The effect of group cognitive behavioral therapy on cognitive emotion regulation strategies of adolescents with bipolar disorder during their euthymic phase: A randomized, controlled trial

Abstract

Background and Objectives: Bipolar disorder (BD) is defined as emotion dysregulation. Since such dysregulation is also present during remission, it may be a risk factor for the development of further affective episodes. Therefore, the current study aimed at examining the impact of group cognitive behavioral therapy (GCBT), in comparison to treatment as usual (TAU), on the cognitive emotion regulation strategies of patients with BD. Patients and Methods: The current single-blind, randomized, controlled trial (RCT) was performed from 2015 to 2017 at the Psychiatric Clinic of Razi Hospital affiliated to Tabriz University of Medical Sciences, Tabriz, Iran. A total of 70 adolescents with early-onset BD were selected by the convenience sampling method based on the diagnostic and statistical manual of mental disorders-fourth edition-text revision (DSM-IV-TR) and allocated into receive either 12 sessions of GCBT (N = 35) or TAU (N = 35). Cognitive emotion regulation strategies were evaluated by cognitive emotion regulation questionnaire (CERQ) at baseline, after the intervention, and at 3-month follow-up. Efforts were made to follow up all randomized participants even if they withdrew from the assigned treatment prior to completion of GCBT sessions. Results: Compliance with treatment was moderate and the mean number of GCBT sessions that the participants attended was 6.97 (2.81). The 2 groups had significant differences in terms of post-test scores for other-blame (P = 0.001), rumination (P = 0.049), positive refocus (P = 0.008), positive reappraisal (P = 0.005), and putting into perspective (P = 0.001). In the 3-month follow-up, the 2 groups were significantly different only in other-blame (P = 0.001), positive reappraisal (P = 0.001), and putting into perspective subscales (P = 0.001). Therefore, the effects of the intervention were not effectively sustained after 3 months and there was room for improvement in terms of both outcome and compliance. Conclusions: The GCBT is more effective when the participants are involved in the study and get instructions on emotion regulation. However, since the effects of the intervention were not sustained for most of the subscales after 3 months, booster sessions might improve and prolong the impact of psychotherapies.