Goal Pursuit-Focused CBT for Bipolar Disorder: A Four-Case Series

BD is a chronic, cyclical condition marked by severe mood instability and significant impairment. Although pharmacological and psychotherapeutic interventions have demonstrated efficacy, challenges remain in preventing relapse and sustaining long-term euthymia. This study evaluates a CBT-based intervention designed to reduce symptom severity and recurrence by targeting three core maintenance factors: intolerance of anergic states, addiction to mania, and meta-emotional problems.

Four individuals diagnosed with BD participated in a one-year CBT intervention tailored to address these key vulnerabilities. Assessments were conducted at baseline, post-treatment, and at 18- and 24-month follow-ups, measuring depression, mania, quality of life, and personality functioning. Changes were evaluated with RCI and repeated measures ANOVA.

All four patients showed a marked reduction in depressive symptoms at the end of treatment and at the 24-month follow-up, with a large effect size (η² = 0.83). Improvements were also observed in the quality of life and maladaptive personality traits over time. Notably, euthymia was maintained throughout the follow-up period, with no recurrence of manic episodes or new affective cycles.

Despite limitations, these preliminary findings suggest that this three-goal CBT intervention targeting core maintenance factors in bipolar disorder may promote sustained clinical improvements, increase long-term stability, and reduce reliance on medication.