Cognitive remediation therapy for patients with bipolar disorder: A randomised proof‐of‐concept trial

Abstract

Objectives Cognitive remediation therapy (CRT) may benefit people with bipolar disorder type I and II for whom cognitive impairment is a major contributor to disability. Extensive research has demonstrated CRT to improve cognition and psychosocial functioning in people with different diagnoses, but randomised trials of evidenced therapy programmes are lacking for bipolar disorders. The Cognitive Remediation in Bipolar (CRiB) study aimed to determine whether an established CRT programme is feasible and acceptable for people with bipolar disorders. Methods This proof‐of‐concept, single‐blind randomised trial recruited participants aged 18‐65 with bipolar disorder, not currently experiencing an episode. They were 1:1 block randomised to treatment‐as‐usual (TAU) with or without individual CRT for 12 weeks. The partly computerised CRT programme (“CIRCuiTS”) was therapist‐led and is evidence‐based from trials in those with psychotic illnesses. Data were collected and analysed by investigators blinded to group allocation. The main outcomes (week 13 and 25) examined participant retention, intervention feasibility and putative effects of CRT on cognitive and psychosocial functioning via intention‐to‐treat analyses. Trial registration: ISRCTN ID32290525. Results Sixty participants were recruited (02/2016‐06/2018) and randomised to CRT (n = 29) or TAU (n = 31). Trial withdrawals were equivalent (CRT n = 2/29; TAU n = 5/31). CRT satisfaction indicated high acceptability. Intention‐to‐treat analyses (N = 60) demonstrated greater improvements for CRT‐ than TAU‐randomised participants: at both week 13 and 25, CIRCuiTS participants showed larger improvements in the following domains (week 25 effect sizes reported here): IQ (SES = 0.71, 95% CI [0.29,1.13]), working memory (SES = 0.70, 95% CI [0.31,1.10]), executive function (SES = 0.93, 95% CI [0.33,1.54]), psychosocial functioning (SES = 0.49, 95% CI [0.18,0.80]) and goal attainment (SES = 2.02, 95% CI [0.89,3.14]). No serious adverse events were reported. Conclusions CRT is feasible for individuals with bipolar disorders and may enhance cognition and functioning. The reported effect sizes from this proof‐of‐concept trial encourage further investigation in a definitive trial.

Inflammatory biomarkers and cognitive functioning in individuals with euthymic bipolar disorder: exploratory study

“…This study is a secondary analysis of cross-sectional (baseline) data from the Cognitive Remediation in Bipolar (CRiB) study. 8 Methodological details of the CRiB study have been described previously. 8 , 31 The CRiB study investigated a sample of 60 participants; the present analysis focuses on a subsample of 44 individuals who provided blood for biomarker analysis ( N = 44), which was an optional assessment in the CRiB study.…”

Role of cognitive reserve in cognitive variability in euthymic individuals with bipolar disorder: cross-sectional cluster analysis

“…This is a cross-sectional secondary analysis of baseline data from the Cognitive Remediation in Bipolar (CRiB) study, a feasibility trial comparing cognitive remediation with treatment as usual in people with bipolar disorder. 20,21 Written informed consent was obtained from all participants prior to inclusion. Baseline assessments were undertaken before random allocation to the treatment or the control group.…”

Does cognitive improvement translate into functional changes? Exploring the transfer mechanisms of cognitive remediation therapy for euthymic people with bipolar disorder

“…Although treatment effects on cognition and functioning were previously estimated (Strawbridge et al, 2021), this analysis was repeated since we considered an extended sample for this study. Repeated measures ANOVAs were conducted to assess the main effects of treatment group, time and a group × time interaction effect on cognitive and functional outcomes.…”

“…The characteristics of the CR paradigm we used for CRiB may explain how cognitive changes exert an effect on psychosocial functioning (Strawbridge et al, 2021). CIRCuiTS prompts the development and use of strategies to compensate for potential cognitive shortcomings, while a substantial part of therapy time is devoted to how participants can transfer newly acquired Psychological Medicine strategies and cognitive skills to daily-life activities and personal goals (Reeder et al, 2016).…”

“…For people with BD, evidence for the potential benefits of CR is still emerging and more high-quality randomized trials are required to establish these effects (Bellani et al, 2019;Tsapekos et al, 2020a). Recent trials report promising findings for the effect of CR on functional outcomes (Bernabei et al, 2020;Lengvenyte, Coppola, Jaussent, Courtet, & Olié, 2020;Strawbridge et al, 2021). According to a CR model, changes in functioning are not only explained by a direct effect of the therapy, but can also be attributed to the indirect effect that cognitive improvements have on functioning (Wykes & Spaulding, 2011).…”