Summary: Dialectical behavior therapy (DBT) appears to be a feasible and acceptable therapy to help with mood regulation in those with bipolar disorder.
Source: University of Exeter
Researchers have conducted a new trial to identify how an existing psychological therapy can be adapted to help people cope with and manage frequent Bipolar mood swings.
A subgroup of those with Bipolar Spectrum Disorders experience ongoing mood fluctuations outside of full episodes. These shifts in mood can sometimes make it difficult to live life to the full, and can be a source of difficulties in relationships with others. There are currently few therapy options available for people living with dramatic weekly, daily or even hourly mood swings.
The ThRIVe-B programme, carried out by researchers at the University of Exeter, involved taking an existing psychological therapy for another group of people that aims to help with emotion regulation, known as Dialectical Behaviour Therapy (DPT), and adapting it for people who have these frequent Bipolar mood swings.
DPT teaches skills both in acceptance of situations and emotional responses and is currently offered to people who have a diagnosis of Emotionally Unstable Personality Disorder.
“We have psychological therapies that can be helpful for people with Bipolar but there’s less available for people who have very frequent and ongoing mood swings within Bipolar” said lead author Dr Kim Wright, of the University of Exeter.
“We wanted to see how acceptable the therapy would be to the people who received it and do a test run to identify what changes need to be made before conducting a larger trial.”
The study took place in Devon and Cumbria and 43 participants were placed randomly into two groups.
Half of the participants received the new therapy. The other half continued with their usual NHS care.
The therapy lasted for around six months and participants were interviewed at various stages and asked to complete questionnaires when the study started and three, six, nine and 15 months later.
Participants were invited to reflect upon their behavioural response to extreme mood and activation states day-to-day and modify this where necessary.
In DPT this is achieved by building mindful awareness skills and through giving participants a framework through which to appraise their emotional responses and to develop alternative ways of relating to and managing these.
The therapy involved attending 16 group sessions and also some individual sessions with a therapist.
To support this, there was home practice as well as handouts and a ThrIVe-B smartphone app where participants could rate their mood.
“Because of the small numbers of people tested, the trial was never intended to evaluate the benefit of the treatment itself. Instead the study aimed to evaluate feasibility and acceptability of this therapy” Dr Wright explained.
“Overall, the study shows that there is demand from people with Bipolar for a psychological therapy addressing ongoing mood instability, and that a larger trial of a therapy like this is feasible.
“Our next steps will be to refine the therapy in line with what we learned from this study, such as simplifying content and considering individual rather than group delivery.”
Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme)
Background
A subgroup of those with bipolar spectrum disorders experience ongoing mood fluctuations outside of full episodes.
We conducted a randomised, controlled feasibility study of a Dialectical Behavioural Therapy-informed approach for bipolar mood fluctuations (Therapy for Inter-episode mood Variability in Bipolar [ThrIVe-B]). Our study aimed to examine the feasibility and acceptability of a future definitive trial evaluating the clinical and cost effectiveness of the ThrIVe-B programme.
Participants were required to meet diagnostic criteria for a bipolar spectrum disorder and report frequent mood swings outside of acute episodes. They were randomised to treatment as usual (control arm) or the ThrIVe-B intervention plus treatment as usual (intervention arm). Follow-up points were at 3, 6, 9 and 15 months after baseline, with 9 months as the primary end point.
To evaluate feasibility and acceptability we examined recruitment and retention rates, completion rates for study measures, adverse events and feedback from participants on their experience of study participation and therapy.
Results
Of the target 48 participants, 43 were recruited (22 in the intervention arm; 21 in the control arm), with a recruitment rate of 3.9 participants per month. At 9 months 74% of participants engaged in research follow-up assessment, exceeding the pre-specified criterion of 60%. There were no serious concerns about the safety of the research procedures or the intervention.
On one of the four candidate primary outcome measures, the 95% CI for the between-group mean difference score excluded the null effect and included the minimal clinically important difference, favouring the intervention arm, whilst on no measure was there evidence of deterioration in the intervention arm relative to the control arm.
Attendance of the intervention (50% attending at least half of the mandatory sessions) was below the pre-specified continuation criterion of 60%, and qualitative feedback from participants indicated areas that may have hampered or facilitated engagement.
Conclusions
It is broadly feasible to conduct a trial of this design within the population of people with frequent bipolar mood swings. Changes should be made to the therapy to increase uptake, such as simplifying content and considering individual rather than group delivery.
Trial registration ISRCTN: ISRCTN54234300
Source: University of Exeter
Original Research: Closed access.
“Psychological therapy for mood instability within bipolar spectrum disorder: a randomised, controlled feasibility trial of a dialectical behaviour therapy-informed approach (the ThrIVe-B programme)” by Kim Wright et al. International Journal of Bipolar Disorder
