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OBJECTIVE: In a previous randomized controlled study, the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year. This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months. METHOD: Patients with DSM-IV bipolar I disorder (N=103) suffering from frequent relapses were randomly assigned into a cognitive therapy plus medication group or a control condition of medication only. Independent raters, who were blind to patient group status, assessed patients at 6-month intervals. RESULTS: Over 30 months, the cognitive therapy group had significantly better outcome in terms of time to relapse. However, the effect of relapse prevention was mainly in the first year. The cognitive therapy group also spent 110 fewer days (95% CI=32 to 189) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days (95% CI=3 to 105) in bipolar episodes out of a total of 450 for the last 18 months. Multivariate analyses of variance showed that over the last 18 months, the cognitive therapy group exhibited significantly better mood ratings, social functioning, coping with bipolar prodromes, and dysfunctional goal attainment cognition. CONCLUSIONS: Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled. However, the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period. Further studies should explore the effect of booster sessions or maintenance therapy.
In the last few years, evidence for the efficacy of psychotherapy specific for bipolar disorder is emerging (1–3). We recently reported a randomized controlled study of a relapse prevention approach that showed significant beneficial short-term effects of cognitive therapy for up to 1 year (4). Over the 12-month period, the cognitive therapy group had significantly fewer bipolar episodes, fewer days in bipolar episodes, and fewer bipolar admissions. The cognitive therapy group also had significantly higher social functioning and showed less mood symptoms on the monthly mood questionnaires. However, given the frequent relapsing nature of bipolar disorder (5, 6), a longer-term follow-up period is of paramount importance if cognitive therapy is to be a successful form of treatment. Furthermore, cognitive therapy traditionally has a large skill acquisition component. If therapy results in skill acquisition, it should delay or prevent relapses. Hence, a longer-term follow-up period will provide an estimate of the enduring effect of cognitive therapy.
The purpose of this article is to report an additional 18 months of follow-up data for the original treatment trial, resulting in a total of 30 months of data (6 months of treatment and 2 years of follow-up evaluations). Apart from important clinical data such as bipolar episodes, the length of episodes, and social functioning, we also report changes in coping with bipolar prodromes and in cognitive dysfunctional beliefs.
Our primary hypotheses were as follows:
1.
Relative to subjects in a control condition, patients assigned to cognitive therapy would have fewer bipolar episodes and fewer days in bipolar episodes.
2.
Relative to subjects in a control condition, patients assigned to cognitive therapy would have higher social functioning, better coping strategies for bipolar prodromes, and lower dysfunctional high goal attainment attitudes.
Our secondary hypotheses were that compared with subjects in a control condition, patients assigned to cognitive therapy would have lower depression and mania mood scores and show better medication compliance.
ส่วน AbstractSection:NextOBJECTIVE: In a previous randomized controlled study, the authors reported significant beneficial effects of cognitive therapy for relapse prevention in bipolar disorder patients up to 1 year. This study reports additional 18-month follow-up data and presents an overview of the effect of therapy over 30 months. METHOD: Patients with DSM-IV bipolar I disorder (N=103) suffering from frequent relapses were randomly assigned into a cognitive therapy plus medication group or a control condition of medication only. Independent raters, who were blind to patient group status, assessed patients at 6-month intervals. RESULTS: Over 30 months, the cognitive therapy group had significantly better outcome in terms of time to relapse. However, the effect of relapse prevention was mainly in the first year. The cognitive therapy group also spent 110 fewer days (95% CI=32 to 189) in bipolar episodes out of a total of 900 for the whole 30 months and 54 fewer days (95% CI=3 to 105) in bipolar episodes out of a total of 450 for the last 18 months. Multivariate analyses of variance showed that over the last 18 months, the cognitive therapy group exhibited significantly better mood ratings, social functioning, coping with bipolar prodromes, and dysfunctional goal attainment cognition. CONCLUSIONS: Patients in the cognitive therapy group had significantly fewer days in bipolar episodes after the effect of medication compliance was controlled. However, the results showed that cognitive therapy had no significant effect in relapse reduction over the last 18 months of the study period. Further studies should explore the effect of booster sessions or maintenance therapy.In the last few years, evidence for the efficacy of psychotherapy specific for bipolar disorder is emerging (1–3). We recently reported a randomized controlled study of a relapse prevention approach that showed significant beneficial short-term effects of cognitive therapy for up to 1 year (4). Over the 12-month period, the cognitive therapy group had significantly fewer bipolar episodes, fewer days in bipolar episodes, and fewer bipolar admissions. The cognitive therapy group also had significantly higher social functioning and showed less mood symptoms on the monthly mood questionnaires. However, given the frequent relapsing nature of bipolar disorder (5, 6), a longer-term follow-up period is of paramount importance if cognitive therapy is to be a successful form of treatment. Furthermore, cognitive therapy traditionally has a large skill acquisition component. If therapy results in skill acquisition, it should delay or prevent relapses. Hence, a longer-term follow-up period will provide an estimate of the enduring effect of cognitive therapy.The purpose of this article is to report an additional 18 months of follow-up data for the original treatment trial, resulting in a total of 30 months of data (6 months of treatment and 2 years of follow-up evaluations). Apart from important clinical data such as bipolar episodes, the length of episodes, and social functioning, we also report changes in coping with bipolar prodromes and in cognitive dysfunctional beliefs.
Our primary hypotheses were as follows:
1.
Relative to subjects in a control condition, patients assigned to cognitive therapy would have fewer bipolar episodes and fewer days in bipolar episodes.
2.
Relative to subjects in a control condition, patients assigned to cognitive therapy would have higher social functioning, better coping strategies for bipolar prodromes, and lower dysfunctional high goal attainment attitudes.
Our secondary hypotheses were that compared with subjects in a control condition, patients assigned to cognitive therapy would have lower depression and mania mood scores and show better medication compliance.
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