Treating anxiety in the context of bipolar disorder (BD) is feasible and acceptable, but interventions still need to be adapted to create better clinical outcomes, according to research published in Depression and Anxiety.
The researchers developed their intervention to treat anxiety in context of bipolar disorder (AIBD), using individual qualitative interviews and 3 focus groups. Key elements of AIBD include flexible engagement, reviewing of positive experiences and coping, reviewing of difficulties, and a flexible, formulation-driven approach to individual therapy plan development.
The study included adults with BD and clinically significant anxiety symptoms (n=72). Participants were randomly assigned to AIBD plus treatment as usual or treatment as usual alone. Participants undergoing AIBD had 10 sessions of psychological therapy, using a formulation-based approach. The researchers assessed feasibility and acceptability through recruitment, retention, therapy attendance, alliance, fidelity, and qualitative feedback. They assessed clinical outcomes at baseline, 16, 28, and 80 weeks, with interim assessments of relapse at 32 and 64 weeks.
There was 88% retention to 16 weeks and 74% retention to 80 weeks, and rates were similar in both treatment groups. Participants in the AIBD group attended an average of 7.7 (standard deviation, 2.8) sessions.
The researchers found that therapeutic alliance and therapy fidelity were both acceptable. Through qualitative interviews, they found that participants valued integrated support for anxiety with BD and coping strategies, whereas some participants suggested a longer intervention period.
From baseline through 80 weeks of follow-up, there was no significant difference in clinical outcomes between treatment groups.
“More robust clinical outcomes might be obtained by opting for more restrictive inclusion criteria particularly with respect to duration of BD course,” the researchers wrote. “If successful, a definitive trial employing a revised version of the AIBD intervention would provide a timely addition to therapeutic options for BD consistent with the importance of anxiety in [National Institute for Health and Care Excellence] BD guidelines.”
Jones SH, Knowles D, Tyler E, et al. The feasibility and acceptability of a novel anxiety in bipolar disorder intervention compared to treatment as usual: a randomized controlled trial [published online July 19, 2018]. Depress Anxiety. doi: 10.1002/da.22781