Cognitive Analytic Therapy for Bipolar Disorder: A Pilot Randomized Controlled Trial
Abstract
The evidence base for treatment of bipolar affective disorder (BD) demands the evaluation of new psychotherapies in order to broaden patient choice. This study reports on the feasibility, safety, helpfulness and effectiveness of cognitive analytic therapy (CAT). In a pilot randomized controlled trial, BD patients in remission were randomized to either receiving 24 sessions of CAT (n = 9) or treatment as usual (n = 9) and were assessed in terms of symptoms, functioning and service usage over time. In the CAT arm no adverse events occurred, 8/9 completed treatment, 5/8 attended all 24 sessions and 2/8 were categorized as recovered. The most common helpful event during CAT was recognition of patterns in mood variability, with helpfulness themes changing according to phase of therapy. No major differences were found when comparing the arms over time in terms of service usage or psychometric outcomes. The study suggests that conducting further research into the effectiveness of CAT in treating BD is warranted and guidance regarding future trials is provided. Copyright © 2016 John Wiley & Sons, Ltd. Key Practitioner Message: Treating BD with CAT appears feasible and safe. Retaining fidelity to the reformulation, recognition and revision structure of CAT appears useful. Participants stated that across the phases of CAT, focussing on patterns of mood variability was consistently helpful.
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Evidence for CAT for bipolar affective disorder is limited.
“Evidence for the treatment of bipolar affective disorder with cognitive analytic therapy (CAT) is limited”
From Effectiveness of cognitive analytic therapy for bipolar affective disorder: A co‐produced single subject cumulative treatment design with extended follow‐up (A <sup>1</sup> /B/A <sup>2</sup> /C‐FU) (2022) · cites this paper as Evans et al. (2017)
CAT has demonstrated promise in helping patients better manage extreme mood variability.
“which has demonstrated the promise of this brief, integrative and relational approach in helping patient's better manage extreme mood variability (Evans et al., 2017; Kerr, 2001).”
From Effectiveness of cognitive analytic therapy for bipolar affective disorder: A co‐produced single subject cumulative treatment design with extended follow‐up (A <sup>1</sup> /B/A <sup>2</sup> /C‐FU) (2022) · cites this paper as Evans et al., 2017
Applicability of CAT approach to bipolar populations continues to show promise.
“although the applicability of the CAT approach to bipolar populations continues to show promise (Evans et al., 2017).”
From Effectiveness of cognitive analytic therapy for bipolar affective disorder: A co‐produced single subject cumulative treatment design with extended follow‐up (A <sup>1</sup> /B/A <sup>2</sup> /C‐FU) (2022) · cites this paper as Evans et al., 2017
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Gibbons, R., & O'Reilly, J. (2021) · Cambridge University Press eBooks · doi:10.1017/9781108686976.032
CAT for people with a diagnosis of bipolar disorder
Evans, M. (2024) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780198866572.013.28
Self-citationKhodayarifard, M., Kamranvand, M., & Rostami, R. (2024) · doi:10.22541/au.171603849.97984515/v1
Basco, M. R. (2025) · Cambridge University Press eBooks · doi:10.1017/9781009086264.004
Margetts, E., Bowe, J., Fox, J. R. E., & Elahi, A. (2026) · Counselling and Psychotherapy Research · doi:10.1002/capr.70233
- Authors
- Evans, M., Kellett, S., Heyland, S., Hall, J., & Majid, S.
- Affiliations
- Manchester Mental Health and Social Care Trust (GB)
- Sheffield Health and Social Care NHS Foundation Trust (GB)
- Birmingham and Solihull Mental Health NHS Foundation Trust (GB)
- University of Sheffield (GB)
- Corresponding author
- Evans, Mark
- Venue
- Clinical Psychology & Psychotherapy
- Publisher
- Wiley
- Published
- 2016-12-20
- Volume
- 24
- Issue
- 1
- Pages
- 22-35
- ISSN
- 1063-3995 (ISSN-L)
- 1099-0879
- OpenAlex
- W2563019452
- Cited by
- 48
- References
- 68
- Citations by year
- 2026: 1 · 2025: 1 · 2024: 2 · 2022: 2 · 2021: 34 · 2020: 4 · 2019: 1 · 2018: 3
- FWCI
- 1.18
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Clinical Psychology & Psychotherapy (publishedVersion)
- PubMed (publishedVersion)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Social Sciences › Psychology › Clinical Psychology › Psychotherapy Techniques and Applications
- Keywords
- cognitive analytic therapy, bipolar disorder, mood variability, treatment feasibility, treatment safety, remission, intervention fidelity
- MeSH terms
- Adult, Affect, Awareness, Bipolar Disorder, Feasibility Studies, Female, Humans, Male, Middle Aged, Object Attachment, Pilot Projects, Psychoanalytic Therapy, Cognitive Behavioral Therapy, Patient Satisfaction, Personal Construct Theory
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