Department of Psychiatry, University of Toronto, Toronto, Ontario.
J Clin Psychiatry. 2012 Jun;73(6):803-10. doi: 10.4088/JCP.11m07343.
OBJECTIVE: Bipolar disorder is insufficiently controlled by medication, so several adjunctive psychosocial interventions have been tested. Few studies have compared these psychosocial treatments, all of which are lengthy, expensive, and difficult to disseminate. We compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive and longer individual cognitive-behavioral therapy intervention, measuring longitudinal outcome in mood burden in bipolar disorder. METHOD: This single-blind randomized controlled trial was conducted between June 2002 and September 2006. A total of 204 participants (ages 18-64 years) with DSM-IV bipolar disorder type I or II participated from 4 Canadian academic centers. Subjects were recruited via advertisements or physician referral when well or minimally symptomatic, with few exclusionary criteria to enhance generalizability. Participants were assigned to receive either 20 individual sessions of cognitive-behavioral therapy or 6 sessions of group psychoeducation. The primary outcome of symptom course and morbidity was assessed prospectively over 72 weeks using the Longitudinal Interval Follow-up Evaluation, which yields depression and mania symptom burden scores for each week. RESULTS: Both treatments had similar outcomes with respect to reduction of symptom burden and the likelihood of relapse. Eight percent of subjects dropped out prior to receiving psychoeducation, while 64% were treatment completers; rates were similar for cognitive-behavioral therapy (6% and 66%, respectively). Psychoeducation cost $180 per subject compared to cognitive-behavioral therapy at $1,200 per subject. CONCLUSIONS: Despite longer treatment duration and individualized treatment, cognitive-behavioral therapy did not show a significantly greater clinical benefit compared to group psychoeducation. Psychoeducation is less expensive to provide and requires less clinician training to deliver, suggesting its comparative attractiveness. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00188838.
目的：双相情感障碍的药物治疗效果不足，因此已测试了几种辅助心理社会干预措施。很少有研究比较这些心理社会治疗方法，所有这些方法都耗时、昂贵且难以推广。我们比较了一种简短的心理教育小组干预与一种更全面和更长时间的个体认知行为治疗干预的相对有效性，以衡量双相情感障碍的情绪负担的纵向结局。
方法：这是一项单盲随机对照试验，于 2002 年 6 月至 2006 年 9 月进行。共有 204 名符合 DSM-IV 双相情感障碍 I 型或 II 型的参与者（年龄 18-64 岁）来自加拿大 4 个学术中心。通过广告或医生推荐招募参与者，当他们病情稳定或症状轻微且排除标准很少时，以增强普遍性。参与者被分配接受 20 次个体认知行为治疗或 6 次小组心理教育。使用纵向间隔随访评估前瞻性评估 72 周的症状过程和发病率，该评估为每周产生抑郁和躁狂症状负担评分。
结果：两种治疗方法在减轻症状负担和复发可能性方面的结果相似。8%的受试者在接受心理教育前退出，而 64%的受试者完成了治疗；认知行为治疗的比例相似（分别为 6%和 66%）。与认知行为治疗相比，心理教育的每位受试者成本为 180 美元，而认知行为治疗为 1200 美元。
结论：尽管治疗时间更长且采用个体化治疗，但认知行为治疗并未显示出与小组心理教育相比具有显著更大的临床益处。心理教育提供成本更低，且需要更少的临床医生培训来实施，这表明其相对吸引力。
试验注册：ClinicalTrials.gov 标识符：NCT00188838。
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