Jillian R. Ball

A Randomized Controlled Study of Cognitive Behavior Therapy and Behavioral Family Therapy for Anorexia Nervosa Patients

Very few studies have examined the role of cognitive behavior therapy (CBT) in the outpatient treatment of anorexia nervosa. This study used a randomized, controlled design to evaluate a 12-month, manual based program of CBT, with behavioral family therapy as the comparison group. Twenty-five adolescents and young adults with anorexia nervosa, currently living with their families, were recruited into the study with both treatment groups receiving 21–25 sessions of therapy. Outcome measures included nutritional status, eating behaviors, mood, self-esteem, and family communication. Sixty percent of the total sample and 72% of treatment completers had “good” outcome (defined as maintaining weight within 10% of average body weight and regular menstrual cycles) at post-treatment and at six months follow-up. No significant differences between treatment groups were found and the majority of patients did not reach symptomatic recovery. While limited by the small sample size, the findings compliment and extend previous research.

A randomized controlled trial of mindfulness-based cognitive therapy for bipolar disorder.

To compare the efficacy of mindfulness‐based cognitive therapy (MBCT) plus treatment as usual (TAU) to TAU alone for patients with bipolar disorder over a 12‐month follow‐up period.

Schema-focused cognitive therapy for bipolar disorder: reducing vulnerability to relapse through attitudinal change

Objective: Acceptance of, and adaptability to illness, are major determinants of adherence to treatment and functional recovery. This paper addresses the major psychosocial factors associated with bipolar disorder and the role of psychological interventions in symptom management and adaptability to the illness experience. A new model is presented highlighting the role of developmental experiences and temperament in determining reactions to bipolar disorder. The authors propose that by addressing reactions to the illness experiences and effects on self-concept through schema-focused cognitive therapy, functional recovery is more likely to occur among those patients functioning below expectation. Method: A systematic review of the current literature including an Index Medicus/MEDLINE search was conducted, focusing on risk factors, cognitive vulnerabilities and triggers associated with bipolar disorder. Psychological treatments available for the treatment of bipolar disorder are reviewed and details of a novel schema-focused cognitive model for this condition are presented. Traditional models of adaptation to chronic illness are outlined and incorporated into the proposed model. Schema-focused cognitive therapy is proposed as an approach to help patients reduce cognitive vulnerability to relapse in addition to adopting effective mood management strategies. Results and Conclusions: There is a need for psychological treatments which reduce the risks associated with poor functionality in patients with bipolar disorder. Schema-focused cognitive therapy specifically targets the temperament, developmental experiences and cognitive vulnerabilities that determine adjustment to illness. This proposed treatment, combined with pharmacotherapy, may offer new psychotherapeutic options for the future.

Characteristics of bipolar disorder in an Australian specialist outpatient clinic: comparison across large datasets

Objectives: There have been relatively few detailed reports on the sociodemographic and clinical characteristics of bipolar disorder in large outpatient clinical samples. This paper reports on findings from the Black Dog Institute Bipolar Disorders Clinic (BDI-BDC) and compares this dataset with the predominantly outpatient Stanley Foundation Bipolar Disorders Network (SFBN) and Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) samples. Methods: A total of 217 patients with DSM-IV bipolar disorder were assessed in detail in the BDI-BDC using a series of standardized and non-standardized structured interviews. Ninety per cent had bipolar I disorder, and 10% bipolar II disorder. This sample was compared with the SFBN and STEP-BD datasets. Results: The sociodemographic characteristics of the three samples were remarkably similar. Female gender and younger age were overrepresented compared to the general population. Functional impairment, indicated by marital status and labour force participation, was clearly more common among the study subjects than in the general population. In all three samples, prior educational attainment was higher than the general population. With respect to clinical features, approximately half of each sample was euthymic and approximately one-third was in a DSM-IV episode of depression at study entry. One-half reported depression as their first episode of mood disturbance. Similar proportions identified positive family histories of bipolar disorder (40%) and unipolar depression (55%). Other clinical characteristics demonstrated more variation between the samples. The STEP-BD population reported an earlier age of onset. The SFBN subjects reported higher numbers of overall episodes, but psychotic features and suicide attempts were less common than in the BDI-BDC sample. Conclusions: This report highlights the marked commonalities of the sociodemographic and clinical characteristics of patients with bipolar disorder recruited predominantly in the outpatient setting in three different continents, that is, Australia, North America and Europe. It also demonstrates some critical distinctions between such samples, emphasizing the need to be aware of these differences when interpreting findings, such as treatment outcome, from different bipolar disorder datasets.

The association between meditation practice and treatment outcome in Mindfulness-based Cognitive Therapy for bipolar disorder.

