Ellard Kristen K, Bernstein Emily E, Hearing Casey, Baek Ji Hyun, Sylvia Louisa G, Nierenberg Andrew A, Barlow David H, Deckersbach Thilo
Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
Department of Psychology, Harvard University, Cambridge, MA, USA.
J Affect Disord. 2017 Sep;219:209-221. doi: 10.1016/j.jad.2017.05.011. Epub 2017 May 10.
Comorbid anxiety in bipolar disorder (BD) is associated with greater illness severity, reduced treatment response, and greater impairment. Treating anxiety in the context of BD is crucial for improving illness course and outcomes. The current study examined the feasibility, acceptability and preliminary efficacy of the Unified Protocol (UP), a transdiagnostic cognitive behavioral therapy, as an adjunctive treatment to pharmacotherapy for BD and comorbid anxiety disorders.
Twenty-nine patients with BD and at least one comorbid anxiety disorder were randomized to pharmacotherapy treatment-as-usual (TAU) or TAU with 18 sessions of the UP (UP+TAU). All patients completed assessments every four weeks to track symptoms, functioning, emotion regulation and temperament. Linear mixed-model regressions were conducted to track symptom changes over time and to examine the relationship between emotion-related variables and treatment response.
Satisfaction ratings were equivalent for both treatment groups. Patients in the UP+TAU group evidenced significantly greater reductions over time in anxiety and depression symptoms (Cohen's d's>0.80). Baseline levels of neuroticism, perceived affective control, and emotion regulation ability predicted magnitude of symptom change for the UP+TAU group only. Greater change in perceived control of emotions and emotion regulation skills predicted greater change in anxiety related symptoms.
This was a pilot feasibility and acceptability trial; results should be interpreted with caution.
Treatment with the UP+TAU was rated high in patient satisfaction, and resulted in significantly greater improvement on indices of anxiety and depression relative to TAU. This suggests that the UP may be a feasible treatment approach for BD with comorbid anxiety.
双相情感障碍（BD）中的共病焦虑与更高的疾病严重程度、治疗反应降低和更大的功能损害有关。在双相情感障碍背景下治疗焦虑对于改善病程和预后至关重要。本研究考察了统一方案（UP）这一跨诊断认知行为疗法作为双相情感障碍和共病焦虑症药物治疗辅助疗法的可行性、可接受性和初步疗效。
29例患有双相情感障碍且至少有一种共病焦虑症的患者被随机分为常规药物治疗组（TAU）或接受18次统一方案治疗的常规药物治疗组（UP+TAU）。所有患者每四周完成一次评估，以追踪症状、功能、情绪调节和气质。进行线性混合模型回归以追踪症状随时间的变化，并检验与情绪相关变量和治疗反应之间的关系。
两个治疗组的满意度评分相当。UP+TAU组的患者随着时间的推移焦虑和抑郁症状明显减轻（科恩d值>0.80）。仅UP+TAU组的神经质、感知情感控制和情绪调节能力的基线水平可预测症状变化程度。感知情绪控制和情绪调节技能的更大变化可预测焦虑相关症状的更大变化。
这是一项初步的可行性和可接受性试验；结果应谨慎解读。
UP+TAU治疗的患者满意度较高，相对于TAU，焦虑和抑郁指标有显著改善。这表明统一方案可能是双相情感障碍合并共病焦虑的一种可行治疗方法。
