Spectrum Centre for Mental Health Research, Institute for Health Research, Lancaster University, Lancaster, UK.
Clin Psychol Psychother. 2011 Sep-Oct;18(5):426-37. doi: 10.1002/cpp.783. Epub 2011 Sep 6.
Although comorbid substance use is a common problem in bipolar disorder, there has been little research into options for psychological therapy. Studies to date have concentrated on purely cognitive-behavioural approaches, which are not equipped to deal with the ambivalence to change exhibited by many towards therapy designed to change substance use. This paper provides the first report of an integrated psychological treatment approach for bipolar disorder with comorbid substance use. The intervention reported combines motivational interviewing and cognitive-behavioural therapy to address ambivalence and equips individuals with strategies to address substance use. Across five individual case studies, preliminary evidence is reported to support the acceptability and the feasibility of this approach. Despite most participants not highlighting their substance use as a primary therapy target, all but one exhibited reduced use of drugs or alcohol at the end of therapy, sustained at 6 months' follow-up. There was some evidence for improvements in mood symptoms and impulsiveness, but this was less clear-cut. The impact of social and relationship issues on therapy process and outcome is discussed. The implications of the current findings for future intervention research in this area are considered.
尽管共病物质使用在双相情感障碍中是一个常见问题，但针对心理治疗选择的研究却很少。迄今为止的研究主要集中在纯粹的认知行为方法上，这些方法无法应对许多人对旨在改变物质使用的治疗所表现出的矛盾心理。本文首次报告了一种针对共病物质使用的双相情感障碍的综合心理治疗方法。报告中所采用的干预措施将动机性访谈和认知行为疗法相结合，以解决矛盾心理，并为个人提供解决物质使用问题的策略。通过五个个体案例研究，报告了初步证据支持该方法的可接受性和可行性。尽管大多数参与者没有将他们的物质使用作为主要治疗目标，但除了一名参与者外，所有人在治疗结束时都减少了药物或酒精的使用，在 6 个月的随访中仍保持了这一趋势。在情绪症状和冲动性方面有一些改善的证据，但这并不明显。还讨论了社会和关系问题对治疗过程和结果的影响。考虑了当前发现对该领域未来干预研究的影响。
