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Hanssen I, Ten Klooster P, Kraiss J, Huijbers M, Regeer E, Kupka R, Bohlmeijer E, Speckens A. Predicting which intervention works better for whom: Moderators of treatment effect of Mindfulness-Based Cognitive Therapy and Positive Psychology Intervention in patients with bipolar disorder. J Affect Disord 2024; 360:79-87. [PMID: 38788858 DOI: 10.1016/j.jad.2024.05.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 05/09/2024] [Accepted: 05/21/2024] [Indexed: 05/26/2024]
Abstract
BACKGROUND This study aimed to identify moderators of treatment effect (i.e. depressive symptoms and well-being) of Mindfulness-Based Cognitive Therapy (MBCT) and Positive Psychology Intervention (PPI) in patients with bipolar disorder. METHODS Data were drawn from two multicenter randomized controlled trials investigating effectiveness of MBCT vs treatment as usual (TAU; n = 144) and PPI vs TAU (n = 97) in bipolar disorder. Outcomes were assessed at baseline, posttreatment, and 12 months after baseline. Data were analyzed using separate linear regression models, comparing the pooled MBCT or PPI outcomes to TAU, and comparing MBCT to PPI. RESULTS The exploratory analyses not corrected for multiple comparisons showed a number of variables that were associated with stronger response to the interventions, including higher baseline anxiety, lower well-being, and lower levels of self-focused positive rumination, well-being, and self-compassion, and variables associated with a stronger response to either MBCT (higher levels of depression and anxiety and being married) or PPI (being male). After correcting for multiple testing, depressive symptoms appeared to be the most robust variable associated with better response to MBCT than PPI. LIMITATIONS The RCTs handled slightly different enrollment criteria and outcome measures. CONCLUSIONS The most robust finding is that patients with more severe symptomatology seem to benefit more from MBCT than PPI. CLINICAL IMPLICATIONS This is a first step to improve personalized assignment of third-wave CBT interventions for patients with bipolar disorder. However, before definite treatment assignment criteria can be formulated and implemented in clinical practice, these findings should be replicated.
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Affiliation(s)
- Imke Hanssen
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands.
| | - Peter Ten Klooster
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Jannis Kraiss
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Marloes Huijbers
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands
| | - Eline Regeer
- Altrecht Institute for Mental Health Care, Outpatient Clinical for Bipolar Disorders, Utrecht, the Netherlands
| | - Ralph Kupka
- Amsterdam University Medical Center, Vrije Universiteit, Department of Psychiatry, Amsterdam, the Netherlands
| | - Ernst Bohlmeijer
- University of Twente, Department of Psychology, Health, and Technology, Center for eHealth and Well-being Research, Enschede, the Netherlands
| | - Anne Speckens
- Radboud University Medical Center, Department of Psychiatry, Center for Mindfulness, Nijmegen, the Netherlands
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Kraiss JT, Ten Klooster PM, Chrispijn M, Stevens A, Doornbos B, Kupka RW, Bohlmeijer ET. A multicomponent positive psychology intervention for euthymic patients with bipolar disorder to improve mental well-being and personal recovery: A pragmatic randomized controlled trial. Bipolar Disord 2023; 25:683-695. [PMID: 36856065 DOI: 10.1111/bdi.13313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
OBJECTIVE Mental well-being and personal recovery are important treatment targets for patients with bipolar disorder (BD). The goal of this study was to evaluate the effectiveness of an 8-week group multicomponent positive psychology intervention (PPI) for euthymic patients with BD as an adjunct to treatment as usual (TAU) compared to TAU alone. METHODS Patients with BD were randomized to receive TAU (n = 43) or the PPI in addition to TAU (n = 54). The primary outcome was well being measured with the Mental Health Continuum-Short Form. Personal recovery was measured with the Questionnaire about the Process of Recovery. Data were collected at baseline, mid-treatment, post-treatment and 6- and 12-month follow-up. Life chart interviews were conducted at 12 months to retrospectively assess recurrence of depression and mania. RESULTS Significant group-by-time interaction effects for well-being and personal recovery were found favouring the PPI. At post-treatment, between-group differences were significant for well-being (d = 0.77) and personal recovery (d = 0.76). Between-group effects for well-being were still significant at 6-month follow-up (d = 0.72). Effects on well-being and personal recovery within the intervention group were sustained until 12-month follow-up. Survival analyses showed no significant differences in time to recurrence. CONCLUSIONS The multicomponent PPI evaluated in this study is effective in improving mental well-being and personal recovery in euthymic patients with BD and would therefore be a valuable addition to the current treatment of euthymic BD patients. The fact that the study was carried out in a pragmatic RCT demonstrates that this intervention can be applied in a real-world clinical setting.
