Brief Research Report: A Pilot Study of Cognitive Behavioral Regulation Therapy (CBT-REG) for Young People at High Risk of Early Transition to Bipolar Disorders

Abstract

Attempts to increase early identification of individuals in the early stages of bipolar disorders (i.e., individuals at high risk of bipolar disorders and/or experiencing a subthreshold syndrome with bipolar symptoms) have highlighted the need to develop high benefit-low risk interventions. We suggest that any new psychological therapy should (i) be acceptable to young people seeking help for the first time, (ii) be applicable to “at risk” conditions and sub-syndromal states and (iii) consider pluripotent factors that may be linked to illness progression not only for bipolar disorders specifically but also for other potential disease trajectories. However, evidence indicates that current interventions for youth with emerging mood disorders mainly represent approaches abbreviated from “disorder-specific” therapies used with older adults and are primarily offered to first episode cases of bipolar disorders who are also receiving psychotropic medication. This brief report discusses empirical findings used to construct core targets for therapeutic interventions that might reduce or delay transition to full-threshold bipolar disorders. We describe an intervention that includes strategies for problem-solving, reducing sleep-wake cycle disturbances, self-management of rumination and that addresses the needs of individuals with “sub-threshold” presentations who are probably at risk of developing a bipolar or other major mental disorders. Outcome data from a case series of 14 youth indicates that the intervention appears to demonstrate a relatively high benefit-to-risk ratio, promising levels of engagement with the therapy modules, and the therapy appears to be acceptable to a wide range of help-seeking youth with early expressions of bipolar psychopathology.

Self-regulation in youth with bipolar disorder

“… 68 Recent studies have begun to show the results of cognitive behavioral therapy (CBT) for ER. 69 , 70 Yang et al 69 investigated the efficacy of 12 weeks of Mindfulness-Based Cognitive Therapy for Children (MBCT-C) on structural brain networks for mood-dysregulated youth with familial risk for BD and found that, after MBCT-C, disrupted topological properties in the mood-dysregulated group were significantly reduced. A pilot study by Scott & Meyer 70 investigated the effects of Cognitive Behavioral Regulation Therapy (CBT-REG) for young people at high risk of PBD, with outcome data indicating that the intervention appears to demonstrate a relatively high benefit-to-risk ratio.…”