Feasibility and Acceptability of the ‘HABIT’ Group Programme for Comorbid Bipolar and Alcohol and Substance use Disorders

Abstract

This small pilot study suggests our intensive group therapy is acceptable and feasible. If findings are replicated, we may have identified a therapy that, for the first time, leads to improvement in both mood and substance use outcomes in clients with difficult-to-treat comorbid BD-ASUD. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message Comorbidity between bipolar and alcohol and substance use disorders (BD-ASUD) is frequent and highly disabling; Therapeutic research on approaches that can simultaneously help BD and ASUD is lacking; Previous research highlights the need for integrated treatment of both conditions but showed improvements limited to either element of the comorbid disorder; This pilot study supports the feasibility and acceptability of an intensive, 14-session group therapy programme that integrates CBT and mindfulness approaches.

The effectiveness of adjunct mindfulness-based intervention in treatment of bipolar disorder: A systematic review and meta-analysis

“…After excluding five studies with mixed populations of patients (e.g. both patients with BD and major depression joined together) (Crane et al, 2008;Garland et al, 2016;Hamilton et al, 2012;Kenny and Williams, 2007;Ramel et al, 2004)(full details in Figure 1 and Supplementary Table 2), 12 articles met the inclusion criteria (Biseul et al, 2016;Bos et al, 2014;Deckersbach et al, 2012;Howells et al, 2014;Ives-Deliperi et al, 2013;Miklowitz et al, 2009;Miklowitz et al, 2015;Perich et al, 2013a;Perich et al, 2013b;Stange et al, 2011;Weber et al, 2010;Williams et al, 2008) ( Table 1). The enrolled studies included 274 participants (68.5% female), with a mean age of 41.1 (standard deviation (SD)=10.7) years.…”

“…The remaining nine studies were uncontrolled studies and included 142 participants (mean age = 41.8 (SD=10.8) years, mean proportion of females = 73.7%) (Biseul et al, 2016;Bos et al, 2014;Deckersbach et al, 2012;Howells et al, 2014;Miklowitz et al, 2009;Miklowitz et al, 2015;Perich et al, 2013a;Stange et al, 2011;Weber et al, 2010). The baseline mood characteristics of the participants in these selected studies were euthymic (defined as a HADS score < 10 and YMRS score <4) (Howells et al, 2014), in remission (defined as meeting the DSM-IV-TR or National Institute of Mental Health (NIMH) criteria) (Miklowitz et al, 2009;Williams et al, 2008), or residual depressive or manic symptoms (Biseul et al, 2016;Deckersbach et al, 2012;Ives-Deliperi et al, 2013;Miklowitz et al, 2015;Perich et al, 2013a;Perich et al, 2013b;Stange et al, 2011;Weber et al, 2010) (Supplementary Table 5).…”

“…Of them, 10 used MBCT (Deckersbach et al, 2012;Howells et al, 2014;Ives-Deliperi et al, 2013;Miklowitz et al, 2009;Miklowitz et al, 2015;Perich et al, 2013a;Perich et al, 2013b;Stange et al, 2011;Weber et al, 2010;Williams et al, 2008), one used mindfulness-based relapse prevention (MBRP) (Biseul et al, 2016), and one used mindfulness training (Bos et al, 2014). The duration of mindfulness therapy in these studies was 8 (Biseul et al, 2016;Bos et al, 2014;Howells et al, 2014;Ives-Deliperi et al, 2013;Miklowitz et al, 2009;Miklowitz et al, 2015;Perich et al, 2013a;Perich et al, 2013b;Weber et al, 2010;Williams et al, 2008) or 12 weeks (Deckersbach et al, 2012;Stange et al, 2011). Six of the studies provided follow-up data (at 1, 3, 6, and 12 months after the MBIs) (Deckersbach et al, 2012;Miklowitz et al, 2015;Perich et al, 2013a;Perich et al, 2013b;Stange et al, 2011;Weber et al, 2010).…”

“…However, relatively few studies have investigated the effect of MBIs on treatment outcomes in patients with BD. Uncontrolled (Biseul et al, 2016;Bos et al, 2014;Crane et al, 2008;Deckersbach et al, 2012;Howells et al, 2014;Miklowitz et al, 2009;Miklowitz et al, 2015;Murray et al, 2015;Perich et al, 2013a;Stange et al, 2011;Weber et al, 2010) and controlled trials (Ives-Deliperi et al, 2013;Perich et al, 2013b;Van Dijk et al, 2013;Williams et al, 2008) have shown that the combination of MBIs with pharmacotherapy and treatment as usual (TAU) can have beneficial effects for patients with BD. Furthermore, a previous functional magnetic resonance imaging study showed the potential involvement and beneficial effects of MBIs in specific neural circuits underlying emotional regulation (Opialla et al, 2015), which is one of the main core inter-episode symptoms in BD (Gruber, 2011).…”

“…Whilst helpful, the generic focus, the fact that only two trials involving participants with BD were included, and failure to consider core symptoms of BD such as mania (Chiesa and Serretti, 2011), limits the conclusions regarding the efficacy of MBIs in patients with BD. More recently, several uncontrolled clinical trials examined the effectiveness of MBIs in patients with BD (Biseul et al, 2016;Bos et al, 2014;Miklowitz et al, 2015;Murray et al, 2015), however no dedicated systematic review and meta-analysis has investigated the use of MBIs as treatment for BD.…”