Cognitive Behavioral Therapy Useful for Bipolar Disorder in Children

Laurie Barclay, MD

October 20, 2003

Oct. 20, 2003 — Cognitive behavioral therapy (CBT) is useful for the treatment of bipolar disorder in children, according to a presentation at the American Academy of Child and Adolescent Psychiatry annual meeting in Miami, Florida. Findings from this study and an accompanying manual also will be published in a forthcoming issue of the Journal of the American Academy of Child and Adolescent Psychiatry.

"This is ground-breaking research," lead author Mani N. Pavuluri, MD, from the University of Illinois at Chicago, told Medscape. "It marries interpersonal therapy with CBT, making it highly practical, with an excellent response in all dimensions of therapy."

Child and Family Focused Cognitive Behavioral Therapy (CFF-CBT) is a new, developmentally sensitive psychosocial intervention for pediatric bipolar disorder (PBD) and is intended for use along with medication. Its theoretical basis includes the need to address problems specific to pediatric bipolar disorder, a biological theory of excessive reactivity, and environmental stressors. Over 12 sessions, CFF-CBT actively involves children, their parents, and siblings.

In this exploratory investigation, 34 patients with PBD (mean age, 11.33 years) were treated with CFF-CBT plus medication in a specialty clinic. Symptom severity and functioning were evaluated before and after treatment using the severity scales of the Clinical Global Impression Scales for Bipolar Disorder (CGI-BP) and the Children's Global Assessment Scale (CGAS).

After completion of therapy, patients had significant reductions in severity scores on all CGI-BP scales, suggesting improvement in mania, depression, aggression, attention deficit-hyeractivity disorder, and sleep disorder, and, to a lesser extent, psychosis. CGAS scores were also significantly higher after treatment, and parents reported high levels of treatment adherence and satisfaction.

According to Dr. Pavuluri, the strengths of this treatment include its applicability to both children and adolescents, flexible timing allowing a two- to four-week gap between sessions, a checklist covering pertinent points for practitioners, therapy for parents helping them react appropriately to explosive behavior, and involvement of siblings.

Dr. Pavuluri summarizes the goals of CFF-CBT using the mnemonic "RAINBOW": R for routine; A for affect regulation; I for I can do it; N for No negative thoughts, live in the now; B for Be a good friend, balanced life style for parents; O for Oh how can we solve it? (collaborative problem-solving); and W for ways to get support.

"We want beautiful colors of mood like the rainbow, but not the extreme blue of depression or the extreme red of mania," he said.

The Campus Research Board, Colbeth Foundation supported this study. None of the authors have any pertinent financial disclosures.

AACAP 50th Annual Meeting: Abstract C6. Presented Oct. 14-19, 2003.

Reviewed by Gary D. Vogin, MD

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