The British Journal of Psychiatry (2006) 188: 313-320. doi: 10.1192/bjp.188.4.313
© 2006 The Royal College of Psychiatrists
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Cognitive–behavioural therapy for severe and recurrent bipolar disorders

Randomised controlled trial{dagger}

JAN SCOTT, MD, FRCPsych

Department of Psychological Medicine, Institute of Psychiatry, London

EUGENE PAYKEL, MD, FRCP, FRCPsych, FMedSci

Department of Psychiatry, University of Cambridge

RICHARD MORRISS, MD, FRCPsych

Department of Psychiatry, Royal Liverpool University Hospital

RICHARD BENTALL, PhD, FBPsS

Department of Psychology, University of Manchester

PETER KINDERMAN, PhD, FBPsS

Department of Clinical Psychology, University of Liverpool

TONY JOHNSON, PhD, CStat

Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge

ROSEMARY ABBOTT, PhD and HAZEL HAYHURST, MA, PhD{ddagger}

Department of Psychiatry, University of Cambridge, Addenbrooke’s Hospital, Cambridge, UK

Correspondence: Professor Jan Scott, Department of Psychological Medicine, PO Box 96, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail: j.scott{at}iop.kcl.ac.uk

Declaration of interest None. Funding detailed in Acknowledgements.

{dagger} See pp. 321–322, this issue.

{ddagger} On behalf of the members of the Multicentre Trial of Cognitive–Behavioural Therapy for Bipolar Disorders (MCTBP) research team.

Background Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders.

Aims To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT).

Method We undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for18 months.

Results More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes.

Conclusions People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those receiving mental healthcare.


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