The Effect of Group Cognitive Behavioral Therapy on Cognitive Emotion Regulation Strategies of Adolescents with Bipolar Disorder during their Euthymic Phase: A Randomized Controlled Trial

Abstract

Abstract Background and objective: Bipolar disorder (BD) is defined as emotion dysregulation. Since such dysregulation is also present during remission, it may be a risk factor for the development of further affective episodes. Therefore, this study examined the effectiveness of group cognitive behavioral therapy (GCBT), in comparison to treatment as usual (TAU), on the cognitive emotion regulation strategies of patients with BD. Patients and Methods: This single-blind randomized controlled trial was performed in 2015 to 2016 at the psychiatric clinic of Razi University Hospital (Tabriz, Iran). A total of 70 convenient remitted adolescents with early-onset BD according to the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision (DSM-IV-TR) were allocated to receive either 12 sessions of GCBT (n = 35) or TAU (n = 35). Cognitive emotion regulation strategies were evaluated by Cognitive Emotion Regulation Questionnaire (CERQ) at baseline, after the intervention, and at three-month follow-up. Efforts were made to follow up all randomized participants even if they withdrew from the assigned treatment prior to completion of GCBT sessions. Results: Compliance to treatment was moderate and the mean number of GCBT sessions participants attended was 6.97 (2.81). The two groups had significant differences in terms of post-test scores for other-blame (P< 0.001), rumination (P= 0.049), positive refocus (P= 0.008), positive reappraisal (P= 0.005), and putting into perspective (P< 0.001). In three-month follow-up, the two groups were significantly different only in other-blame (P< 0.001), positive reappraisal (P< 0.001), and putting into perspective subscales (P= 0.001). Therefore, the effects of the intervention were not effectively sustained after three months and there is room for improvement in terms of both outcome and compliance. Conclusions: The GCBT is more effective when the participants are involved in the study and get instructions on emotion regulation. However, since the effects of the intervention were not sustained for most of the subscales after three months, booster sessions might improve and prolong the effectiveness of psychotherapies.