Cognitive behavioral group therapy for bipolar disorder with comorbid anxiety disorder: a mixed-methods feasibility pilot study

BACKGROUND: Half of all individuals with bipolar disorder (BD) are estimated to have or develop a comorbid anxiety disorder (AD). Comorbid AD is associated with decreased treatment response and a more severe illness trajectory. However, as only a few studies have targeted comorbid anxiety as a treatment goal in BD, this mixed-methods study aimed to assess the feasibility and preliminary effect of a cognitive behavioral therapy (CBT) based group course for comorbid ADs in people with BD.

METHODS: Nine individuals with BD and comorbid AD completed a CBT group course for anxiety consisting of 15 weekly sessions. The study employed a mixed-methods design combining a longitudinal follow-up study of the CBT-based group therapy intervention with a qualitative evaluation 6 months after treatment completion (follow-up).

RESULTS: A reduction in anxiety and an improvement in functioning were observed from baseline to post-treatment. The effects persisted and even improved at the six months follow up. In the qualitative evaluation, the participants reported a positive outcome and highlighted the unique qualities of the group setting, especially the opportunity to 'mirror themselves in others.' Participants felt better equipped to handle anxiety, experienced an improved quality of life and more stability in their BD.

CONCLUSIONS: The CBT group course was a feasible and acceptable treatment for comorbid AD in BD with improvements in anxiety and functioning persisting at the 6-months follow-up. Participants appreciated the unique benefits of the group setting. Future randomized studies including individuals with BD and comorbid anxiety are recommended.