Evaluating the Effectiveness of Imagery Focussed Therapy
Condition: Bipolar Disorder
MeSH terms: Bipolar Disorder
Study type: Interventional

Summary: 
      This study explores the effectiveness of a brief Imagery-focussed Cognitive Therapy (imCT)
      compared to psychoeducation, regarded as treatment as usual for this patient population, in
      patients suffering from BD receiving mood stabilising medication. ImCT was successfully
      tested in a pilot study using a case series design. The investigators now elaborate on this
      study comparing effectiveness of the intervention to psychoeducation/TAU.
    

Detailed description: 
      Bipolar disorder (BD) is a severe mental health illness affecting 1.9% to 2.4% of the
      population and is associated with high inter episode distress, ongoing mood swings (mood
      variability), high suicide risks and high co-morbidity (especially anxiety). 50% of patients
      do not recover within one year, and only 25% of patients achieve full recovery of function,
      despite receiving the recommended lead intervention consisting of pharmacotherapy (mood
      stabilisers such as lithium). Added psychoeducation and cognitive behavioural interventions
      (CBT) have only modest effects. Overall there is consensus for the need to update CBT and
      increase its effectiveness, aimed at not only managing symptoms but also targeting
      perpetuating or precipitating factors influencing symptoms, especially mood variability.

      Recent studies suggest that patients with BD experience more vivid, compelling and upsetting
      mental images compared to patients suffering from unipolar depression and healthy controls
      and that this may contribute to or even maintain their clinical difficulties. That is,
      imagery in experimental research has proven to have a stronger effect on mood changes than
      verbal cognitions. The amplified imagery vividness of patients suffering from BD might
      therefore precipitate or perpetuate their mood variability. In many other mental health
      problems imagery interventions as a stand-alone intervention, or added to regular CBT, are
      offered with the aim to decrease imagery vividness or modify/update appraisals of imagery. In
      BD patients such interventions, therefore, might also target important precipitating or
      perpetuating factors influencing their mood problems.

      This study aims to assess the effectiveness of a brief Imagery-focussed Cognitive Therapy
      (imCT) compared to psychoeducation, regarded as treatment as usual for this patient
      population, in patients suffering from BD receiving mood stabilising medication. ImCT was
      successfully tested in a pilot study using a case series design. The investigators now
      elaborate on this study comparing effectiveness of the intervention to psychoeducation/TAU.
      The investigators hypothesise that (1a) mood variability (primary outcome variable) and (1b)
      symptoms of depression, mania and anxiety (secondary outcome variables) show stronger
      decreases in BD patients receiving imCT than in patients receiving psychoeducation/TAU.
      Moreover, (2) in the imCT group this effect is expected to be mediated by changes in imagery
      which is targeted during this intervention (target imagery). The investigators also hypothese
      that (3) imagery frequency and compellingness and vividness of imagery reduce more in the
      imCT group than in the group receiving psychoeducation/TAU. The primary outcome variable,
      mood variability, is calculated using daily mood measurements, during a 4-week baseline,
      during the invention and after the end of intervention until follow up at 16 weeks, in both
      imCT and psychoeducation/TAU. Most secondary outcome variables are assessed using weekly
      online questionnaires, pre-and post intervention and at 8 and 16 weeks follow-up, anxiety is
      calculated both weekly online and using daily measurements (see below).
    

Intervention name(s): imagery-focused Cognitive Therapy; TAU
Intervention type(s): Other; Other
Intervention description(s): In depth identification phase: Therapists and patient collaboratively map out difficulties and pinpoint a treatment focus.
Imagery interventions: The imagery intervention consists of metacognitive imagery rescripting or promoting positive imagery or competing tasks (or a combination of these).
Consolidation: Consist of fine tuning the strategies, relapse prevention using a video diary.; Psycho-education is offered in groups, using the format described by Honig (Postma, Honig, & van Gent, 2008).
Other intervention name(s): ImCT; Psychoeducation
Allocation: Randomized
Intervention model: Parallel Assignment
Intervention model description: Between groups, comparing Imagery-Focussed therapy with psychoeducation/TAU/within group, comparing baseline phase with treatment phase.
Masking: None (Open Label)
Primary purpose: Treatment