Early cognitive behavioural psychotherapy in subjects at high risk for bipolar affective disorders (Acronym: EarlyCBT)
Final Report Abstract
In a multi-center, randomized, controlled trial, patients at clinical risk for serious mental illness presenting with subthreshold bipolar symptoms aged 15-30 years were randomized to 14 weeks of at-risk for BD-specific group CBT or unstructured group meetings. Primary efficacy endpoints were differences in affective symptomatology and psychosocial functioning at 14 weeks. At-risk status was defined as a combination of subthreshold bipolar symptomatology, reduction of psychosocial functioning and a family history for (schizo)affective disorders. The main results of the presented RCT were: 1) Affective symptomatology and psychosocial functioning improved over time in the sample as a whole; and 2) specific group CBT did not have sufficiently higher efficacy compared to the unstructured group meetings. Also secondary outcomes as perceived chronic stress as well as resources and self-management skills improved over time in both groups. With regard to the lack of an overall higher efficacy of the group CBT intervention, at least six possible reasons should be considered: (1) Remission of symptoms and deficits could be part of the natural course of mood changes with spontaneous remission; (2) The type of psychotherapeutic intervention chosen might not have been an effective one; especially it may be possible that group treatment is inferior to individual therapy; (3) A control condition consisting of unstructured group meetings is a sufficiently effective treatment as well; (4) The content of the newly developed intervention manual might have been too dense to be fully worked through; (5) an insufficient number of patients were at true risk for BD, reducing the potential to show a difference between a specific intervention geared toward improving symptoms and psychosocial functioning associated with BD risk and a non-specific intervention; and (6) the study was underpowered. We experienced difficulties in the recruitment and follow-up process, however, we do not believe that achieving the full sample would have reversed the study findings from a negative to a positive study. Results suggest that young patients at increased risk for the development of serious mental illness presenting with subthreshold bipolar symptoms with already impaired psychosocial functioning benefit from early group sessions. The degree of specificity and psychotherapeutic interaction needed in the intervention requires clarification in future studies. With its safe profile, psychotherapy holds the potential to prevent further impairment and improve the course of illness, or even prevent conversion to BD. Widespread availability of established lowthreshold (easy access) early detection and intervention centers that cover at least the developmental stages of serious mental illnesses would improve early detection of at-risk patients for BD. Individual counseling and symptom-oriented treatment options as well as group settings should be offered and studied regarding their relative efficacy and cost-effectiveness.
Publications
- (2014): Early specific cognitive-behavioural psychotherapy in subjects at high risk for bipolar disorders: study protocol for a randomised controlled trial. Trials. 2014 May 8;15:161
Pfennig, A.; Leopold, K.; Bechdolf, A.; Correll, C. U.; Holtmann, M.; Lambert, M. et al.
(See online at https://doi.org/10.1186/1745-6215-15-161) - Psychotherapeutic interventions in individuals at risk of developing bipolar disorder: a systematic review. Early Interv Psychiatry. 2014 Feb;8(1):3-11
Pfennig, A.; Correll, C.U.; Marx, C., Rottmann-Wolf, M., Meyer, T.D., Bauer, M., Leopold, K.
(See online at https://doi.org/10.1111/eip.12082) - Efficacy of cognitive-behavioral group therapy in patients at risk for serious mental illness presenting with subthreshold bipolar symptoms: results from a pre-specified interim analysis of a multi-center, randomized, controlled study. In revision. Bipolar Disord. 2020 Feb 28
Leopold, K.; Bauer, M.; Bechdolf, A.; Correll, C. U.; Holtmann, M.; Juckel, G. et al.
(See online at https://doi.org/10.1111/bdi.12894)
