Discuss About The Cognitive Behavioral Therapy For Disorder?
Bipolar disorder is considered as one of the prevalent and serious kind of psychiatric disorders (Walker, McGee & Druss, 2015). Cognitive behavioural therapy is one of the best studied procedures with evidential good results (Hutton & Morrison, 2013). In most of the research studies it has reported improvements in the life quality of the bipolar patients treated by CBT with reduced frequency and mood episodes duration along with reduced hospitalisation and increased compliance. But in order to standardise the diagnostic criteria, more studies are required to determine the efficacy of CBT. Therefore in this discussion, the efficacy of the cognitive behavioural therapy in treating the disorder will be evaluated and critically analysed.
Bipolar disorder (BD), one of the serious and prevalent disorder is reported to affect almost 3% of the world population causing substantial damage to the professional and personal life of the patients with suffer from BD (Asherson et al., 2014). This disorder had received increased attention in the past few years and had persuaded the doctors to characterise bipolar disorder as one of the important social issues. Along with understanding the essential components of the symptoms for controlling the occurrence evidential studies have suggested that structured psychotherapy can also be used to modify the disease course (Costa et al., 2010). Recent studies have showed that therapeutic approaches such as Cognitive behavioural therapy (CBT) that aimed in improving the patient’s life showed effective results in treating the patients with BD (Sipe & Eisendrath, 2012).
Cognitive behavioural therapy
In treating the bipolar disorder, the most-studied techniques are cognitive behavioural therapy (CBT) and psychoeductaion. CBT is a group based interventions depending on the premise that mental disorders are manipulated by cognitive factors. In this structured psychotherapy certain goals are established between the heap provider and the patient (Cranston, 2015). The effectiveness of CBT had been established through controlled studies that led to significant changes in dysfunction of behaviours and cognition that might have interfered with the adhered pharmacological treatment (McManus et al., 2012). Following this psychotherapy patients have recorded increased compliance rates along with reduced hospitalization with 6 months of this therapy and follow-up for the next 6 weeks (Kn?chel et al., 2012). CBT interventions goals in preventing and managing the cognitive, behavioural and affective symptoms related to depression or maniac episodes along with cooperation from patients and sometimes from the family too (Juruena, 2012). These interventional strategies are thought to reduce the negative effects of interpersonal and psychosocial areas thereby improving the life of the patients with BD (Mohr et al., 2013). The CBT interventions are conducted by certain strategies such as providing treatment education to the patients and their family along with making them aware of the common problems linked with this disease; educating them to monitor the occurrence and the depressive or maniac severity such as by making mood chart; providing facility to adhere to the pharmacological treatment; facilitating psychological strategies such as ability of cognitive behaviour to manage stress that can hinder the treatment or inculcate the maniac or depressive episodes (Costa et al., 2010). This can be done by controlling the circadian rhythm, training on social skills, recording daily thoughts and problem solving and lastly educating them to reduce the stigma and trauma along with diagnosis (Dobson & Dobson, 2016).
Effectiveness of CBT on bipolar disorder
Cognitive–behavioral therapy conjunct with BD patients’ pharmacotherapy modifies the disease course (Reinares, S?nchez-Moreno & Fountoulakis, 2014). All studies, comprising individual or group showed improved patterns in mood and social behaviour which gained with further follow-up. CBT gives positive outcomes for BD prognosis and can be used from onset of BD (Parkins, 2013). There are numerous evidences about the efficiency of CBT on treating BD patients are discussed below.
