title: Bipolar disorder with comorbid anxiety disorders: impact of comorbidity on treatment outcome in cognitive-behavioral therapy and psychoeducation.
abstract: BACKGROUND
  Comorbid anxiety disorders are extremely prevalent in bipolar disorder (BD) and have substantial impact on the course of illness. Limited evidence regarding treatment factors has led to a renewal of research efforts examining both the impact of treatments on comorbid anxiety and the impact of comorbid anxiety on treatments. The current study examines the impact of comorbid anxiety disorders on response to two psychosocial interventions for BD.
  
  
  METHODS
  A sample of 204 patients with BD took part in the study. Of them, 41.7% had a comorbid anxiety disorder. All participants received either individual cognitive-behavioral therapy or group psychoeducation for BD. Evaluations included complete pretreatment and 18-month follow-up assessments of mood and anxiety symptoms, functioning, medication compliance, dysfunctional attitudes, and coping style. Outcome was compared based on the presence or absence of a comorbid anxiety disorder.
  
  
  CONCLUSIONS
  The participants with comorbid anxiety disorders ranked more severe than those without on several measures. Despite more severe illness characteristics, the magnitude of their treatment gains was equivalent or superior to that of the participants without anxiety disorders on a variety of outcome measures. Although the treatments did not specifically target the anxiety disorder, the participants made significant improvements in anxiety symptoms. Despite greater illness severity, patients with comorbid anxiety disorders can make substantial gains from psychosocial interventions targeting BD. Even in the presence of an anxiety disorder, they are able to attend to the content of the psychosocial treatments and apply it to better manage their condition. The presence of a comorbid anxiety disorder should not be considered a deterrent to offering BD-focused psychosocial treatments.
authors.affiliation: Université de Saint-Boniface, Suite 2237, 200 Cathedral Avenue, Winnipeg, Manitoba R2H 0H7 Canada ; University Health Network, Toronto, Canada.
authors.forename: Lisa D
authors.initials: LD
authors.lastname: Hawke
authors.affiliation: York University, Toronto, Canada ; Adler International Learning, Toronto, Canada.
authors.forename: Vytas
authors.initials: V
authors.lastname: Velyvis
authors.affiliation: University Health Network, Toronto, Canada ; University of Toronto, Toronto, Canada.
authors.forename: Sagar V
authors.initials: SV
authors.lastname: Parikh
keywords: Anxiety disorders; Bipolar disorder; Cognitive-behavioral therapy; Comorbidity; Psychoeducation