Case Formulation in Cognitive Behaviour Therapy: The Treatment of Challenging and Complex Cases by

Language: eng
Format: azw3
ISBN: 9780415741781
Publisher: Taylor and Francis
Published: 2015-06-18T16:00:00+00:00

Chapter 9

Cognitive behavioural case formulation in bipolar disorder

Elizabeth Tyler and Steven Jones

Prevalence and severity

Bipolar disorder is a severe and chronic mental health problem characterised by recurrent episodes of depression and mania/hypomania. Lifetime prevalence estimates are 1.0% for bipolar disorder I and 1.1% bipolar disorder II (Merikangas et al., 2007). Bipolar disorder I involves periods of severe episodes of mania to depression. Bipolar disorder II involves a milder form of mood elevation (hypomania) with periods of severe depression.

Whilst bipolar disorder is sometimes associated with achievement and artistic creativity (Goodwin and Jamison, 2007; Murray and Johnson, 2010), it is often associated with considerable burden for individuals, including elevated rates of anxiety, substance use, suicidality, disability and unemployment (Fajutrao et al., 2009). Bipolar disorder is now placed within the top 20 most disabling illnesses in the world (Vos et al., 2012) and approximately 20–25% of individuals will attempt suicide at some point in their lifetime (Merikangas et al., 2011). The estimated cost to the English economy is £5.2 billion per year (McCrone et al., 2008) and in the US Kleinman et al. (2003) estimated total annual costs were $45.2 billion (1991 values). Bipolar disorder represents a considerable financial burden to society, with many individuals unable to work due to inadequate treatment.

It is only in the last 15–20 years that the importance of psychological, and particularly cognitive behavioural, treatment has been recognised for bipolar disorder (Lam et al., 2010; Basco and Rush, 2007; Johnson and Leahy, 2005; Newman et al., 2001). The assumption that bipolar disorder is primarily a genetic/biological illness, with a relatively benign presentation between episodes, had led to medication with lithium or a similar medication (Scott, 1995; Scott and Colom, 2005; Vieta and Colom, 2004) being seen as the mainstay of treatment for mood stabilisation. Consistent with this approach, there is clear evidence that Lithium is more effective than placebo in preventing relapse in bipolar disorder (Burgess et al., 2001) and that it is likely to be more effective than more recently investigated mood stabilisers such as carbamazepine and sodium valproate (Kessing et al., 2011; NICE, 2006).

However, medication is not adequate on its own, and lithium is not always beneficial for individuals with bipolar disorder (Goodwin, 2009; Geddes et al., 2004; Cipriani et al., 2005). A 1990 National Institute of Mental Health (NIMH) report noted that 40% of individuals treated with lithium did not experience a significant improvement in clinical state or relapse risk (Prien and Potter, 1990). Furthermore, Denicoff et al. (1997) reported that over 30% of patients stopped taking either lithium or carbamazepine within a year due to lack of efficacy. Other reports have concurred that many individuals with bipolar disorder continue to relapse despite prophylactic lithium treatment (Geddes et al., 2004; Burgess et al., 2001).

Since the publication of the NIMH report, which called for the development of effective psychosocial interventions for the treatment of bipolar disorder (Prien and Potter, 1990), there has been rapid development of psychological treatment approaches for this disorder, as will be described below. The

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