title: Group acceptance and commitment therapy (ACT) for bipolar disorder and co-existing anxiety - an open pilot study.
abstract: Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and Action Questionnaire - AAQ-2) before, during and after the treatment. At post-treatment, the participants reported significant improvements in all outcome measures, with large effects (Cohen's d between 0.73 and 1.98). The mean reduction in anxiety symptoms was 45%. At post-treatment, 96% of the patients were classified as responders on at least one of the outcome measures. A limitation is that the trial is uncontrolled. The results suggest that ACT has the potential to be an effective treatment for BD patients with co-existing anxiety. Further randomized studies are warranted.
authors.affiliation: a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden  .
authors.forename: Sara
authors.initials: S
authors.lastname: Pankowski
authors.affiliation: a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden  .
authors.forename: Mats
authors.initials: M
authors.lastname: Adler
authors.affiliation: a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden  .|b Department of Behavioural Sciences and Learning , Linköping University , Linköping , Sweden.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Andersson
authors.affiliation: a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden  .
authors.forename: Nils
authors.initials: N
authors.lastname: Lindefors
authors.affiliation: a Department of Clinical Neuroscience , Karolinska Institutet , Stockholm , Sweden  .
authors.forename: Cecilia
authors.initials: C
authors.lastname: Svanborg
mesh_terms: D064869:Acceptance and Commitment Therapy / Q000379:methods*; D000328:Adult; D001007:Anxiety / Q000453:epidemiology / Q000628:therapy*; D001714:Bipolar Disorder / Q000453:epidemiology / Q000628:therapy*; D006801:Humans; D017063:Outcome Assessment, Health Care; D010865:Pilot Projects; D011615:Psychotherapy, Group / Q000379:methods*
keywords: Acceptance and commitment therapy; anxiety; bipolar disorder; quality of life