BACKGROUND: Grounded in a model focused on exposure to response-contingent positive reinforcement, and with evidence supporting its acute treatment effects for unipolar depression, an adjunctive behavioral activation (BA) intervention may be especially well suited to the treatment of bipolar depression. The goal of this study was to modify BA for the adjunctive treatment of bipolar depression and to pilot it in a proof of concept trial to assess its preliminary feasibility and acceptability for this population. METHODS: Twelve adults with bipolar depression were recruited from hospital settings and enrolled in a 20-week open trial of the modified BA, delivered in 16 outpatient sessions, as an adjunct to community pharmacotherapy for bipolar disorder. Symptom severity was assessed at pretreatment and posttreatment by an independent evaluator. Patient satisfaction was also assessed posttreatment. RESULTS: Feasibility and acceptability were high, with 10 of 12 patients completing treatment, an average of 14.8 (SD=5.2) of 16 sessions attended, and high levels of self-reported treatment satisfaction. Patients exhibited statistically significant improvement from pretreatment to posttreatment on measures of depressive symptoms, manic symptoms, and severity of suicidal ideation. CONCLUSIONS: Although preliminary and requiring replication in a larger sample, these study data suggest that a modified BA intervention may offer promise as an adjunctive approach for the acute treatment of bipolar depression. Future studies that use more rigorous randomized controlled designs and that directly assess potential mechanisms of action are recommended.
BACKGROUND: Grounded in a model focused on exposure to response-contingent positive reinforcement, and with evidence supporting its acute treatment effects for unipolar depression, an adjunctive behavioral activation (BA) intervention may be especially well suited to the treatment of bipolar depression. The goal of this study was to modify BA for the adjunctive treatment of bipolar depression and to pilot it in a proof of concept trial to assess its preliminary feasibility and acceptability for this population. METHODS: Twelve adults with bipolar depression were recruited from hospital settings and enrolled in a 20-week open trial of the modified BA, delivered in 16 outpatient sessions, as an adjunct to community pharmacotherapy for bipolar disorder. Symptom severity was assessed at pretreatment and posttreatment by an independent evaluator. Patient satisfaction was also assessed posttreatment. RESULTS: Feasibility and acceptability were high, with 10 of 12 patients completing treatment, an average of 14.8 (SD=5.2) of 16 sessions attended, and high levels of self-reported treatment satisfaction. Patients exhibited statistically significant improvement from pretreatment to posttreatment on measures of depressive symptoms, manic symptoms, and severity of suicidal ideation. CONCLUSIONS: Although preliminary and requiring replication in a larger sample, these study data suggest that a modified BA intervention may offer promise as an adjunctive approach for the acute treatment of bipolar depression. Future studies that use more rigorous randomized controlled designs and that directly assess potential mechanisms of action are recommended.
Authors: Roger D Weiss; Margaret L Griffin; Monika E Kolodziej; Shelly F Greenfield; Lisa M Najavits; Dennis C Daley; Heidi Ray Doreau; John A Hennen Journal: Am J Psychiatry Date: 2007-01 Impact factor: 18.112
Authors: Joseph R Calabrese; Robert M A Hirschfeld; Michael Reed; Marilyn A Davies; Mark A Frye; Paul E Keck; Lydia Lewis; Susan L McElroy; James P McNulty; Karen D Wagner Journal: J Clin Psychiatry Date: 2003-04 Impact factor: 4.384
Authors: Lauren B Alloy; Lyn Y Abramson; Patricia D Walshaw; Alex Cogswell; Louisa D Grandin; Megan E Hughes; Brian M Iacoviello; Wayne G Whitehouse; Snezana Urosevic; Robin Nusslock; Michael E Hogan Journal: Bipolar Disord Date: 2008-03 Impact factor: 6.744
Authors: Fabiano G Nery; Hua-Hsuan Chen; John P Hatch; Mark A Nicoletti; Paolo Brambilla; Roberto B Sassi; Alan G Mallinger; Matcheri S Keshavan; Jair C Soares Journal: Bipolar Disord Date: 2009-03 Impact factor: 6.744
Authors: Francesco Colom; Eduard Vieta; Anabel Martinez-Aran; Maria Reinares; Jose Manuel Goikolea; Antonio Benabarre; Carla Torrent; Merce Comes; Barbara Corbella; Gemma Parramon; Josep Corominas Journal: Arch Gen Psychiatry Date: 2003-04
Authors: Isabella Pacchiarotti; David J Bond; Ross J Baldessarini; Willem A Nolen; Heinz Grunze; Rasmus W Licht; Robert M Post; Michael Berk; Guy M Goodwin; Gary S Sachs; Leonardo Tondo; Robert L Findling; Eric A Youngstrom; Mauricio Tohen; Juan Undurraga; Ana González-Pinto; Joseph F Goldberg; Ayşegül Yildiz; Lori L Altshuler; Joseph R Calabrese; Philip B Mitchell; Michael E Thase; Athanasios Koukopoulos; Francesc Colom; Mark A Frye; Gin S Malhi; Konstantinos N Fountoulakis; Gustavo Vázquez; Roy H Perlis; Terence A Ketter; Frederick Cassidy; Hagop Akiskal; Jean-Michel Azorin; Marc Valentí; Diego Hidalgo Mazzei; Beny Lafer; Tadafumi Kato; Lorenzo Mazzarini; Anabel Martínez-Aran; Gordon Parker; Daniel Souery; Ayşegül Ozerdem; Susan L McElroy; Paolo Girardi; Michael Bauer; Lakshmi N Yatham; Carlos A Zarate; Andrew A Nierenberg; Boris Birmaher; Shigenobu Kanba; Rif S El-Mallakh; Alessandro Serretti; Zoltan Rihmer; Allan H Young; Georgios D Kotzalidis; Glenda M MacQueen; Charles L Bowden; S Nassir Ghaemi; Carlos Lopez-Jaramillo; Janusz Rybakowski; Kyooseob Ha; Giulio Perugi; Siegfried Kasper; Jay D Amsterdam; Robert M Hirschfeld; Flávio Kapczinski; Eduard Vieta Journal: Am J Psychiatry Date: 2013-11 Impact factor: 18.112