This study aimed to examine the impact of quantity of mindfulness meditation practice on the outcome of psychiatric symptoms following Mindfulness-based Cognitive Therapy (MBCT) for those diagnosed with bipolar disorder. Meditation homework was collected at the beginning of each session for the MBCT program to assess quantity of meditation practice. Clinician-administered measures of hypo/mania and depression along with self-report anxiety, depression and stress symptom questionnaires were administered pre-, post-treatment and at 12-month follow-up. A significant correlation was found between a greater number of days meditated throughout the 8-week trial and clinician-rated depression scores on the Montgomery-Åsberg Depression Rating Scale at 12-month follow-up. There were significant differences found between those who meditated for 3 days a week or more and those who meditated less often on trait anxiety post-treatment and clinician-rated depression at 12-month follow-up whilst trends were noted for self-reported depression. A greater number of days meditated during the 8-week MBCT program was related to lower depression scores at 12-month follow-up, and there was evidence to suggest that mindfulness meditation practice was associated with improvements in depression and anxiety symptoms if a certain minimum amount (3 times a week or more) was practiced weekly throughout the 8-week MBCT program.

Summary of guideline for the treatment of bipolar disorder

The past decade has witnessed an extraordinary expansion of treatments available for bipolar disorder. Ten years ago, lithium was the only approved agent for this condition. Since that time, carbamazepine, valproate and olanzapine have received regulatory approval for the acute treatment of mania. Concurrently, randomized controlled trials of various psychological interventions have been recently reported, respecting the important psychological effects of this condition. The present summary provides recommended treatment guidelines for each phase of this condition: mania, mixed episodes, depression and long-term prophylaxis. Levels of evidence for specific treatments are provided and placed in the context of overall principles of quality clinical management.

Mindfulness, response styles and dysfunctional attitudes in bipolar disorder

BACKGROUND This study aimed to examine differences between mindfulness, dysfunctional attitudes and response styles in subjects with bipolar disorder, major depressive disorder and controls. METHOD A total of 192 participants were included in this study: 90 with bipolar disorder, 36 with remitted major depressive disorder and 66 subjects without a current or past history of a mood disorder. RESULTS After controlling for current mood state and co-morbid anxiety disorders, the groups did not differ on mindfulness or response styles scores, however, those with bipolar disorder scored significantly higher on the Dependency and Achievement subscales of the Dysfunctional Attitudes Scale than the other two groups. LIMITATIONS Sample sizes were relatively small for the control and remitted major depressive disorder groups making it difficult to draw definitive conclusions. CONCLUSIONS Participants with bipolar disorder appear to significantly differ from remitted depressives and controls on certain cognitive styles such as Dependency and Achievement on the Dysfunctional Attitudes Scale. Further research may help to understand how these cognitive domains impact on the course and outcome of bipolar disorder.

Clinical utility of the modified Stroop task as a treatment outcome measure: Questions raised

Data from an outpatient treatment trial for anorexia nervosa were examined to gain preliminary insights as to whether the modified Stroop colour-naming task might offer a useful measure of treatment outcome. It was hypothesised that interference for eating-, weight- and shape-related words on a modified version on the Stroop colour-naming task would decrease with successful treatment. Studies to date suggest that eating disorder patients show interference on the Stroop colour-naming task for food- and shape-related words. The study was designed to assess selective-information changes for patients with anorexia nervosa before and after treatment in association with other psychological measures. Pretreatment and post-treatment assessments were collected from a clinical trial of 25 women who met Diagnostic and Statistical Manual of Mental Disorders (4th ed., DSM-IV) criteria for anorexia nervosa. Using repeated measures analysis of variance, a significant Time × Card interaction was found on the Food and Con...

Impaired psychosocial functioning in bipolar disorder: the relative contributions of inter-episodic symptoms and illness episodes.

262 paranoid individuals will show normal or high selfesteem on overt measures, whereas covert measures will show hidden feelings of low self-esteem. Methods: The present study used a new methodology that has been widely used in investigations of implicit attitudes, the Implicit Association Test (IAT), to assess covert self-esteem and to test the above prediction. Overt self-esteem was assessed using the Rosenberg Self-Esteem Scale and an adjective self-relevance ratings measure. These measures were administered to 10 patients with acute persecutory delusions, 10 patients with persecutory delusions in remission and 19 matched healthy control participants. Results: Patients with acute persecutory delusions were found to have lower covert self-esteem (as assessed using the IAT) than healthy controls and patients with remitted persecutory delusions. On the two measures of overt self-esteem, however, the persecutory deluded group did not differ signifi cantly from the other groups once the effects of comorbid depression had been taken into account. Conclusions: The results of the present study are consistent with a model of persecutory delusions as serving a defensive function. As such, they are consistent with a psychotherapeutic approach to what are perhaps the most frequently observed symptoms of schizophrenia.