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Affiliation(s)
- Jannis T Kraiss
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Peter M Ten Klooster
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | | | - Anja Stevens
- Centre for Bipolar Disorders, Dimence Mental Health, Deventer, The Netherlands
| | - Bennard Doornbos
- Department of Specialized Training, Psychiatric Hospital Mental Health Services Drenthe, Outpatient Clinics, Assen, The Netherlands
- Lentis Research, Lentis Psychiatric Institute, Groningen, The Netherlands
| | - Ralph W Kupka
- VU University Medical Center, Department of Psychiatry, Amsterdam Public Health research center, Amsterdam, The Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Kloos N, Kraiss J, Ten Klooster P, Bohlmeijer E. First validation of the model of sustainable mental health: Structural model validity and the indirect role of adaptation. J Clin Psychol 2023; 79:2650-2667. [PMID: 37543726 DOI: 10.1002/jclp.23574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 03/22/2023] [Accepted: 07/16/2023] [Indexed: 08/07/2023]
Abstract
OBJECTIVES There is a growing interest in mental well-being as a vital outcome in clinical practice in addition to mental illness. The model of sustainable mental health (SMH) was recently introduced to delineate how interventions can improve mental health by targeting barriers and resources of adaptation to life stressors, improving the ability to adapt and thereby reducing mental illness and improving mental well-being. The aim of the current study is to empirically validate the conceptual model of SMH as well as the assumed indirect role of ability to adapt. METHODS This study used an existing dataset of the general population with self-reported reduced well-being due to the corona crisis (n = 849, mean age 53 years, SD = 15). Measurements of mental illness (depression and anxiety), mental well-being, ability to adapt, a specific barrier for adaptation (i.e., repetitive negative thinking), and a specific resource for adaptation (i.e., positive reframing) were included. Structural equation modeling was used to assess both the structural validity of the model and the indirect effect of ability to adapt. RESULTS An acceptable to good fit was found for the model of SMH and all paths between the proposed elements of the model were significant and in the hypothesized direction. Ability to adapt served as an indirect pathway trough which repetitive negative thinking (B = 0.149, 95% confidence interval [CI] = 0.016-0.028) and positive reframing (B = 0.163, 95% CI = 0.065-0.123) were linked with mental illness and mental well-being. CONCLUSION The current study provides the first empirical support of the internal validity of the model of SMH in a sample of the general population with reduced well-being, suggesting that barriers and resources to adaptation have an effect on mental illness and mental well-being through the ability to adapt. The model of SMH may therefore be a good model to use in research and clinical practice for developing, implementing, and evaluating a balanced treatment approach targeting both barriers and resources for adaptation.
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Affiliation(s)
- Noortje Kloos
- Centre for eHealth and Well-Being Research, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
- Radboud Alzheimer Center, Department of Primary and Community Care, Radboudumc, Nijmegen, The Netherlands
- School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Jannis Kraiss
- Centre for eHealth and Well-Being Research, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Peter Ten Klooster
- Centre for eHealth and Well-Being Research, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
| | - Ernst Bohlmeijer
- Centre for eHealth and Well-Being Research, Department of Psychology, Health and Technology, University of Twente, Enschede, The Netherlands
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Geerling B, Kelders SM, Stevens AWMM, Kupka RW, Bohlmeijer ET. A Web-Based Positive Psychology App for Patients With Bipolar Disorder: Development Study. JMIR Form Res 2022; 6:e39476. [PMID: 35946327 PMCID: PMC9531003 DOI: 10.2196/39476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/04/2022] [Accepted: 08/09/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Patients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD. OBJECTIVE This study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD. METHODS The study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app. RESULTS Focus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms. CONCLUSIONS With the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD.
