Bipolar Affective Disorder; Remission in
Conditions
Keywords
bipolar disorder, CBT, resilience, quality of life, psychiatric nurse
Brief summary
Bipolar disorder (BD) is a chronic and recurrent mood disorder characterized by alternating episodes of mania, depression, or mixed states, interspersed with periods of remission. These episodes can severely impair interpersonal relationships, occupational functioning, and overall quality of life. In 2019, approximately 40 million people worldwide were diagnosed with BD. BD is a lifelong chronic condition despite pharmacotherapy and lifestyle changes. Traditional psychiatric care has primarily focused on symptom reduction and relapse prevention, often overlooking broader psychosocial aspects such as interpersonal functioning and life satisfaction. Recently, recovery has come to include living a meaningful life despite illness-related challenges. Psychological resilience has gained prominence within this recovery framework. It refers to the capacity to adapt positively to adversity, shaped by both internal traits and external supports. Core elements include effective coping, adaptability, and recovery from stress, which support functional outcomes in mental illness. Given the strong link between stress and relapse in BD, resilience is thought to play a critical role in illness trajectory. Research consistently shows that individuals with BD have lower resilience than healthy controls, and resilience is associated with fewer depressive symptoms and better quality of life. Importantly, resilience is modifiable and can be enhanced through psychosocial interventions. Studies highlight the benefits of resilience-building programs in reducing depressive vulnerability and improving life satisfaction and emotion regulation. Among these, CBT effectively promotes cognitive and functional recovery in BD by targeting maladaptive thought patterns and building adaptive coping skills. Despite growing evidence, few CBT-based interventions target resilience in individuals with BD. However, resilience is linked to key psychosocial competencies such as problem-solving, self-efficacy, assertiveness, and self-management. Based on this, the current study implemented a CBT-based Psychological Resilience Enhancement Program designed to strengthen adaptive coping and functional adjustment in individuals with BD. Considering the substantial personal and societal burden of BD, enhancing psychological resilience is a critical therapeutic goal. This study aimed to evaluate the effects of a CBT-based intervention on psychological resilience and quality of life in individuals with BD.
Interventions
BEHAVIORALCBT-Based Psychological Resilience Enhancement Program for Individuals with BD
Session 1 (Psychoeducation): Enhancing knowledge and insight regarding Bipolar Disorder via Socratic questioning and case formulation. Session 2 (Locus of Control): Shifting belief from external determinism to an internal locus of control using pie charts and didactic instruction. Session 3 (Self-Management): Acquiring skills to manage early warning signs and high-risk behaviors. Session 4 (Coping with Stress): Developing and implementing effective coping strategies. Session 5 (Problem-Solving): Utilizing a structured approach to resolve daily life problems. Session 6 (Thoughts and Emotions): Identifying emotional reactions to stimuli using the downward arrow technique, playing devil's advocate, and imagery. Session 7 (Realistic Thoughts): Fostering cognitive flexibility through examining evidence and evaluating thought functionality. Session 8 (Social Skills): Establishing external support systems to reinforce self-esteem and self-efficacy via role-playing.
Sponsors
Cumhuriyet University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
A randomized controlled trial with a pretest-posttest-follow-up design was conducted between May 2021 and April 2023. Twenty-two participants were randomly assigned to an intervention group (n = 10), which completed an eight-week CBT-based resilience program, or a control group (n = 12), which received standard care. Psychological resilience and quality of life were assessed at baseline, post-intervention (week 9), and follow-up (week 21) using the Connor-Davidson Resilience Scale (CD-RISC) and the Brief Quality of Life in Bipolar Disorder Scale (Brief QoL.BD).
Intervention model description
A randomized controlled trial with a pretest-posttest-follow-up design was conducted between May 2021 and April 2023. Twenty-two participants were randomly assigned to an intervention group (n = 10), which completed an eight-week CBT-based resilience program, or a control group (n = 12), which received standard care. Psychological resilience and quality of life were assessed at baseline, post-intervention (week 9), and follow-up (week 21) using the Connor-Davidson Resilience Scale (CD-RISC) and the Brief Quality of Life in Bipolar Disorder Scale (Brief QoL.BD). Data were analyzed using independent samples t-tests and repeated measures ANOVA. Effect sizes were calculated to assess clinical relevance.
Eligibility
Sex/Gender
ALL
Age
18 Years to 60 Years
Healthy volunteers
No
Inclusion criteria
* Aged between 18 and 60 years * Minimum of primary school education * Ability to communicate verbally * Score ≤ 5 on the YMRS * Score ≤ 17 on the BDI * Residence within the city center * Voluntary participation with signed informed consent
Exclusion criteria
* Diagnosis of intellectual disability * Speech or hearing impairment * Presence of comorbid psychiatric disorders
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Connor-Davidson Resilience Scale (CD-RISC) | Baseline, 9 week and 21. week | Connor-Davidson Resilience Scale (CD-RISC): Developed by Connor and Davidson in 2003 to measure individuals' psychological resilience, this scale primarily focuses on stress, coping, and adaptability. It is a 25-item, five-point Likert-type scale, with each item evaluated between 0 and 4, ranging from "not true at all" (0 points) to "true nearly all the time" (4 points). The maximum achievable score on the scale is 100. Higher scores denote greater psychological resilience, whereas lower scores indicate reduced resilience. During its development phase, the scale was administered to both normative and clinical populations. Data collected face-to-face via clinical interview |
| Brief Quality of Life in Bipolar Disorder Scale (Brief QoL.BD) | Baseline, 9. week and 21. week | Brief Quality of Life in Bipolar Disorder Scale (Brief QoL.BD): Developed by Michalak and Murray (2010) to evaluate the quality of life in patients with bipolar disorder. It is a 12-item quality of life scale specifically designed for bipolar disorder. It comprises one item for each of the following core domains: physical health, sleep, mood, cognition, leisure, social relationships, spirituality, finances, household, self-esteem, independence, and identity. The scale is rated on a five-point Likert scale ranging from 1 ("strongly disagree") to 5 ("strongly agree"), yielding a total score between 12 and 60. Higher scores indicate a better quality of life. Data collected face-to-face via clinical interview |
| Beck Depression Inventory (BDI) | Baseline, 9. week and 21. week | Beck Depression Inventory (BDI): This scale consists of 21 items designed to measure the affective, somatic, cognitive, and motivational symptoms of depression, with each item scored on a scale from 0 to 3. The total possible score ranges from 0 to 63. The assessment is based on the cumulative score obtained from all items, where higher scores indicate greater depression severity. In the present study, the BDI was utilized to verify the remission status required for the inclusion of patients diagnosed with bipolar disorder. Patients who scored 17 or lower on the inventory were included in the research. Data collected face-to-face via clinical interview |
| Young Mania Rating Scale (YMRS) | Baseline, 9. week and 21. week | Young Mania Rating Scale (YMRS): Developed by Young et al. in 1978, this scale is utilized to assess the severity of manic states. It comprises 11 Likert-type items, each assessing symptom severity across five levels. The total score ranges from 0 to 60, with higher scores denoting increased mania severity. In the current study, the YMRS was employed to confirm the remission status necessary for the inclusion of patients with bipolar disorder. Patients obtaining a score of 5 or lower on the scale were eligible for inclusion. Data collected face-to-face via clinical interview |
Countries
Turkey (Türkiye)
Contacts
PRINCIPAL_INVESTIGATORAYŞE AKSOY, Dr.
Karaman Training and Research Hospital
Outcome results
None listed