- CBT on individual: Cognitive behavioural therapy intervention is considered as one of the best studied example for treating BD in the field of psychiatry (Geddes & Miklowitz, (2013). First study was conducted in 1984 understand the adherence of lithium therapy on 28 patients. Half of the group who received CBT interventions with 6 sessions showed increased compliance with reduced hospitalization and recurrence rates than the other half of the group who received lithium therapy (Prasko et al., 2013). In 2000, study conducted by Lam et al. showed increased compliance to medication with fewer BP episodes on 25 patients followed by 12 to 25 sessions (Searson et al., 2012). In 2001, 21 patients were addressed to 25 sessions of CBT and showed significant result when compared with the untreated 21 patients showing reduced relapse rates and lesser hospitalization (Isasi et al., 2014). Scott et al. performed on 253 patients with severe and different stages of comorbidites through a randomised multicenter study. Among the 127 patients, only 40% among them obtained the objective with 20 sessions. No difference was observed between the control and the group taken concluding that adjunction of CBT is more effective than treating the individuals showing less than 12 stages of BD (Yatham et al., 2013). In 2010, the combined treatment comprising psychoeducational, CBT and pharmacological was conducted on half of 40 patients with refractory BD showed effective results (Stratford et al., 2015). In 2014, 951 patients with 857 having major depression and rest with BD were evaluated through CBT for severed mood dysfunction in an acute setting and showed significant reduction in symptoms, self-harm, substance abuse with improve life (Jeremian, 2014). A recent study on meta-analysis concluded that majority of the studies depicted a short-term effectiveness in minimising BD relapse rate thereby improving the severity of mania rather than depression and effects get minimised with time (Berlim, Tovar-Perdomo & Fleck, 2015).
- CBT on group: Palmer et al. in 1995 conducted group CBT on 6 BD patients for 17 weeks based on pharmacotherapy maintenance, in which 2 patients showed effective CBT results. Group mindfulness CBT with 8 sessions showed increased reduction in depression, anxiety and mania with reduced mood episodes (Bream et al., 2017). Another study showed no difference related to recurrence time, episodes count in 18 CBT sessions (Abreu, 2016). A latest study for 20 sessions on compared group who had only pharmacotherapy and after 6, 12 months and 5 years of evaluation showed reduced symptoms of BD than the controls (Wiles et al., 2013).
- Mindfulness-based cognitive therapy (MBCT): This is a combined therapy with CBT associated with meditation focussing on BD. In 2010, 23 groups comprising 15 BD patients went through at least 4 MBCT sessions. Though they showed reduced depression by mindfulness technique but the effect reduced with time (Willett & Lau, 2015). In 2012, 12 patients of BD group with 8 controls had electroencephalography studies (EEG) just before and after the MBCT treatment for 8 weeks. The EEG studies should improvement in right frontal cortex with increased attention and activated level (Howells et al., 2014). Perich et al. conducted MBCT by comparing with the usual treatment with 95 BD patients in 2013 and did not find any significant difference in the duration or recurrence of the mood phases. But significant difference was noted in anxiety symptoms (Perich et al., 2013). This same group was analysed by incorporating meditation practice with a sample of 34 BD patients and found that mindfulness meditation if practiced for minion 3 weeks improved the symptoms of depression and anxiety (Miller, 2014).
Another study was conducted on female-specific unit for treating BD. In this study it showed positive outcome by treating her with combined CBT, restabilising on psychotropic medications along with a female specific unit (Palmer, 2013).
Comparing CBT with other interventions
In the last few years the field of psychology had adopted the evidence based practice. But still there are some controversies for the fast adoption of cognitive behavioural therapy (CBT) over the other treatment methods. There are some studies which proved that the CBT is the most effective treatment for number of disabilities of mental health (Gale, 2017). In addition the CBT treatments are generally short in duration and the results are more stable than other treatment methods. There are some traditional therapists who raised the voice against the CBT, because they said that in mental problems there is much complication which is impossible to cure in short period of time (Deckersbach, Eisner & Sylvia, 2016).
In the perspective of “Systemic Treatment Enhancement Program for Bipolar Disorder”, patients under the intensive psychotherapy showed that they need very short time span to recover and also the recovery rates were very high. In 2008 and 2012, 2 experiments were done by the help of randomized control theory. In 2008, 29 bipolar patients were selected and were divided into two groups, first group got 7 patients of psychotherapy and other got 13 sessions of CBT. After one year the people of the second group were found with less depressed mood and using less amount of antidepressant (Berk et al., 2014). In 2012, experiments comprising 76 patients with bipolar disorder with Susan and divided into two groups, the first group received the CBT and second received the supportive therapy. The report of the groups showed no changes in symptoms or relapse rates.
