The Effectiveness of Compassion-focused  Therapy on Patients with Bipolar Disorder,  A Randomized Clinical Trial: The Effectiveness of Compassion-focused Therapy on Patients with Bipolar Disorder

Forouzan Behrouzian; Hatam Boostani; Esmaeil Mousavi Asl; Neda Sadrizadeh; Shima Nemati Jole Karan

doi:10.31661/gmj.v13i.3359

Authors

Forouzan Behrouzian Department of Psychiatry, Golestan Hospital ,School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Hatam Boostani Department of Psychiatry, Golestan Hospital ,School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Esmaeil Mousavi Asl Department of Psychiatry, Golestan Hospital ,School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Neda Sadrizadeh Department of Psychiatry, Golestan Hospital ,School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
Shima Nemati Jole Karan Department of Psychiatry, Golestan Hospital ,School of Medicine, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

DOI:

https://doi.org/10.31661/gmj.v13i.3359

Keywords:

Compassion-focused; Psychotherapy; Clinical Trial; Therapy; Bipolar Disorder

Abstract

Background: Multifarious complications are attributed to the bipolar disorder; while existing treatments are not yet fully effective. we evaluated effects of Compassion-focused therapy (CFT), an integrated psychological technique to include kinder thinking habit. Materials and Methods: This was a randomized trial (IRCT20211206053298N1) on a total of 26 individuals satisfying the diagnostic criteria for bipolar disorder who were allocated in two study arms by simple random allocation method, first receiving both CFT and conventional therapy (n=13) and seconds receiving traditional therapy alone (n=13). Compassion-focused therapy received consisted of ten sessions of CFT in conjunction with the customary treatment. Various psychological constructs, including self-compassion, self-criticism, shame, and distress associated with bipolar disorder were examined at beginning of study, after finishing the sessions, and 2 months later. Data analysis involved using repeated measures analysis of variance (RM-ANOVA) with statistically significant threshold of under 0.05 in SPSS V. 21. Results: There were no differences in educational level, gender, occupation, history of hospitalization, medical illness, and marital status between the study groups (P>0.05). There was a significant difference in trend of changes of studied variables. Intervention group showed a significant sharp decrease in shame (from baseline value of 12.76±4.38 to 4.46±7.26 two months later), self-criticism scores (26.61±6.57 at baseline and 14.76±5.74 at two-months period), and distress scores (21.0±2.29 at baseline to 11.75 ±2.00 at two-months period) from study beginning to final follow up that also had a more substantial decline than the control group (P<0.05). Both groups showed increased self-compassion score during the time with no differences among their increasing trend (P=0.725).
Conclusion: The effect of CFT on the psychological treatment outcomes for individuals diagnosed with bipolar disorder appears to be significant, while it was not as effective on the self-compassion score. So, further studies would be helpful to draw a more precise conclusion.

References

Medscape. com. Bipolar Affective Disorder: 2011; Available from http://emedicine.medscape.com /article /286342.

Melisa S. Bipolar disorder. 1st ed. USA: NH; 2002: 1-12.

Barekatin M, Tavakkoli M, Molavi H, Maroofi M, Salehi M. (2007) Normality, reliability, and validity of Young Mania Rating Scale. Journal of Psychology. 2007; 2: 150-167.

Diagnostic and Statistical Manual of Mental Disorders. Fifth Edition. England, London: American.Psychiatric Association; 2013.

Merikangas KR, Akiskal HS, Angst J, Greenberg PE, Hirschfeld RM, Petukhova M, Kessler RC. Lifetime and 12-month prevalence of bipolar spectrum disorder in the National Comorbidity Survey replication. Archives of general psychiatry. 2007 May 1;64(5):543-52.

https://doi.org/10.1001/archpsyc.64.5.543

PMid:17485606 PMCid:PMC1931566

Mohammadi MR, Davidian H, Noorbala A, Malekafzali H, Naghavi H, Pouretemad H, et al. An epidemiological survey of psychiatric disorders in Iran. J Clin Pract & Mohammadi, M Epidem Ment Health. 2005; 1: 16.

https://doi.org/10.1186/1745-0179-1-16

PMid:16185355 PMCid:PMC1253522

Ball J, Mitchell P, Malhi G, Skillecorn A, Smith M. Schema-focused cognitive therapy for bipolar disorder: reducing vulnerability to relapse through attitudinal change. Australian & New Zealand Journal of Psychiatry. 2003 Feb;37(1):41-8.

https://doi.org/10.1046/j.1440-1614.2003.01098.x

PMid:12534655

Word Health Organization. The burden of mental disorders. a comparison of methods between the Australian burden of disease studies and the Global Burden of Disease study: T Vos , CD Mathers 2000; Available from http://apps.who.int/iris/bitstream/10665/57224/1/ bu0610.