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Affiliation(s)
- Bart Geerling
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
- Centre for Bipolar Disorder, Dimence Mental Health Institute, Deventer, Netherlands
| | - Saskia M Kelders
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
- Optentia Research Focus Area, North-West University, Vanderbijlpark, South Africa
| | - Anja W M M Stevens
- Centre for Bipolar Disorder, Dimence Mental Health Institute, Deventer, Netherlands
| | - Ralph W Kupka
- Department of Psychiatry, Mental Health Program, Amsterdam Public Health, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Ernst T Bohlmeijer
- Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands
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Chirio-Espitalier M, Schreck B, Duval M, Hardouin JB, Moret L, Bronnec MG. Exploring the Personal Recovery Construct in Bipolar Disorders: Definition, Usage and Measurement. A Systematic Review. Front Psychiatry 2022; 13:876761. [PMID: 35815013 PMCID: PMC9263970 DOI: 10.3389/fpsyt.2022.876761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Personal recovery from psychiatric disorders is a journey toward a satisfying and hopeful life despite the possible persistence of symptoms. This concept has gained interest and become an increasingly important goal in mental health care programmes. Personal Recovery is well described in the context of severe mental illnesses in general, but little is known about this journey in bipolar disorders and the factors underlying it. A systematic review was conducted according to the PRISMA recommendations, focusing on studies exploring personal recovery in bipolar disorder specifically. The latter have integrated a comprehensive approach to the concept, the existing means of measurement or have explored the levers of recovery in care. Twenty-four articles were selected, including seven qualitative, 12 observational, and five interventional studies. The Bipolar Recovery Questionnaire was the only scale developed de novo from qualitative work with bipolar people. Personal recovery did not correlate very closely with symptomatology. Some elements of personal recovery in bipolar disorder were similar to those in other severe mental illnesses: meaning in life, self-determination, hope, and low self-stigma. Specific levers differed: mental relationships with mood swings, including acceptance and decrease in hypervigilance, and openness to others, including trust and closeness. The studies highlighted the role of caregiver posture and the quality of communication within care, as well as the knowledge gained from peers. The choice to exclude articles not focused on bipolar disorder resulted in the provision of very specific information, and the small number of articles to date may limit the scope of the evidence. New components of personal recovery in bipolar disorder emerged from this review; these components could be taken into account in the construction of care tools, as well as in the caregiving posture. Strengthening skills of openness to others could also be a central target of recovery-focused care.
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Affiliation(s)
- Marion Chirio-Espitalier
- Nantes University, CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes, France.,Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
| | - Benoit Schreck
- Nantes University, CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes, France.,Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
| | - Melanie Duval
- Department of Public Health, University Hospital of Nantes, Nantes, France
| | - Jean-Benoit Hardouin
- Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
| | - Leila Moret
- Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France.,Department of Public Health, University Hospital of Nantes, Nantes, France
| | - Marie Grall Bronnec
- Nantes University, CHU Nantes, UIC Psychiatrie et Santé Mentale, Nantes, France.,Nantes University, Univ Tours, CHU Nantes, INSERM, MethodS in Patients Centered Outcomes and HEalth ResEarch, SPHERE, Nantes, France
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Bohlmeijer E, Westerhof G. The Model for Sustainable Mental Health: Future Directions for Integrating Positive Psychology Into Mental Health Care. Front Psychol 2021; 12:747999. [PMID: 34744925 PMCID: PMC8566941 DOI: 10.3389/fpsyg.2021.747999] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 09/13/2021] [Indexed: 11/13/2022] Open
Abstract
This position paper proposes a model for systematic integration of positive psychology interventions (PPIs) in mental healthcare. On the one hand, PPIs can contribute to the decrease of dysfunctional processes underlying mental illness. This evidence is at the core of the new domains of positive clinical psychology and positive psychiatry. On the other hand, a growing number of studies demonstrate that mental health is not merely the absence of mental illness. Mental wellbeing represents a related but separate dimension of mental health. Mental wellbeing reduces the risk of future incidence of mental illness and is highly valued by people receiving psychological treatment as an important aspect of personal and complete recovery and personal growth. This makes mental wellbeing a vital outcome of mental healthcare. PPIs can directly increase mental wellbeing. The model of sustainable mental health is presented integrating the science of positive psychology and mental wellbeing into mental healthcare. This heuristic model can guide both practitioners and researchers in developing, implementing, and evaluating a more balanced, both complaint- and strength-oriented, treatment approach. The role of gratitude interventions is discussed as an example of applying the model. Also, three potential modalities for implementing PPIs as positive psychotherapy in treatment are as: positive psychotherapy as primary treatment, as combinatorial treatment, and as intervention for personal recovery of people with severe or persistent mental disorder. Finally, we argue that longitudinal studies are needed to substantiate the model and the processes involved.
