Integrated anxiety intervention trial updates

1. Lessons Learnt in Trial Development
and Implementation
Steven Jones

2. CBT for Anxiety Recovery CBT
Individual
Interventions
for early BD
Recovery CBT for
established BD
MI-CBT for
alcohol in BD
Group
Interventions
Family
intervention
REACT trial
Psycho- CA REACT
education vs
peer support
IBPI study ERP
Online
Interventions
Triple P pilot
Living with BD

3. • In a recent survey of 9000 people with a bipolar
diagnosis.
• 92% has at least one other comorbid diagnosis
• Main ones highlighted
• Anxiety
• Alcohol/substance use
• Impulse control disorders (attention, behaviour
or anger problems)
• Merikangas et al., 2007

4. • 93% of people with a bipolar diagnosis have lifetime experience of
anxiety.
• 32% of people have current anxiety difficulties
• Co-morbid anxiety and bipolar are associated with
– poor treatment response
– increased suicidality
– earlier age of onset
– greater risk of relapse
• Effective interventions exist for anxiety and bipolar separately.
• No definitive research into psychological treatment of bipolar and
anxiety together.
McIntyre, et al., 2006
Otto et al., 2006
Feske, et al., 2000
Frank, et al., 2002
Henry, et al., 2003
Ouimet et al, 2009

5. The following slides present independent research commissioned by the National Institute for
Health Research (NIHR) under its Programme Grants for Applied Research funding scheme (RP-PG-
0407-10389). Further support was received from primary care trusts, mental health trusts,
the Mental Health Research Network and Comprehensive Local Research Networks in North
West England.
The views expressed in this publication are those of the authors and not necessarily those of the
NHS, the NIHR or the Department of Health.

6. • Most therapy approaches split anxiety and BD.
• Common therapist question – which do we treat first?
• People’s lived experience however integrates both.
• “I think the thing to do would be to find out why I
become so anxious, unreasonably so over little things
and why I would get so anxious that ...I would do
something as dramatic as abandon my son, jump in my
car and drive away. Why would that be a good idea? but
that is driven seriously by anxiety”

7. • Informed by evidence-based CBT for
anxiety & bipolar
• 10 therapy sessions over 4 months
• Delivered by BABCP accredited therapists
• Therapy individualised and formulation
driven

8. • Recruitment = 72 participants (37 intervention/35
control).
• Bipolar disorder & anxiety (HADS 8+)
• 18+
• English speaking
• No episode in the past 4 weeks
• No current suicidal intent
• Not taking part in any other intervention study

10. • Better able to control BD
• Change views of BD – averting relapse
• Anxiety improved – better coping skills
• Reduced medication
• Changes to lifestyle and behaviour
• Feel like a better person!

11. • Integrating service user views into
development of therapy led to more
individualised therapy
• Consequence – good recruitment and
retention
• General positive experiences of therapy
process and structure -
– NB not everyone some felt a bit rushed
• Next step definitive trial – hopefully

12. • Contact Steve Jones –
s.jones7@lancaster.ac.uk

13. Clinical Outcomes
• Primary clinical outcomes
• Anxiety symptoms - HAM-AD and STAI
• Time to relapses of mood episodes as
measured by SCID-LIFE
• Mood symptoms - HAM-AD and MAS
• Analysis to take place in next few weeks!