Behavioural therapy for inter-episode bipolar symptoms: a multiple baseline case series evaluation

Between major affective episodes some people with bipolar disorder experience persistent low mood or mood instability. Here we report an initial evaluation of the STABILISE programme (ISRCTN19416314; registration date 01.02.23), an adaptation of individual behavioural therapy that includes concepts and techniques addressing emotion regulation designed to support people experiencing these inter-episode symptoms. This study aimed to evaluate the safety, feasibility and acceptability of the intervention and to explore whether the pattern of clinical change had potential for the intervention to be of benefit. Twelve individuals with inter-episode bipolar symptoms received the STABILISE therapy in a randomised, multiple baseline case series. Participants were randomly assigned to wait 3, 4 or 5 weeks before commencing treatment, which comprised up to 22 sessions up to 7 months. Measures of symptoms, mood lability, recovery and quality of life were completed at intake, pre-therapy, and post therapy. Participants completed weekly measures of affective symptoms over the baseline and therapy periods, and for three weeks after.

All 12 participants completed the therapy programme and reported high levels of satisfaction overall. No adverse events were judged to be therapy related. There was one instance of reliable deterioration on one outcome measure. Across all parameters of clinical change 9 of the 12 participants showed an overall pattern of improvement and none showed a pattern of deterioration overall.

This study provides preliminary support for the feasibility, acceptability, safety, and clinical potential of the STABILISE therapy. Further investigation of these aspects in a larger sample and within a randomised controlled trial design is required.