title: Psychotherapies for comorbid anxiety in bipolar spectrum disorders.
abstract: BACKGROUND
  Comorbid anxiety disorders are highly prevalent in bipolar disorder and have been shown to have serious negative impacts on the course of illness. The pharmacological treatment of anxiety can interact with the bipolar disorder and has not been proven effective. As such, many have recommended the psychological treatment of anxiety. This paper reviews the literature on psychological treatments for anxiety comorbid to bipolar disorder.
  
  
  METHODS
  The Medline, PsychInfo and Web of Science databases were thoroughly examined for relevant treatment studies.
  
  
  RESULTS
  Despite frequent recommendations in the literature, surprisingly few have studied the psychological treatment of comorbid anxiety in bipolar disorders. Nevertheless, preliminary results suggest that comorbid anxiety disorders can be effectively treated in a bipolar clientele using cognitive-behavioral therapy, mindfulness-based cognitive-behavioral therapy or relaxation training. In contrast, interpersonal, family therapy and psychoeducation alone would not seem to be beneficial treatment alternatives for anxiety. Cognitive-behavioral therapy appears to reduce the symptoms of obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, post-traumatic stress disorder and general symptoms of anxiety among patients with bipolar disorder. However, the long-term maintenance of anxiety treatment effects may be somewhat reduced and adaptations may be called for to augment and sustain benefits.
  
  
  CONCLUSIONS
  There is an urgent need for randomized controlled trials of different forms of psychotherapy for anxiety disorders comorbid to bipolar disorder. Until such trials are available, the most promising approach would appear to be the sequential or modular CBT-based treatment of the anxiety disorder.
authors.affiliation: École de psychologie, Université Laval, Canada. Martin.Provencher@psy.ulaval.ca
authors.forename: Martin D
authors.initials: MD
authors.lastname: Provencher
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Hawke
authors.forename: Emmanuelle
authors.initials: E
authors.lastname: Thienot
mesh_terms: D014151:Anti-Anxiety Agents / Q000627:therapeutic use; D001007:Anxiety; D001008:Anxiety Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D001010:Anxiety, Separation / Q000188:drug therapy; D001714:Bipolar Disorder / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D015897:Comorbidity; D006801:Humans; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D016584:Panic Disorder / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D015995:Prevalence; D011613:Psychotherapy / Q000379:methods*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology
chemical_list: D014151:Anti-Anxiety Agents