A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: a Canadian Network for Mood and Anxiety treatments (CANMAT) study [CME].
OBJECTIVE
Bipolar disorder is insufficiently controlled by medication, so several adjunctive psychosocial interventions have been tested. Few studies have compared these psychosocial treatments, all of which are lengthy, expensive, and difficult to disseminate. We compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive and longer individual cognitive-behavioral therapy intervention, measuring longitudinal outcome in mood burden in bipolar disorder.


METHODS
This single-blind randomized controlled trial was conducted between June 2002 and September 2006. A total of 204 participants (ages 18-64 years) with DSM-IV bipolar disorder type I or II participated from 4 Canadian academic centers. Subjects were recruited via advertisements or physician referral when well or minimally symptomatic, with few exclusionary criteria to enhance generalizability. Participants were assigned to receive either 20 individual sessions of cognitive-behavioral therapy or 6 sessions of group psychoeducation. The primary outcome of symptom course and morbidity was assessed prospectively over 72 weeks using the Longitudinal Interval Follow-up Evaluation, which yields depression and mania symptom burden scores for each week.


RESULTS
Both treatments had similar outcomes with respect to reduction of symptom burden and the likelihood of relapse. Eight percent of subjects dropped out prior to receiving psychoeducation, while 64% were treatment completers; rates were similar for cognitive-behavioral therapy (6% and 66%, respectively). Psychoeducation cost $180 per subject compared to cognitive-behavioral therapy at $1,200 per subject.


CONCLUSIONS
Despite longer treatment duration and individualized treatment, cognitive-behavioral therapy did not show a significantly greater clinical benefit compared to group psychoeducation. Psychoeducation is less expensive to provide and requires less clinician training to deliver, suggesting its comparative attractiveness.


BACKGROUND
ClinicalTrials.gov identifier: NCT00188838.
Department of Psychiatry, University of Toronto, Toronto, Ontario. sagar.parikh@uhn.ca
Sagar V
SV
Parikh
Ari
A
Zaretsky
Serge
S
Beaulieu
Lakshmi N
LN
Yatham
L Trevor
LT
Young
Irene
I
Patelis-Siotis
Glenda M
GM
Macqueen
Anthony
A
Levitt
Tamara
T
Arenovich
Pablo
P
Cervantes
Vytas
V
Velyvis
Sidney H
SH
Kennedy
David L
DL
Streiner
D000293:Adolescent; D000328:Adult; D001714:Bipolar Disorder / Q000191:economics / Q000628:therapy*; D002170:Canada; D015928:Cognitive Behavioral Therapy / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010352:Patient Dropouts / Q000706:statistics & numerical data; D010353:Patient Education as Topic / Q000379:methods* / Q000706:statistics & numerical data; D011615:Psychotherapy, Group / Q000191:economics / Q000379:methods* / Q000706:statistics & numerical data; D016037:Single-Blind Method