A Randomized Controlled Trial of Psychoeducation or Cognitive-Behavioral Therapy in Bipolar Disorder: A Canadian Network for Mood and Anxiety Treatments (CANMAT) Study
Department of Psychiatry, University of Toronto, Toronto, Ontario. The Journal of Clinical Psychiatry
(Impact Factor: 5.5).
06/2012; 73(6):803-10. DOI: 10.4088/JCP.11m07343
Bipolar disorder is insufficiently controlled by medication, so several adjunctive psychosocial interventions have been tested. Few studies have compared these psychosocial treatments, all of which are lengthy, expensive, and difficult to disseminate. We compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive and longer individual cognitive-behavioral therapy intervention, measuring longitudinal outcome in mood burden in bipolar disorder.
This single-blind randomized controlled trial was conducted between June 2002 and September 2006. A total of 204 participants (ages 18-64 years) with DSM-IV bipolar disorder type I or II participated from 4 Canadian academic centers. Subjects were recruited via advertisements or physician referral when well or minimally symptomatic, with few exclusionary criteria to enhance generalizability. Participants were assigned to receive either 20 individual sessions of cognitive-behavioral therapy or 6 sessions of group psychoeducation. The primary outcome of symptom course and morbidity was assessed prospectively over 72 weeks using the Longitudinal Interval Follow-up Evaluation, which yields depression and mania symptom burden scores for each week.
Both treatments had similar outcomes with respect to reduction of symptom burden and the likelihood of relapse. Eight percent of subjects dropped out prior to receiving psychoeducation, while 64% were treatment completers; rates were similar for cognitive-behavioral therapy (6% and 66%, respectively). Psychoeducation cost $180 per subject compared to cognitive-behavioral therapy at $1,200 per subject.
Despite longer treatment duration and individualized treatment, cognitive-behavioral therapy did not show a significantly greater clinical benefit compared to group psychoeducation. Psychoeducation is less expensive to provide and requires less clinician training to deliver, suggesting its comparative attractiveness.
ClinicalTrials.gov identifier: NCT00188838.
Available from: Amanda J Shallcross
- "A critical next step in evaluating MBCT is to test whether reductions in depression relapse rates and depressive symptoms are specific to MBCT or whether other psychoeducational interventions may produce similar benefits. This is important because MBCT is not yet widely available or accessible, and a generalized psychoeducation treatment may have cost, accessibility, and dissemination advantages (Parikh et al., 2012). Further, to begin to understand the active ingredients of MBCT, it is necessary to compare it to a structurally equivalent and therapeutically credible active control condition (ACC) that is matched to MBCT on nonspecific factors (e.g., social support, treatment-related activity outside of class, interaction with a facilitator, expected positive outcomes), but lacks mindfulness and cognitive therapy components (Kirsch, 2005). "
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We evaluated the comparative effectiveness of mindfulness-based cognitive therapy (MBCT) versus an active control condition (ACC) for depression relapse prevention, depressive symptom reduction, and improvement in life satisfaction.
Ninety-two participants in remission from major depressive disorder with residual depressive symptoms were randomized to either an 8-week MBCT or a validated ACC that is structurally equivalent to MBCT and controls for nonspecific effects (e.g., interaction with a facilitator, perceived social support, treatment outcome expectations). Both interventions were delivered according to their published manuals.
Intention-to-treat analyses indicated no differences between MBCT and ACC in depression relapse rates or time to relapse over a 60-week follow-up. Both groups experienced significant and equal reductions in depressive symptoms and improvements in life satisfaction. A significant quadratic interaction (Group × Time) indicated that the pattern of depressive symptom reduction differed between groups. The ACC experienced immediate symptom reduction postintervention and then a gradual increase over the 60-week follow-up. The MBCT group experienced a gradual linear symptom reduction. The pattern for life satisfaction was identical but only marginally significant.
MBCT did not differ from an ACC on rates of depression relapse, symptom reduction, or life satisfaction, suggesting that MBCT is no more effective for preventing depression relapse and reducing depressive symptoms than the active components of the ACC. Differences in trajectory of depressive symptom improvement suggest that the intervention-specific skills acquired may be associated with differential rates of therapeutic benefit. This study demonstrates the importance of comparing psychotherapeutic interventions to active control conditions. (PsycINFO Database Record
Available from: Dondu Cuhadar
- "Yanos, Roe, and Lysaker (2011) used a combination of psychoeducation (3 weeks), cognitive restructuring (8 weeks) and narrative enhancement (8 weeks) with mental illness patients and reported that internalized stigma reduced. Parikh et al. (2012) used cognitive behavioral therapy and psychoeducation (20 sessions of CBT, 6 sessions of psychoeducation) and found that psychoeducation showed greater clinical benefit compared to cognitive behavioral therapy. The aim of this study was to determine the effectiveness of a psychoeducation program designed to reduce internalized stigmatization in patients diagnosed with bipolar disorder. "
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ABSTRACT: This research was conducted as an experiment-control experimental study which aimed to determine the effectiveness of a psychoeducation program prepared to reduce internalized stigmatization. The study included 47 patients (24 experimental, 23 control) who had been diagnosed with bipolar disorder. At the end of the psychoeducation program, a significant decrease was observed in the total ISSMI mean scores, as well as in the ISSMI subscale mean scores for subscales such as alienation, approval of stereotypes, perceived discrimination and social withdrawal (p<0.05). The results demonstrated that a psychoeducation program designed for internalized stigmatization may have positive effects on the internalized stigmatization levels of patients with bipolar disorder.
Available from: Sagar V Parikh
- "Patients also face substantial residual or interepisodic symptoms (Benazzi, 2004; Paykel et al., 2006), complex comorbidity (Schaffer et al., 2006; Sublette et al., 2009), high suicidality (Judd and Akiskal, 2003), and reduced quality of life (Brissos et al., 2008). While the first line of treatment is pharmacotherapy, adjunctive psychotherapy has also shown promise in improving the course of illness, including psychoeducation, cognitive-behavioral therapy (CBT), interpersonal and social rhythm therapy and familyfocused therapy (Basco and Rush, 2005; Colom and Lam, 2005; Frank, 2005; Miklowitz, 2004a; Parikh et al., 2012; Provencher et al., 2010). Although psychosocial treatments have provided benefits, effect sizes have been small to moderate, leaving some room for improvement. "
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ABSTRACT: Schema therapy (ST) is an integrative form of psychotherapy developed for complex, chronic psychological disorders with a characterlogical underpinning. Bipolar disorder is just such a disorder-complex and often comorbid, with demonstrated stable cognitive and personality features that complicate the course of illness. This article presents the reasons justifying the application of ST to bipolar disorder and proposes a treatment rationale and future directions for treatment and research. If well adapted to the characteristics of bipolar disorder, ST might prove to be an effective adjunctive psychotherapy option that attenuates emotional reactivity, reduces symptoms and improves quality of life.
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