Background Alcohol use is a common problem in bipolar disorder (BD) and evidence indicates more promising outcomes for alcohol use than other substances. No trials have evaluated individual integrated motivational interviewing and cognitive behaviour therapy (MI-CBT) for problematic alcohol use in BD. We therefore assessed the feasibility and acceptability of a novel MI-CBT intervention for alcohol use in BD. Methods A single blind RCT was conducted to compare MI-CBT plus treatment as usual (TAU) with TAU only. MI-CBT was delivered over 20 sessions with participants followed at 3, 6, 9 and 12 months post-randomisation. Primary outcomes were the feasibility and acceptability of MI-CBT (recruitment to target, retention to follow-up, absence of untoward incidents). We also conducted preliminary analyses of alcohol and mood outcomes (frequency and severity of alcohol use and time to mood relapse). Results 44 participants were recruited with 75% retention to 6 and 12 months follow-up. Therapy participants attended a mean of 17.6 (SD 4.5) sessions. Therapy alliance and treatment fidelity were acceptable. Qualitative interviews indicated the intervention was experienced as collaborative, and helpful, in addressing mood and alcohol issues, although risk of overconfidence following therapy was also identified. Clinical outcomes did not differ between arms at 12 months follow-up. Limitations As a feasibility and acceptability trial any secondary results should be treated with caution. Conclusions Integrated MI-CBT intervention is feasible and acceptable, but lack of clinical impact, albeit in a feasibility study, suggests need for further development. Potential adaptations are discussed.

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BackgroundCo-morbid substance misuse, particularly alcohol, is common in bipolar disorder (BD) and associated with worse treatment outcomes. Research into psychological interventions for substance misuse in BD is at an early stage and no studies have specifically targeted problematic alcohol use. This paper describes the context and protocol for a feasibility and acceptability randomised controlled trial (RCT) evaluating a novel intervention combining motivational interviewing and cognitive behavioural therapy (MI-CBT) for participants with BD and problematic alcohol use, developed in collaboration with people with lived experience of both issues.Methods and designAn RCT will assess the feasibility and acceptability of MI-CBT in addition to treatment as usual (TAU) compared with TAU alone. Participants will be recruited from across the North West of England through NHS services and self-referral. The primary outcomes will be the feasibility and acceptability of the intervention assessed by recruitment to target, adherence to intervention, retention rate at follow-up, absence of adverse events and qualitative analysis of participants' reported experiences of intervention. The effect size of the impact of the intervention on alcohol use and mood outcomes will also be estimated. In addition, we will explore a number of potential process variables in therapy.DiscussionThis is the first RCT evaluating MI-CBT for BD and problematic alcohol use. Given the prevalence and impact of alcohol problems in BD this novel integrated intervention may have potential to offer important improvements in clinical and functional outcomes.

Purpose Insecure and unresolved attachments have been linked to poorer psychological health and interpersonal functioning for people with intellectual disabilities (IDs), but research in this area is limited, especially for adults. Studies using the Adult Attachment Projective (AAP) have been restricted to clinical samples, where insecure and unresolved attachments are typically more prevalent. The purpose of this study is to compare clinical and non-clinical groups of adults with IDs on the AAP, plus measures of psychological health and interpersonal functioning, to investigate whether group differences found in the typically developing population are also present for adults with IDs. Design/methodology/approach A cross-sectional, between-group design was used. Adults with IDs (clinical group n = 11 and non-clinical group n = 13) completed measures of attachment, psychological distress/positive well-being and interpersonal functioning. Attachment classifications were compared in the clinical versus non-clinical groups. Measures of psychological distress, positive well-being and interpersonal functioning were compared between those with insecure-organised versus unresolved classifications. Findings No participants were classified as secure, and there were high rates of unresolved attachment. There were no differences between clinical and non-clinical groups with regards to the distribution of insecure-organised (i.e. dismissing or preoccupied) versus unresolved classifications. There were no differences between groups with regards to psychological distress, positive well-being or interpersonal functioning. The authors consider limitations in the method of group differentiation and suggest further research to better understand the development of internal working models of attachment in this population. Originality/value To the best of the authors’ knowledge, this study is one of only three to examine attachment state of mind in adults with IDs using the AAP and the first to examine differences between clinical and non-clinical groups.