Assistance Publique-Hôpitaux de Paris, GH Saint-Louis-Lariboisière-Fernand Widal, Département de Psychiatrie et de Médecine Addictologique, Paris, France.
Fondation FondaMental, Créteil, France.
Clin Psychol Psychother. 2017 Jul;24(4):887-898. doi: 10.1002/cpp.2053. Epub 2016 Oct 20.
We investigated the feasibility and acceptability of an integrated group therapy (called HABIT) for comorbid bipolar disorder (BD) and alcohol and substance use disorders (ASUD) (BD-ASUD), a disabling clinical presentation for which no specific treatment has been validated. The 14-session HABIT programme employs psychoeducation-oriented cognitive-behaviour therapy (CBT) followed by mindfulness-based relapse prevention (MBRP) therapy.
Potential group participants were recruited from adult clients with a DSM-IV diagnosis of BD and an ASUD who were referred by their treating clinician. Observer-rated changes in mood symptoms and ASUD, attendance rates and subjective feedback are reported.
Eight of 12 clients referred to the programme initially agreed to join the group, six attended the first group session and five clients completed the programme. Group mean scores for mood symptoms improved over time, with slightly greater reductions in depression during the first module. About 50% of individuals showed clinically significant improvement (≥30% reduction) in alcohol and substance use. Attendance rates showed some variability between individuals and across sessions, but the average attendance rate of the group was marginally higher for the first module (86%) as compared with the second module (77%). Most clients reported high levels of general satisfaction with a group specifically targeted at individuals with BD-ASUD.
This small pilot study suggests our intensive group therapy is acceptable and feasible. If findings are replicated, we may have identified a therapy that, for the first time, leads to improvement in both mood and substance use outcomes in clients with difficult-to-treat comorbid BD-ASUD. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Comorbidity between bipolar and alcohol and substance use disorders (BD-ASUD) is frequent and highly disabling; Therapeutic research on approaches that can simultaneously help BD and ASUD is lacking; Previous research highlights the need for integrated treatment of both conditions but showed improvements limited to either element of the comorbid disorder; This pilot study supports the feasibility and acceptability of an intensive, 14-session group therapy programme that integrates CBT and mindfulness approaches.
我们研究了一种综合团体治疗（称为 HABIT）治疗共病双相情感障碍（BD）和酒精及物质使用障碍（ASUD）的可行性和可接受性，这种共病临床表现尚无特定治疗方法。该 14 节 HABIT 方案采用以心理教育为导向的认知行为疗法（CBT），然后是基于正念的复发预防（MBRP）疗法。
从由治疗医生转诊的 DSM-IV 诊断为 BD 和 ASUD 的成年患者中招募潜在的团体参与者。报告了情绪症状和 ASUD 的观察者评定变化、出席率和主观反馈。
最初有 12 名符合条件的患者同意参加该团体，其中 8 人参加了首次团体会议，6 人参加了首次团体会议，5 人完成了该团体方案。随着时间的推移，情绪症状的团体平均评分有所改善，第一模块期间抑郁症状的减轻幅度略大。大约 50%的个体在酒精和物质使用方面显示出临床显著改善（≥30%的减少）。个体之间和各次会议之间的出席率存在一定差异，但第一模块的团体平均出席率（86%）略高于第二模块（77%）。大多数患者对专门针对 BD-ASUD 患者的团体治疗表示高度满意。
这项小型试点研究表明，我们的强化团体治疗是可以接受和可行的。如果研究结果得到复制，我们可能已经确定了一种治疗方法，该方法首次导致治疗困难的共病 BD-ASUD 患者的情绪和物质使用结果均得到改善。