In 2000 years Parekh et al. compare the society I didn't found any significant change in the city group despite of longer and individual treatment (Reinares, 2017). Later they analyzed some other patients into different groups into different groups for investigating the changes in the early Mania symptoms and ascertained that both the groups have similar improvements in bipolar disorder. In a recent review on different psychological interventions for bipolar disorder the authors stated that CBT is very much effective in reducing the depressive symptoms of bipolar disorders. Hence we can use the CBT as the better way for improving the depressive and anxiety symptoms of bipolar disorder.
Thus it could be concluded that bipolar disorder is recorded as one of the most prevalent and serious mental disorders. The aim of this article is to prove that the cognitive behavioral therapy one of the popular and mostly used psychotherapy for the bipolar patients. Some of the studies explained the cognitive therapy efficiency in different phases of the bipolar disease. Studies showed that the patient treated with CBT had improvement with the reduction in both mood swings and depression, some patient also showed that they are now reduced the intake of antidepressant. Thus to treat the bipolar disorder the cognitive behavioral therapy can be used effectively.
Abreu, T. (2016). A review on the effectiveness of cognitive-behavioural therapy for bipolar affective disorder.
Asherson, P., Young, A. H., Eich-H?chli, D., Moran, P., Porsdal, V., & Deberdt, W. (2014). Differential diagnosis, comorbidity, and treatment of attention-deficit/hyperactivity disorder in relation to bipolar disorder or borderline personality disorder in adults. Current Medical Research and Opinion, 30(8), 1657-1672.
Berk, M., Berk, L., Dodd, S., Cotton, S., Macneil, C., Daglas, R., ... & Malhi, G. S. (2014). Stage managing bipolar disorder. Bipolar disorders, 16(5), 471-477.
Berlim, M. T., Tovar-Perdomo, S., & Fleck, M. P. (2015). Treatment-resistant major depressive disorder: current definitions, epidemiology, and assessment. Treatment-Resistant Mood Disorders, 1-12.
Bream, V., Challacombe, F., Palmer, A., & Salkovskis, P. (2017). Cognitive Behaviour Therapy for Obsessive-compulsive Disorder. Oxford University Press.
Costa, R. T. D., Range, B. P., Malagris, L. E. N., Sardinha, A., Carvalho, M. R. D., & Nardi, A. E. (2010). Cognitive–behavioral therapy for bipolar disorder. Expert review of neurotherapeutics, 10(7), 1089-1099.
Cranston, C. C. (2015). A randomized controlled trial to dismantle components of exposure, relaxation, and rescripting therapy for chronic nightmares and sleep disturbances in trauma-exposed persons. The University of Tulsa.
Deckersbach, T., Eisner, L., & Sylvia, L. (2016). Cognitive behavioral therapy for bipolar disorder. In The Massachusetts General Hospital Handbook of Cognitive Behavioral Therapy (pp. 87-103). Springer New York.
Dobson, D., & Dobson, K. S. (2016). Evidence-based practice of cognitive-behavioral therapy. Guilford Publications.
Gale, C. (2017). CBT for Bipolar disorder.
Geddes, J. R., & Miklowitz, D. J. (2013). Treatment of bipolar disorder. The Lancet, 381(9878), 1672-1682.
Howells, F. M., Rauch, H. L., Ives-Deliperi, V. L., Horn, N. R., & Stein, D. J. (2014). Mindfulness based cognitive therapy may improve emotional processing in bipolar disorder: pilot ERP and HRV study. Metabolic brain disease, 29(2), 367-375.
Hutton, P., & Morrison, A. P. (2013). Collaborative empiricism in cognitive therapy for psychosis: a practice guide. Cognitive and Behavioral Practice, 20(4), 429-444.
Isasi, A. G., Echeburua, E., Liminana, J. M., & Gonzalez-Pinto, A. (2014). Psychoeducation and cognitive-behavioral therapy for patients with refractory bipolar disorder: a 5-year controlled clinical trial. European psychiatry, 29(3), 134-141.
Jeremian, R. (2014). Epigenetic Studies of Bipolar Disorder (Doctoral dissertation).
