Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial
Transdiagnostic treatment of bipolar disorder and comorbid anxiety using the Unified Protocol for Emotional Disorders: A pilot feasibility and acceptability trial
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DOI：
10.1016/j.jad.2017.05.011
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发表时间：
2017-09-01
影响因子：
6.6
通讯作者：
Deckersbach, Thilo
中科院分区：
文献类型：
--
作者：
Ellard, Kristen K.;Bernstein, Emily E.;Deckersbach, Thilo
背景：双相情感障碍（BD）的共病焦虑与更严重的疾病、更低的治疗反应和更大的损害相关。在双相障碍的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）作为一种跨诊断认知行为疗法作为双相障碍和共病焦虑症药物治疗的辅助治疗的可行性、可接受性和初步疗效。方法：29例伴有至少一种共病焦虑症的双相障碍患者随机分为常规药物治疗组（TAU）或TAU组（UP+TAU） 18组。所有患者每四周完成一次评估，以跟踪症状、功能、情绪调节和气质。进行线性混合模型回归以跟踪症状随时间的变化，并检查情绪相关变量与治疗反应之间的关系。结果：两个治疗组的满意度评分相等。随着时间的推移，UP+TAU组患者的焦虑和抑郁症状明显减少（Cohen's d's > 0.80）。神经质、感知情感控制和情绪调节能力的基线水平仅预测UP+TAU组的症状改变程度。感知情绪控制和情绪调节技能的较大变化预示着焦虑相关症状的较大变化。局限性：这是一个试点可行性和可接受性试验；结果应谨慎解释。结论：UP+TAU治疗患者满意度较高，焦虑和抑郁指标的改善明显大于TAU治疗。这表明UP可能是双相障碍合并焦虑的一种可行的治疗方法。
Background: 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.Methods: 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.Results: 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.Limitations: This was a pilot feasibility and acceptability trial; results should be interpreted with caution.Conclusions: 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.