Novel Intervention for Anxiety Symptoms Among People with Bipolar Disorder

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April 29, 2019
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Anxiety is common in Bipolar Disorder (BD) that is characterized by worse clinical outcomes including increased suicidality. Despite effective psychological interventions for the management of anxiety, research into treating anxiety in bipolar disorder remains underdeveloped. In fact, current psychological approaches for the management of bipolar disorders have been found to have mixed and inconsistent results, with a consensus that they only provide significant, but modest, effect on clinical outcomes. Even patients often come back with similar complaints after series of long-term psychotherapeutical and pharmacological interventions. This situation have caused some scientists and healthcare providers to believe that all psychiatric disorders have suffered from a dearth of truly novel pharmacological interventions.

Psychologists at Lancaster University have devised a novel psychological intervention to address Anxiety in Bipolar Disorder (AIBD). Anxiety is common in Bipolar Disorder (BD) and associated with worse clinical outcomes including increased suicidality. Despite effective psychological treatments for anxiety, research into treating anxiety in BD is underdeveloped.

Bipolar disorder, formerly called manic depression, is a mental health disorder that is characterized by extreme mood swings that include emotional highs (mania or hypomania) and lows (depression).

Researchers led by Professors Steven Jones and Fiona Lobban offered adults with both Bipolar Disorder and clinically significant anxiety symptoms either treatment as usual or the novel intervention.

The study involved participants with bipolar disorder (BD) and symptoms of clinically significant anxiety (n=72). Participants were randomly assigned to Anxiety in Bipolar Disorder (AIBD) plus treatment as usual or treatment as usual alone. Participants with symptoms of AIBD had 10 long sessions of psychological therapy, through a system of formulation-based approach. The neuropsychiatrists assessed feasibility and acceptability through recruitment, retention, therapy attendance, alliance, fidelity, and qualitative feedback. They assessed clinical outcomes at baseline, 16, 28, and 80 weeks, with interim assessments of relapse at 32 and 64 weeks.

There was 88% retention to 16 weeks and 74% retention to 80 weeks, and rates were similar in both treatment groups. Participants in the AIBD group attended an average of 7.7 (standard deviation, 2.8) sessions. To validate their result, individual-based formulation approach was used to guide the specific intervention plan. The process involves appropriate cognitive behavioral strategies focused on addressing anxiety experiences and consequent behaviour.

“The individualized formulation-driven approach took into account level of engagement and motivation and explored links between anxiety and bipolar experiences, including issues around functioning, to elicit personally valued treatment goals.” Said Professor Jones, one of the scientists.

The CBT approach typically involved learning more and gaining an understanding of the foundation and nature of their anxiety symptoms and to develop strategies which they can develop on their own to enable them cope with anxiety symptoms using CBT techniques such as relaxation and breathing techniques, cognitive restructuring, behavioral experiments, thought monitoring and challenging and adaptive problem solving.

Participants indicated they valued the intervention in contrast with previous forms of support received. They identified the benefits of treating anxiety and BD together in contrast with previous experiences of having these problems addressed separately.

William Kellogg is a veteran writer who’s covered the subject of the intersection of technology, health and mental wellness for nearly two decades.
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