The Sequential Combination of Cognitive Behavioral Treatment and Well-Being Therapy in Cyclothymic Disorder

Abstract

Background: There is a lack of controlled studies of psychological treatment of cyclothymic disorder. The aim of this investigation was to examine the benefits of the sequential combination of cognitive behavioral therapy (CBT) and well-being therapy (WBT) compared to clinical management (CM) in DSM-IV cyclothymic disorder. Methods: Sixty-two patients with DSM-IV cyclothymic disorder were randomly assigned to CBT/WBT (n = 31) or CM (n = 31). Both CBT/WBT and CM consisted of ten 45-min sessions every other week. An independent blind evaluator assessed the patients before treatment, after therapy, and at 1- and 2-year follow-ups. The outcomes included total score of the change version of the Clinical Interview for Depression, and the Mania Scale. All analyses were performed on an intent-to-treat basis. Results: Significant differences were found in all outcome measures, with greater improvements after treatment in the CBT/WBT group compared to the CM group. Therapeutic gains were maintained at 1- and 2-year follow-ups. Conclusions: A sequential combination of CBT and WBT, which addresses both polarities of mood swings and comorbid anxiety, was found to yield significant and persistent benefits in cyclothymic disorder.

Treatment of Cyclothymic Disorder: Commentary

“…0.001), but hypomania scores were only 0.76% greater (9.26 8 3.10 vs. 9.19 8 2.52) [1] . In addition, a small proportion (14.5%) of subjects met DSM-IV criteria for type II BPD at some time, presumably after at least 2 years of cyclothymic disorder ( table 1 ), indicating the presence of major depressive episodes and sustained hypomania [1] . Additional comorbidity involved anxiety disorders, but substance abuse and personality disorders were excluded.…”

“…This commentary was occasioned by the reporting of what appears to be the first randomized, controlled trial of psychotherapy in DSM-IV cyclothymic disorder [1] . It involved 62 untreated patients, randomized to psychiatrist-conducted psychotherapy versus usual (supportive, advisory) clinical care without antidepressant or moodstabilizing medication (benzodiazepines could continue at reduced doses).…”

“…Hypomania ratings similarly improved by 36.3 versus 14.0%, respectively, at 20 weeks (2.6-fold), and by 48.1 versus 15.5% at 2 years (3.1-fold difference). These differences between treatment arms were highly statistically significant [1] . The findings support the hypothesis that cyclothymic disorder is a treatable condition, and that the 5-month psychotherapy intervention offered showed substantial benefits that persisted for at least 2 years.…”

The polarities of psychological well being and their response to treatment

“…Patients with affective disorder may maintain unrealistically high standards and expectations, driven by perfectionistic attitudes, that reflect lack of self-acceptance As a result, any instance of well-being is neutralized by a chronic dissatisfaction with oneself. On the other hand, an inflated self-esteem may be a source of distress and clash with reality, as has been found to be the case in cyclothymia and bipolar disorder (Garland et al, 2010;Fava, Rafanelli, Tomba, Guidi & Grandi, 2011).…”

“…It may entail potential negative physical (Fiedorowicz, Coryell, Rice, Warren, & Haynes, 2012) and cognitive (Fuentes-Durá et al, 2012) implications. Well-being therapy was recently applied in sequential combination with cognitive behavioral therapy (CBT) for the treatment of cyclothymic disorder (Fava, Rafanelli, Tomba, Guidi & Grandi, 2011). Sixty-two patients with DSM-IV cyclothymic disorder were randomly assigned to CBT/WBT (n = 31) or clinical management (CM) (n = 31).…”