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Affiliation(s)
- Ernst Bohlmeijer
- University of Twente, Enschede, Netherlands.,Center for eHealth and well-being, Enschede, Netherlands
| | - Gerben Westerhof
- University of Twente, Enschede, Netherlands.,Center for eHealth and well-being, Enschede, Netherlands
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Kraiss JT, ten Klooster PM, Frye E, Kupka RW, Bohlmeijer ET. Exploring factors associated with personal recovery in bipolar disorder. Psychol Psychother 2021; 94:667-685. [PMID: 33742536 PMCID: PMC8451787 DOI: 10.1111/papt.12339] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/05/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Personal recovery is increasingly recognized as important outcome for people with bipolar disorder (BD), but research addressing associated factors of personal recovery in this group remains scarce. This study aimed to explore the association of sociodemographic variables, social participation, psychopathology, and positive emotion regulation with personal recovery in BD. METHODS Baseline data from a randomized controlled trial and survey data were combined (N = 209) and split into a training (n = 149) and test sample (n = 60). Block-wise regression analyses and model training were used to determine the most relevant predictors. The final parsimonious model was cross-validated in the test sample. RESULTS In the final parsimonious model, satisfaction with social roles (β = .442, p < .001), anxiety symptoms (β = -.328, p < .001), manic symptoms (β = .276, p < .001), and emotion-focused positive rumination (β = .258, p < .001) were independently associated with personal recovery. The model explained 57.3% variance in personal recovery (adjusted R2 = .561) and performed well in predicting personal recovery in the independent test sample (adjusted R2 = .491). CONCLUSIONS Our findings suggest that especially social participation, anxiety and positive rumination might be relevant treatment targets when aiming to improve personal recovery. PRACTITIONER POINTS Personal recovery is considered an increasingly important outcome for people with chronic mental health conditions, including bipolar disorder. We found that anxiety and manic symptoms as well as positive rumination and social participation were independently associated with personal recovery in bipolar disorder. Therefore, these outcomes might be relevant treatment targets when aiming to improve personal recovery in bipolar disorder. Possible interventions to improve these outcomes are discussed, including supported employment and vocational rehabilitation for social participation and exercising with savoring strategies to increase positive rumination.