Revicki DA, Hirschfeld RM, Ahearn EP, Weisler RH, Palmer C, Keck Jr PE. Effectiveness and medical costs of divalproex versus lithium in the treatment of bipolar disorder: results of a naturalistic clinical trial. Journal of affective disorders. 2005 Jun 1;86(2-3):183-93.

https://doi.org/10.1016/j.jad.2005.01.002

PMid:15935238

Gouveia J, Matos M. Can shame memories become a key to identity The centrality of shame memories Pinto .predicts psychopathology. Applied Cognitive Psychology. 2011;25(2):281-90.

https://doi.org/10.1002/acp.1689

Gilbert P. Body shame. A biopsychosocial conceptualisation and overview, with treatment implications: InBody shame; 2014.

https://doi.org/10.4324/9781315820255

Scott J, Mansell W. The nature and treatment of depression in bipolar F -30 disorder: A review and implications for future psychological investigation. Clinical Psychology Review. 2005; 25: 1076-1100.

https://doi.org/10.1016/j.cpr.2005.06.007

PMid:16140444

Jamison KR, Goodwin FK. Manic-depressive illness. New York, NY: Oxford University. 1990;:.

Gilbert P, Clarke M, Hempel S, Miles JN, Irons C. Criticizing and reassuring oneself: An exploration of forms, .styles and reasons in female students. British Journal of Clinical Psychology. 2004;43(1):31-50 .

https://doi.org/10.1348/014466504772812959

PMid:15005905

Straccamore F, Ruggi S, Lingiardi V, Zanardi R, Vecchi S, Oasi O. Personality factors and depressive 37 configurations an exploratory study in an Italian clinical sample. Frontiers in psychology. 2017;8:251.

https://doi.org/10.3389/fpsyg.2017.00251

PMid:28316575 PMCid:PMC5334344

McMurrich SL, Johnson SL. The role of depression, shame-proneness, and guilt-proneness in predicting criticism of relatives towards people with bipolar disorder. Behavior therapy. 2009;40(4):315-24.

https://doi.org/10.1016/j.beth.2008.09.003

PMid:19892077 PMCid:PMC2862217

Scott J. Cognitive therapy as an adjunct to medication in bipolar disorder. Br J Psychiatry. 2001; 178(suppl 41): S164-168.

https://doi.org/10.1192/bjp.178.41.s164

Gitlin MJ, Swendsen J, Heller TL, Hammen C. Relapse and impairment in bipolar disorder. American Journal of Psychiatry. 1995; 152:1635-1640.

https://doi.org/10.1176/ajp.152.11.1635

PMid:7485627

Oud M, Mayo-Wilson E, Braidwood R, Schulte P, Jones SH, Morriss R, Kupka R, Cuijpers P, Kendall T. Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. The .British Journal of Psychiatry. 2016 Mar;208(3):213-22.

https://doi.org/10.1192/bjp.bp.114.157123

PMid:26932483

MacBeth A, Gumley A. Exploring compassion: A meta - analysis of the association between self - compassion and psychopathology. Clinical psychology review. 2012; 32(6): 545 - 552.

https://doi.org/10.1016/j.cpr.2012.06.003

PMid:22796446

Rosenfarb IS, Becker J, Khan A, Mintz J. Dependency and self‐criticism in bipolar and unipolar depressed women. British Journal of Clinical Psychology. 1998 Nov;37(4):409-14.

https://doi.org/10.1111/j.2044-8260.1998.tb01398.x

PMid:9856294

Gharraee B, Tajrishi KZ, Farani AR, Bolhari J, Farahani H. A randomized controlled trial of compassion focused therapy for social anxiety disorder. Iranian Journal of Psychiatry and Behavioral Sciences. 2018 Dec 31;12(4):e80945.

https://doi.org/10.5812/ijpbs.80945

Pascual-Sánchez A, Montes-Rodríguez JM, Jenaro-Río C, Saiz-Ruiz J. Validation of a brief scale for the assessment of distress associated to bipolar disorder. The European Journal of Psychiatry. 2019 Jan 1;33(1):32-7.

