome of the first year. Archives of General Psychiatry, 60, 145-152.
• Patelis-Siotis, I., Young, T. L., Robb, J. C., Marriott, M., Bieling, P. J., Cox, L. C. et al. (2001). Group cognitive behavioral therapy for bipolar disorder: a feasibility and effectiveness study. Journal of Affective Disorders, 65, 145-153.

Clinical Resources

• Lam, D. H., Jones, S. H., Hayward, P., & Bright, J. A. (1999). Cognitive therapy for bipolar disorder: A therapist’s guide to concepts, methods, and practice. West Sussex, England: Wiley Press.
• Otto, M. W., Reilly-Harrington, N. A., Kogan, J. N., Henin, A., Knauz, R. O., & Sachs, G. S. (2009). Managing bipolar disorder: A cognitive-behavioral approach (Therapist guide).  New York: Oxford University Press. (As validated in the context of the Miklowitz trial listed)

Training Opportunities

For more information about workshops, contact Dominic Lam, University of Hull, Holly House, Welton Old Road, Welton, Brough, North Humber HU15 1HU, Tel: 01482 669310

Teaching Resources

CBT for Bipolar Disorder Slide Set

*Although findings of two trials indicated that CT lead to reduced depression, CT has been labeled as probably efficacious due to null results in at least one major study.