Terapia cognitivo comportamental para o transtorno bipolar (original) (raw)
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Cognitive Behavioral Therapy in Treatment of Bipolar Disorder
Archives of Neuropsychiatry, 2021
Biological underpinnings (i.e., “bio” of bio-psycho-social approach) of Bipolar Disorder (BD) comes to the forefront when addressing its etiology and treatment. However, it is a condition that is challenging to manage with medication, and often the medication alone is insufficient since the symptoms of the disease have different episode characteristics. When the prevalence and inefficacy of drug treatments are considered together, the cruciality of psychosocial interventions in the treatment of the is undeniable. Moreover, treatment non-compliance is another problem that needs to be addressed psychosocially. Cognitive Behavioral Therapy (CBT) has its unique place among psychosocial interventions with numerous features such as being empirical and flexible, and it is recommended as an evidence-based adjuvant therapy in all stages of the disorder except acute mania. In this review, we discuss how CBT is used in specific domains of the disorder, following a general outlook on the eviden...
Cognitive-behavioral therapy: applications for the management of bipolar disorder
Bipolar Disorders, 2001
Objecti7es: This paper reviews cognitive-behavioral therapy (CBT) for bipolar disorder (BD). Data on the poor outcome of about 50% of patients diagnosed with BD supports the addition of a psychosocial intervention for the treatment of this recurring disorder. The psychoeducational nature of CBT, the effectiveness of CBT in increasing compliance to pharmacological treatment, and the ability of CBT to prevent relapse in unipolar depression (UD) are well suited to the treatment of BD. Method: Psychosocial interventions for BD will be briefly reviewed. Individual and group CBT interventions (published and unpublished) will also be reviewed. The significance of comorbid anxiety disorders regarding response to treatment will also be discussed. A review of the treatment protocol with the specific cognitive-behavioral interventions as applied to BD will be presented. Finally, a case example will be presented to illustrate the application of CBT to BD. Results: Preliminary results indicate that CBT may be an effective adjunctive, intervention for the treatment of BD. Specifically CBT may be helpful in increasing compliance, improving quality of life and functioning, help early symptom recognition, decrease relapse and decrease depressive symptomatology. Conclusions: Preliminary data on CBT for BD are promising but more rigorous randomized clinical trials are needed to confirm the efficacy of CBT for BD. An other area of research should be to pursue the understanding of cognitive processes in BD which would allow us to refine and develop CBT interventions unique to this disorder.
Cognitive therapy as an adjunct to medication in bipolar disorder
British Journal of Psychiatry, 2001
BackgroundThere is increasing support for the use of cognitive behaviour therapy as an adjunct to medication for patients with bipolar disorder.AimsTo explore current psychological models of bipolar disorder, describing the clinical rationale for using cognitive therapy and providing a brief overview of the approach.MethodResults from outcome studies are discussed.ResultsPreliminary findings indicate that cognitive therapy may be beneficial for patients with bipolar disorder. The collaborative, educational style of cognitive therapy, the use of a stepwise approach and of guided discovery is particularly suitable for patients who wish to take an equal and active role in their therapy.ConclusionsRandomised, controlled trials of cognitive therapy in bipolar disorder are required to establish the short-term and long-term benefits of therapy, and whether any reported health gain exceeds that of treatment as usual.
Cognitive Therapy for Bipolar Depression: A Pilot Study
The Canadian Journal of Psychiatry, 1999
Objective: While the efficacy of cognitive-behaviour therapy (CBT) for the treatment of acute unipolar major depression is well-documented, there is almost no data evaluating its utility in the treatment of bipolar depression. This pilot study compares the efficacy of CBT combined with mood-stabilizer pharmacotherapy for bipolar depression and CBT alone for unipolar depression. Method: A matched-case control design was used to evaluate outcomes following 20 sessions of CBT in 11 depressed bipolar patients and 11 matched recurrent unipolar depressed control subjects. Results: Bipolar depressed patients achieved similar levels of reduction in depressive symptoms following CBT, as did the unipolar depressed group. However, on measures of more pervasive dysfunctional attitudes, bipolar patients did not improve to the same degree. Conclusions: Preliminary findings suggest that CBT warrants further investigation as an effective psychosocial intervention for depression in bipolar patients ...
