A Randomized Controlled Trial of Psychoeducation or Cognitive-Behavioral Therapy in Bipolar Disorder: A Canadian Network for Mood and Anxiety Treatments (CANMAT) Study
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OBJECTIVE: Bipolar disorder is insufficiently controlled by medication, so several adjunctive psychosocial interventions have been tested. Few studies have compared these psychosocial treatments, all of which are lengthy, expensive, and difficult to disseminate. We compared the relative effectiveness of a brief psychoeducation group intervention to a more comprehensive and longer individual cognitive-behavioral therapy intervention, measuring longitudinal outcome in mood burden in bipolar disorder. METHOD: This single-blind randomized controlled trial was conducted between June 2002 and September 2006. A total of 204 participants (ages 18-64 years) with DSM-IV bipolar disorder type I or II participated from 4 Canadian academic centers. Subjects were recruited via advertisements or physician referral when well or minimally symptomatic, with few exclusionary criteria to enhance generalizability. Participants were assigned to receive either 20 individual sessions of cognitive-behavioral therapy or 6 sessions of group psychoeducation. The primary outcome of symptom course and morbidity was assessed prospectively over 72 weeks using the Longitudinal Interval Follow-up Evaluation, which yields depression and mania symptom burden scores for each week. RESULTS: Both treatments had similar outcomes with respect to reduction of symptom burden and the likelihood of relapse. Eight percent of subjects dropped out prior to receiving psychoeducation, while 64% were treatment completers; rates were similar for cognitive-behavioral therapy (6% and 66%, respectively). Psychoeducation cost $180 per subject compared to cognitive-behavioral therapy at $1,200 per subject. CONCLUSIONS: Despite longer treatment duration and individualized treatment, cognitive-behavioral therapy did not show a significantly greater clinical benefit compared to group psychoeducation. Psychoeducation is less expensive to provide and requires less clinician training to deliver, suggesting its comparative attractiveness. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT00188838.
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The six-session Life Goals Program psychoeducational intervention was equivalent in relapse prevention to 20 sessions of individual CBT, at far lower cost.
“One large study demonstrated that the six‐session Life Goals Program psychoeducational intervention was equivalent in relapse prevention to 20 sessions of individual CBT, at far lower cost,81”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [81]
The Abstract and Interventions describe six sessions of Life Goals psychoeducation versus 20 individual CBT sessions. Treatment Outcomes found no significant difference in recurrence, and the Discussion estimates costs of $180 versus $1,200 per participant. But the Discussion explicitly says the study was not powered as an equivalency trial and presents equal effectiveness as a possibility, not a demonstrated finding. (LLM, conf=0.90)
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- Authors
- Parikh, S. V., Zaretsky, A., Beaulieu, S., Yatham, L. N., Young, L. T., Patelis-Siotis, I., MacQueen, G. M., Levitt, A., Arenovich, T., Cervantes, P., Velyvis, V., Kennedy, S. H., & Streiner, D. L.
- Affiliations
- University of Toronto (CA)
- Douglas Mental Health University Institute (CA)
- University of British Columbia (CA)
- McMaster University (CA)
- McGill University (CA)
- Corresponding author
- Parikh, Sagar V.
- ORCID
- Venue
- The Journal of Clinical Psychiatry
- Publisher
- Physicians Postgraduate Press, Inc
- Published
- 2012-06-15
- Volume
- 73
- Issue
- 06
- Pages
- 803-810
- ISSN
- 0160-6689 (ISSN-L)
- OpenAlex
- W2055876105
- Cited by
- 145
- References
- 46
- Citations by year
- 2025: 4 · 2024: 10 · 2023: 5 · 2022: 3 · 2021: 5 · 2020: 9 · 2019: 19 · 2018: 14 · 2017: 14 · 2016: 17 · 2015: 12 · 2014: 20 · 2013: 10 · 2012: 3
- FWCI
- 10.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Journal of Clinical Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Brown University
- Stanley Medical Research Institute (01-153)
- Canadian Institutes of Health Research (MCT55404)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- bipolar disorder, psychoeducation, cognitive behavioral therapy, group psychoeducation, individual psychotherapy, relapse prevention, treatment costs, treatment discontinuation
- MeSH terms
- Adolescent, Adult, Bipolar Disorder, Canada, Female, Humans, Male, Middle Aged, Patient Dropouts, Patient Education as Topic, Psychotherapy, Group, Cognitive Behavioral Therapy, Single-Blind Method, Health Care Costs
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