Abstract
ObjectivesCognitive Behavioral Analysis System of Psychotherapy (CBASP) is an individually administered treatment model designed specifically for Persistent Depression however bipolar patients have traditionally been excluded from CBASP studies. There is a perception that bipolar depression will be harder to treat and requires a unique psychological approach. This pilot study reports on the feasibility of administering the same 20-week manualized group CBASP therapy with bipolar patients currently in a depressive episode.MethodsThis non-randomized, single-arm prospective pilot study, reports on an a posteriori exploration of benefits to bipolar depressed patients (n=26) of the same 20-week group CBASP intervention administered to unipolar depressed patients (n=81). The clinical trial for the initial phase examining benefits of the manualized 20-week group CBASP intervention with unipolar patients was registered with the ISRCTN registry, study ID: ISRCTN95149444. Results reported here include mixed ANOVA analyses, across group treatment models and diagnostic categories. Changes over time in self-reported depressive symptoms (Inventory of Depressive Symptoms -IDS-SR), self-reported social functioning, interpersonal problems and interpersonal dispositions are documented for all patients. An exploratory longitudinal latent class analysis was used to examine patients’ trajectories of improvement in depressive symptoms. Finally, the best predictors of change in reported depressive symptoms were explored with a logistic regression for all patients. ResultsImprovements in depressive symptoms and in social functioning over time were significant for all patients with bipolar patients trending towards a greater improvement in depressive symptoms after controlling for baseline differences. An exploratory Latent Class Analysis identified two different treatment trajectories for the entire sample: 1) moderate to severely depressed patients who improved significantly (49%) and 2) severely depressed patients who did not improve (51%). The best predictors of non-response to group therapy include high baseline problems in social functioning and low rates of self-reported Perceived Improvements in overall health. ConclusionBipolar patients in a depressive episode appear to benefit from the same 20-week group CBASP model designed originally for the treatment of Persistent Depressive Disorder. Bipolar patients seem more easily mobilized both during and outside of group therapy sessions and report more interpersonal confidence and more agency than unipolar depressed patients.
Highlights
Severe depression is a debilitating illness whether it is associated with a bipolar or unipolar mood disorder and often becomes recurrent and refractory
Higher baseline problems in social functioning represent the most important clinical predictor of membership in the second trajectory group of severely depressed patients who do not report improvements in depressive symptoms over the course of group therapy and who perceive their treatment as ineffective. This is the first pilot study examining the feasibility of Cognitive Behavioral Analysis System of Psychotherapy (CBASP) in a group format with bipolar patients currently in a depressive episode, using the same manualized treatment administered to a sample of unipolar depressed patients within the same psychiatric institution
After controlling for baseline differences, bipolar disorder patients trended towards a greater improvement in depressive symptoms
Summary
Severe depression is a debilitating illness whether it is associated with a bipolar or unipolar mood disorder and often becomes recurrent and refractory. Effective Psychosocial interventions recommended for acute depressive episodes in bipolar disorder include psychoeducation and Cognitive Behavioral Therapy [9] (CBT), Family-focused therapy [10] (FFT) as maintenance treatment with euthymic patients, Interpersonal and Social Rhythm Therapy [1] (IPSRT) and Mindfulness-Based Cognitive Therapy [11] (MBCT) for residual sub-syndromal symptoms. CBASP uses an interpersonal and behavioral paradigm to improve social functioning and help depressed patients break their isolation and improve executive functions [12]. It is a highly structured, skills-oriented approach teaching concrete skills to help patients learn interpersonal problem-solving strategies [16]. In spite of wide heterogeneity between trials being compared, there is consistent evidence of the effectiveness of CBASP as monotherapy for acute depression but even more effectiveness when combined with medication for persistent depression [19, 21]
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