The British Journal of Psychiatry, 2006
Background Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. Aims To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive–behavioural therapy (CBT). Method We undertook a multicentre, pragmatic, randomised controlled treatment trial (n=253). Patients were assessed every 8 weeks for 18 months. Results More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio=1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P=0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. Conclusions People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority...
Psychoeducational and cognitive-behavioral strategies in the management of bipolar disorder
Journal of Affective Disorders, 2003
Despite advances in the pharmacologic treatment of bipolar disorder, it is clear that additional strategies are needed to provide patients with longer-term mood stability. Recent years have witnessed the development of a number of psychosocial strategies for bipolar disorder that are design as adjuncts to ongoing pharmacotherapy. In this article we describe psychoeducational and cognitive-behavioral approaches to the management of bipolar disorder, with emphasis on broader treatment packages that can be offered by cognitive-behavior therapists working in specialty bipolar clinics, as well as specific strategies that can be integrated into standard pharmacotherapy for the disorder. A growing body of evidence documents the potential value of these interventions, and large-scale studies are underway, including the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), which will provide outcome on these interventions from the perspective of large, multicenter trials.
Is cognitive-behavioural therapy more effective than psychoeducation in bipolar disorder?
Canadian journal of psychiatry. Revue canadienne de psychiatrie, 2008
Psychosocial research in bipolar disorder (BD) has not yet assessed the relative benefits of a short course of psychoeducation (PE), compared with a longer course of cognitive-behavioural therapy (CBT) containing psychoeducational principles. This pilot study evaluated the efficacy and added benefit of adding a course of CBT to a standard course of brief PE, as maintenance therapy for BD. Seventy-nine consenting adult men and women with BD on stable medication regimens, who were in full or partial remission from an index episode (BD I = 52; BD II = 27), were randomized to receive either 7 sessions of individual PE, or 7 sessions of PE followed by 13 additional individual sessions of CBT. Weekly mood and medication adherence was rated using the National Institute of Mental Health's Life Chart Method, while psychosocial functioning and mental health use were assessed monthly. Forty-six participants completed the entire study. Participants who received CBT in addition to PE experie...
Cognitive Therapy for Bipolar Illness—A Pilot Study of Relapse Prevention
Cognitive Therapy and Research, 2000
Twenty-five (25) bipolar patients taking mood stabilizers and yet still relapsing were recruited into a randomized controlled pilot cognitive therapy study. All subjects were taking mood stabilizers on recruitment. The control group had treatment as usual—that is, the usual outpatients and multidisciplinary team input. The therapy group received between 12 and 20 sessions of cognitive therapy adapted for bipolar illness in addition to treatment as usual. Therapy consisted of a relapse prevention approach and lasted 6 months. Independent assessments showed that the therapy group had significantly fewer bipolar episodes, higher social functioning, and better coping strategies for bipolar prodromes. Furthermore, there was evidence of less fluctuation in symptoms of mania and depression, less hopelessness, and better medication compliance from subjects' monthly self reports. There was no evidence that improvement in the therapy group was due to more medication being prescribed. In fact, there were significantly less neuroleptics being prescribed in the therapy group for the 6 months after therapy. A further study with a larger sample size and longer follow-up period is warranted.
Bipolar disorder and cognitive therapy: A commentary
Cognitive and Behavioral Practice, 2005
This article comments on the three articles Newman, 2005; that deal with the applications of cognitive therapy to treatment of bipolar disord~ They focus on the uses of cognitive therapy in treating three important facets of the special problems of bipolar patients: rapid cycling, severe depression/suicidality, and manic states. This article concludes its commentary with several open questions and ideas about the role of thought suppression and rebound processes in the cycling between depressive or euthymic and manic states in bipolar disorder..