https://doi.org/10.1016/j.ejpsy.2018.11.001

Patel R, Reiss P, Shetty H, Broadbent M, Stewart R, McGuire P, et al. Do antidepressants increase the risk of mania and bipolar disorder in people with depression A retrospective electronic case register cohort study. BMJ Open. 2015; 5 (12):e008341.

https://doi.org/10.1136/bmjopen-2015-008341

PMid:26667012 PMCid:PMC4679886

Kwentus J, Riesenberg RA, Marandi M, Manning RA, Allen MH, Fishman RS, et al. Rapid acute treatment of agitation in patients with bipolar I disorder: a multicenter, randomized, placebo-controlled clinical trial with inhaled loxapine. Bipolar Disord. 2012 Feb; 14(1):31-40.

https://doi.org/10.1111/j.1399-5618.2011.00975.x

PMid:22329470

Bauer M, Alda M, Priller J, Young LT. Implications of the neuroprotective effects of lithium for the treatment of bipolar and neurodegenerative disorders. Pharmacopsychiatry. 2003;36 Suppl 3:S250-4.

https://doi.org/10.1055/s-2003-45138

PMid:14677087

Jiang Y, You J, Zheng X, Lin MP. The qualities of attachment with significant others and self - compassion protect adolescents from non suicida l self - injury. School psychology quarterly. 2017; 32(2): 143.

https://doi.org/10.1037/spq0000187

PMid:28414504

Neff KD, Dahm KA. Self-compassion: What it is, what it does, and how it relates to mindfulness. Handbook of mindfulness and self-regulation. 2015:121-37.

https://doi.org/10.1007/978-1-4939-2263-5_10

Tohen M, Goldberg JF, Arrillaga AM, Azorin JM, Vieta E, HardyBayle MC, et al. A 12-week, double-blind comparison of olanzapine vs haloperidol in the treatment of acute mania. Arch Gen Psychiatry. 2003; 60(12):1218-26.

https://doi.org/10.1001/archpsyc.60.12.1218

PMid:14662554

Tohen M, Baker RW, Altshuler LL, Zarate CA, Suppes T, Ketter TA, et al. Olanzapine versus divalproex in the treatment of acute mania. Am J Psychiatry. 2002;159(6):1011-7.

https://doi.org/10.1176/appi.ajp.159.6.1011

PMid:12042191

Neff KD, Hsieh YP, Dejitterat K. Self compassion, achievement goals, and copi ng with academic failure. Self and identity. 2005;4(3): 263 - 287.

https://doi.org/10.1080/13576500444000317

Lowens I. Compassion focused therapy for people with bipolar disorder International . Journal of Cognitive Therapy. 2010; 3(2):172-85.

https://doi.org/10.1521/ijct.2010.3.2.172

Raniere EL, Alloy LB, Abramson LY. Depressive personality styles and bipolar spectrum Francisdisorders: Prospective tests of the event congruency hypothesis. Bipolar Disorders. 2006 Aug;8(4):382- .99

https://doi.org/10.1111/j.1399-5618.2006.00337.x

PMid:16879139

Braehler C, Gumley A, Harper J, Wallace S, Norrie J, Gilbert P. Exploring change processes in compassion focused therapy in psychosis: Results of a feasibility randomized controlled trial. British Journal of Clinical Psychology. 2013 Jun;52(2):199-214.

https://doi.org/10.1111/bjc.12009

PMid:24215148

Gumley A, Braehler C, Laithwaite H, MacBeth A, Gilbert P. A compassion focused model of recovery after psychosis. International Journal of Cognitive Therapy. 2010 Jun;3(2):186-201.

https://doi.org/10.1521/ijct.2010.3.2.186

Heriot-Maitland C, McCarthy-Jones S, Longden E, Gilbert P. Compassion focused approaches to working with .distressing voices. Frontiers in psychology. 2019 Feb 1;10:152

https://doi.org/10.3389/fpsyg.2019.00152

PMid:30774614 PMCid:PMC6367219

Khalatbari J, Hemmati SV, Mohammadi H. Effect of Compassion-Focused Therapy on Body Image and Marital Satisfaction in Women with Breast Cancer. IRANIAN QUARTERLY JOURNAL OF BREAST DISEASE. 2018;11(3):8-20.

https://doi.org/10.30699/acadpub.ijbd..11.3.7

Toole AM, Craighead LW. Brief self-compassion meditation training for body image distress in young adult .women. Body image. 2016;19:104-12.

https://doi.org/10.1016/j.bodyim.2016.09.001

PMid:27664531

The Effectiveness of Compassion-focused Therapy on Patients with Bipolar Disorder, A Randomized Clinical Trial