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Correspondence |
Department of Psychological Medicine, PO Box 96, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK.
Department of Psychiatry, University of Cambridge, UK
Department of Psychiatry, Royal Liverpool University Hospital, UK
Department of Psychology, University of Manchester, UK
Department of Clinical Psychology, University Psychology, University of Liverpool, UK
Medical Research Council Biostatistics Unit, Institute of Public Health, Cambridge, UK
Department of Psychiatry, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
Correspondence: E-mail: j.scott{at}iop.kcl.ac.uk
EDITED BY KIRIAKOS XENITIDIS and COLIN CAMPBELL
Dr Lam (2006) comments on our study (Scott et al, 2006a), the largest randomised controlled trial (RCT) of psychological treatment for bipolar disorder conducted so far. We respond as follows.
Previous studies of psychological therapies have mostly involved more selected populations at relatively lower risk of relapse. In those circumstances CBT appears beneficial. Our study used a mixed patient sample; many were high-risk or currently symptomatic. We designed the trial in this way to address an issue not explored so far in any other psychological therapy study, namely whether the treatment would be effective in all patients who might be considered for it. Patients were only excluded if participation was unfeasible or unethical.
Our findings indicate that 22 sessions of CBT may not be effective for most people seen in NHS general adult psychiatry settings. In our lower-risk subgroup, similar in characteristics to Dr Lams sample (Lam et al, 2003), CBT may be very helpful. The clinical implications are that for a stable, lower-risk population, early in their history of bipolar recurrences, CBT should be considered as an adjunctive treatment option to further enhance their outcome. For high-risk, complex cases, other forms of therapy should be considered, such as those targeted at medication adherence or relapse prevention, before considering CBT. These recommendations are consistent with the results from published meta-analyses and other findings on psychological therapies in bipolar disorders (Scott & Colom, 2005; Scott et al, 2006b).
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