Juruena, M. F. P. (2012). Cognitive-behavioral therapy for the bipolar disorder patients. In Standard and Innovative Strategies in Cognitive Behavior Therapy. InTech.
Kn?chel, C., Oertel-Kn?chel, V., O’Dwyer, L., Prvulovic, D., Alves, G., Kollmann, B., & Hampel, H. (2012). Cognitive and behavioural effects of physical exercise in psychiatric patients. Progress in neurobiology, 96(1), 46-68.
McManus, F., Surawy, C., Muse, K., Vazquez-Montes, M., & Williams, J. M. G. (2012). A randomized clinical trial of mindfulness-based cognitive therapy versus unrestricted services for health anxiety (hypochondriasis). Journal of consulting and clinical psychology, 80(5), 817.
Miller, L. D. (2014). Effortless mindfulness: genuine mental health through awakened presence. Routledge.
Mohr, D. C., Burns, M. N., Schueller, S. M., Clarke, G., & Klinkman, M. (2013). Behavioral intervention technologies: evidence review and recommendations for future research in mental health. General hospital psychiatry, 35(4), 332-338.
Palmer, C. (2013). Therapeutic interventions. Psychiatric and mental health nursing, 473-503.
Parkins, M. M. (2013). A randomized controlled trial of group cognitive-behavioral therapy for patients with bipolar disorder: Effects on social functioning and quality of life. Palo Alto University.
Perich, T., Manicavasagar, V., Mitchell, P. B., Ball, J. R., & Hadzi?Pavlovic, D. (2013). A randomized controlled trial of mindfulness?based cognitive therapy for bipolar disorder. Acta Psychiatrica Scandinavica, 127(5), 333-343.
Prasko, J., Ociskova, M., Kamaradova, D., Sedlackova, Z., Cerna, M., Mainerova, B., & Sandoval, A. (2013). Bipolar affective disorder and psychoeducation. Neuroendocrinology Letters, 34(2).
Reinares, M. (2017). Psychotherapeutic interventions for bipolar disorder. The Treatment of Bipolar Disorder: Integrative Clinical Strategies and Future Directions.
Reinares, M., S?nchez-Moreno, J., & Fountoulakis, K. N. (2014). Psychosocial interventions in bipolar disorder: what, for whom, and when. Journal of affective disorders, 156, 46-55.
Searson, R., Mansell, W., Lowens, I., & Tai, S. (2012). Think Effectively About Mood Swings (TEAMS): A case series of cognitive–behavioural therapy for bipolar disorders. Journal of behavior therapy and experimental psychiatry, 43(2), 770-779.
Sipe, W. E., & Eisendrath, S. J. (2012). Mindfulness-based cognitive therapy: theory and practice. The Canadian Journal of Psychiatry, 57(2), 63-69.
Stratford, H. J., Cooper, M. J., Di Simplicio, M., Blackwell, S. E., & Holmes, E. A. (2015). Psychological therapy for anxiety in bipolar spectrum disorders: A systematic review. Clinical psychology review, 35, 19-34.
Walker, E. R., McGee, R. E., & Druss, B. G. (2015). Mortality in mental disorders and global disease burden implications: a systematic review and meta-analysis. JAMA psychiatry, 72(4), 334-341.
Wiles, N., Thomas, L., Abel, A., Ridgway, N., Turner, N., Campbell, J., ... & Kuyken, W. (2013). Cognitive behavioural therapy as an adjunct to pharmacotherapy for primary care based patients with treatment resistant depression: results of the CoBalT randomised controlled trial. The Lancet, 381(9864), 375-384.
Willett, B. R., & Lau, M. A. (2015). Clinical Perspectives: Mindfulness-Based Cognitive Therapy and Mood Disorders. In Handbook of Mindfulness and Self-Regulation (pp. 171-183). Springer New York.
Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Beaulieu, S., Alda, M., ... & Ravindran, A. (2013). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) collaborative update of CANMAT guidelines for the management of patients with bipolar disorder: update 2013. Bipolar disorders, 15(1), 1-44.