title: Psychological therapy for anxiety in bipolar spectrum disorders: a systematic review.
abstract: Comorbid anxiety is common in bipolar spectrum disorders [BPSD], and is associated with poor outcomes. Its clinical relevance is highlighted by the "anxious distress specifier" in the revised criteria for Bipolar Disorders in the Diagnostic and Statistical Manual 5th Edition [DSM-5]. This article reviews evidence for the effectiveness of psychological therapy for anxiety in adults with BPSD (bipolar I, II, not otherwise specified, cyclothymia, and rapid cycling disorders). A systematic search yielded 22 treatment studies that included an anxiety-related outcome measure. Cognitive behavioural therapy [CBT] for BPSD incorporating an anxiety component reduces anxiety symptoms in cyclothymia, "refractory" and rapid cycling BPSD, whereas standard bipolar treatments have only a modest effect on anxiety. Preliminary evidence is promising for CBT for post-traumatic stress disorder and generalised anxiety disorder in BPSD. Psychoeducation alone does not appear to reduce anxiety, and data for mindfulness-based cognitive therapy [MBCT] appear equivocal. CBT during euthymic phases has the greatest weight of evidence. Where reported, psychological therapy appears acceptable and safe, but more systematic collection and reporting of safety and acceptability information is needed. Development of psychological models and treatment protocols for anxiety in BPSD may help improve outcomes.
authors.affiliation: Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK; Highfield Unit Oxford, Oxford Health NHS Foundation Trust, Oxford, UK. Electronic address: emily.holmes@mrc-cbu.cam.ac.uk.
authors.forename: Hannah J
authors.initials: HJ
authors.lastname: Stratford
authors.affiliation: Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK.
authors.forename: Myra J
authors.initials: MJ
authors.lastname: Cooper
authors.affiliation: MRC Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Martina
authors.initials: M
authors.lastname: Di Simplicio
authors.affiliation: MRC Cognition and Brain Sciences Unit, Cambridge, UK.
authors.forename: Simon E
authors.initials: SE
authors.lastname: Blackwell
authors.affiliation: MRC Cognition and Brain Sciences Unit, Cambridge, UK; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden. Electronic address: emily.holmes@mrc-cbu.cam.ac.uk.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Holmes
mesh_terms: D001008:Anxiety Disorders / Q000150:complications* / Q000628:therapy*; D001714:Bipolar Disorder / Q000150:complications* / Q000628:therapy*; D006801:Humans; D011613:Psychotherapy / Q000379:methods*
keywords: Anxiety; Anxiety comorbidity; Bipolar disorder; Bipolar spectrum disorders; Cognitive behaviour therapy; Psychological therapy