Cognitive Therapy for Bipolar Disorder

Summarized by Robert W. Griffith, MD
March 24, 2005

Introduction

Psychotherapy, in the form of cognitive therapy, has emerged as a successful way of treating bipolar disorder. And since relapses are one of the most distressing occurrences with bipolar, it was encouraging to hear that cognitive therapy was able to reduce the frequency of relapses over a 12-month period. But how effective has it been over a longer period? A new study has been reported that tackled this question. It's published in the American Journal of Psychiatry, and is summarized here.

What was done

The study was conducted at Kings College Hospital, London, UK. Over 100 bipolar patients were randomly allocated to either 'control' conditions, or cognitive therapy. Those given the control treatment received what was called 'minimal psychiatric care'.¹ The cognitive therapy patients received 'minimal psychiatric care' plus an average of 14 sessions of cognitive therapy over a 6 months period, followed by two booster sessions in the next 6 months.

For the next 24 months, at 6-month intervals, the patients were assessed to determine if they had any bipolar episodes. The raters were unaware of whether the patients came from the control or cognitive therapy group.

What the assessments showed

The relapse rates over the 3-year period are shown in the table:

	Cognitive Behavior	Controls
Bipolar episodes	64%	84%
Manic/hypomanic episodes	50%	67%
Depressive episodes	39%	67%

Cognitive therapy is clearly beneficial in reducing manic, depressive, and bipolar episodes. And results are better for depression than for mania/hypomania. However, this table doesn't tell the whole story. The difference between cognitive therapy and controls was confined to the first 18 months. In the final 18 months of the study, there was little difference in the number of relapses between the two groups.

Those given cognitive therapy spent 110 fewer days in bipolar episodes over the total 900 days of the study, compared with the controls. In the last 18 months, those on cognitive therapy had 54 fewer days in bipolar episodes out of a total of 450 study days, i.e. the proportion for each time period was similar.

What these findings mean

The benefits of cognitive therapy in reducing the numbers of relapses of bipolar disorder are confirmed in this study; moreover, they seem to last for about 18 months after the start of treatment. However, they don't extend any longer.

On the other hand, the total number of days spent in bipolar episodes seems to be reduced evenly over a 3-year period. With this knowledge, therapists and patients must consider whether it wouldn't be better to plan for continued therapy sessions for an indefinite period. Further studies will be needed to develop the best protocol for cognitive therapy in bipolar patients; one must expect that different 'doses' of cognitive therapy will be needed for different patients, just as drug doses have to be individualized.

Source

• Relapse prevention in patients with bipolar disorder: cognitive therapy outcome after 2 years. DH. Lam, P. Hayward, ER. Watkins,  et al., Am J Psychiatry, 2005, vol. 162, pp. 3242--3249

Footnotes
1. Minimal psychiatric care consisted of mood stabilizing medication, such as lithium, valproate, lamotrigine, or olanzapine, with regular psychiatric follow-up.

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