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Affiliation(s)
- Jannis T. Kraiss
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
| | - Peter M. ten Klooster
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
| | - Emily Frye
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
| | - Ralph W. Kupka
- PsychiatryAmsterdam Public Health Research InstituteVrije UniversiteitAmsterdam UMCThe Netherlands
| | - Ernst T. Bohlmeijer
- Department of Psychology, Health, and TechnologyCenter for eHealth and Well‐being ResearchUniversity of TwenteEnschedeNetherlands
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Kraiss JT, Wijnen B, Kupka RW, Bohlmeijer ET, Lokkerbol J. Economic evaluations of non-pharmacological interventions and cost-of-illness studies in bipolar disorder: A systematic review. J Affect Disord 2020; 276:388-401. [PMID: 32871669 DOI: 10.1016/j.jad.2020.06.064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 05/16/2020] [Accepted: 06/14/2020] [Indexed: 11/25/2022]
Abstract
Background Bipolar disorder (BD) is associated with substantial societal burden. Therefore, economic studies in BD are becoming increasingly important. The goal of the current study is three-fold: (1) summarize the evidence regarding economic evaluations (EEs) of non-pharmacological interventions for BD, (2) summarize cost-of-illness studies (COIs) for BD published 2012 or later and (3) assess the quality of the identified studies. Methods A systematic search was conducted in MedLine, EMBASE and PsycINFO. For both EEs and COIs, quality assessments were conducted and general and methodological characteristics of the studies were extracted. Outcomes included incremental-cost-effectiveness ratios for EEs and direct and indirect costs for COIs. Results Eight EEs and ten COIs were identified. The included studies revealed high heterogeneity in general and methodological characteristics and study quality. All interventions resulted in improved clinical outcomes. Five studies additionally concluded decreased total costs. For COIs, we found a wide range of direct ($881-$27,617) and indirect cost estimates per capita per year ($1,568-$116,062). Limitations High heterogeneity in terms of interventions, study design and outcomes made it difficult to compare results across studies. Conclusions Interventions improved clinical outcomes in all studies and led to cost-savings in five studies. Findings suggest that non-pharmacological intervention for BD might be cost-effective. Studies on the costs of BD revealed that BD has a substantial economic burden. However, we also found that the number of EEs was relatively low and methodology was heterogenous and therefore encourage future research to widen the body of knowledge in this research field and use standardized methodology.
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Affiliation(s)
- Jannis T Kraiss
- Center for eHealth and Well-being Research, Department of Psychology, Health, and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, Netherlands.
| | - Ben Wijnen
- Center for Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands; Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, Netherlands.
| | - Ralph W Kupka
- Amsterdam UMC, Vrije Universiteit, Psychiatry, Amsterdam Public Health research institute, Netherlands.
| | - Ernst T Bohlmeijer
- Center for eHealth and Well-being Research, Department of Psychology, Health, and Technology, University of Twente, PO Box 217, 7500 AE, Enschede, Netherlands.
| | - Joran Lokkerbol
- Center for Economic Evaluation and Machine Learning, Trimbos Institute (Netherlands Institute of Mental Health and Addiction), Utrecht, Netherlands.
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Painter JM, Mote J, Peckham AD, Lee EH, Campellone TR, Pearlstein JG, Morgan S, Kring AM, Johnson SL, Moskowitz JT. A positive emotion regulation intervention for bipolar I disorder: Treatment development and initial outcomes. Gen Hosp Psychiatry 2019; 61:96-103. [PMID: 31439286 PMCID: PMC6861691 DOI: 10.1016/j.genhosppsych.2019.07.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/19/2019] [Accepted: 07/22/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE Dysfunction in positive affect is a defining symptom of bipolar I disorder (BD), both during and between mood episodes. We hypothesize that helping people with BD learn skills to create balance in their affective experiences by engaging in strategies that increase low activation positive emotion (LAP; e.g., relaxation) could help to improve well-being during periods of symptom remission. We discuss the development and preliminary outcomes of a positive emotion regulation (PER) group treatment for people with BD, designed as a supplement to pharmacological treatment. METHOD The Learning Affective Understanding for a Rich Emotional Life (LAUREL) intervention is a group-based intervention covering 10 empirically supported skills designed to increase LAP. Sixteen people with BD enrolled in the LAUREL intervention and twelve completed baseline and post-intervention assessments. RESULTS Participants who completed the study (n = 12) attended the majority of groups (87.96%) and reported practicing skills, on average, 16 times a week. We were unable to detect significant differences in mania symptoms following engagement in this PER intervention. Finally, participants reported increases in several areas associated with well-being post-intervention, including mindfulness, reappraisal, and self-compassion. CONCLUSION This study provides a theoretical framework and preliminary support for a PER intervention for BD.
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Affiliation(s)
- Janelle M Painter
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Jasmine Mote
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Andrew D Peckham
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Erica H Lee
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Timothy R Campellone
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Jennifer G Pearlstein
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Stefana Morgan
- University of California, San Francisco, Department of Psychiatry, United States of America.
| | - Ann M Kring
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Sheri L Johnson
- University of California, Berkeley, Department of Psychology, United States of America.
| | - Judith T Moskowitz
- University of California, San Francisco, Department of Psychiatry, United States of America.
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