In regard to the second aim of the study, those received
SSC + UC did not have improved self-efficacy and functioning
or less depressive symptoms as was anticipated.
This lack of positive outcome has also been previously
reported in a large-scale clinical effectiveness study of cognitive
behavioural therapy for bipolar disorder (Scott et al.
2006b) that also recruited patients with complex and recurrent
presentations of bipolar disorders in multiple clinical
sites throughout England, and found that the intervention
did not reduce relapses. These findings likely reflect the
challenges associated with clinical effectiveness trials that
have been identified. Most previous studies have reported
treatment efficacy in less clinically representative samples
(e.g. Lam et al. 2003, Frank et al. 2005) and with patients
who were euthymic on entry (e.g. Perry et al. 1999, Colom
et al. 2003).