The Effect of Group Cognitive-Behavior Therapy in Combination with Pharmacotherapy on Mania and Depression Symptoms and Awareness of Warning Signs of Relapse in Patients with Bipolar Disorder

By Masoudi, Shahed; Gharavi, Morteza Modares et al. | Iranian Journal of Psychiatry, April 1, 2009 | Go to article overview

The Effect of Group Cognitive-Behavior Therapy in Combination with Pharmacotherapy on Mania and Depression Symptoms and Awareness of Warning Signs of Relapse in Patients with Bipolar Disorder


Masoudi, Shahed, Gharavi, Morteza Modares, Hashemabadi, B. Ghanbari, Haghighi, Amir-Reza, Iranian Journal of Psychiatry


Objective: This research has been done according to the cognitive-behavioral theories and biochemical model in order to evaluate the efficiency of Group Cognitive-Behavior Therapy in combination with Pharmacotherapy on Mania and Depression Symptoms and Awareness of warning signs of relapse in patients with Bipolar Disorder.

Methods: In this study with the experimental pretest- posttest- follow up plan , 30 women suffering from bipolar disorder, randomly assigned to receive either the group cognitive-behavior therapy (experimental group, n=15) or usual treatment (control group, n=15);and were follow-up for a six months. patients in both groups were prescribed standard Pharmacotherapy. First all subjects were put to a pretest in equal conditions with measures of scale 2 and 9 of MMPI Test, and warning signs checklist. Then the experimental group received group cognitive-behavior therapy for 8 sessions in addition to their medication therapy. The control group only received medicine. At the end of the experiment, all subjects were tested under equal conditions. After completion of the treatment process, the subjects of both groups were supervised for 6 months. The findings of the study were analyzed by the statistical method of Multi-variable analysis of variance with repetitive measurements.

Results: The findings showed that the group cognitive-behavior therapy had been significantly more efficient in reduction of mania symptoms {p=0/03} and increment of awareness of warning signs of relapse {p=0/00} in comparison with control group; but there is no significantly differences in depression symptoms between two groups.

Conclusion: The findings of this study suggest the beneficial effect of Group cognitive-behavior therapy in reducing of mania symptoms and increment of awareness of warning signs of relapse. Therefore, it can be used as a complementary treatment by clinicians.

Keywords: Behavior therapy, Bipolar disorder, Cognitive therapy, Group psychotherapy, Recurrence, Secondary prevention

Iran J Psychiatry 2009; 4:67-73

Research on the use of psychosocial interventions in treatment of mood disorders is widely focuses on its use to treat Major depression, but there is little work on bipolar disorder, mania, dysthymia and other mood disorders (1).

Bipolar disorder is a common disorder with prevalence rate of 1-2% (2) that results in significant psychosocial impairment, including diminished quality of life and functioning (3).

The main and central core of research and treatment in bipolar disorder is made of biological-medical models

while few biological variables have been detected which are capable of forecasting disorder periods (4).

In addition, although genetic findings indicate heritability, they also provide evidence for a significant role for other factors (5). Also, there are strong evidence that psycho-social variables are capable of forecasting the course of bipolar disorder. For instance, high stress in long periods increases the possibility that the patient displays symptoms of bipolar disorder (6). Also, the negative life events have been found to influence the course of recovery from episodes in patients with bipolar disorder. For example, in a study of 67 patients during hospitalization for depression or mania, negative life events were associated with threefold increase in time for recovery (5). Thus there are strong reasons for taking strategies towards lowering family conflicts, life stresses and social isolation to overcome such symptoms. Also, despite advance in the pharmacotherapy treatment of bipolar disorder, it is clear that to provide patients with longerterm mood stability, additional strategies are needed (7). some patient do not follow medicinal treatment procedures such as lithium, carbamazepine, and valproate (6). A group of patients cannot tolerate the side effects of medicines and therefore do not follow it (2). some other patients are prohibited from taking such medicines due to their complicated conditions such as hypertension, renal dysfunction or pregnancy (6).

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