Metacognitive therapy for bipolar II disorder: A single case series study

Abstract

Background

Bipolar Disorder (BD) is a severe mental disease with a considerable reduction in life quality and high mortality. Self-management interventions and Cognitive behavior therapy (CBT) are the most widely investigated psychological treatments for BD. However, recovery rates are low and only small to moderate effect sizes have been found. Metacognitive therapy is a relatively new treatment for mental disorders based on Wells and Matthews’ transdiagnostic model of emotional disorder – the Self-Regulatory Executive Function (S-REF).

Method

MCT was delivered to three Danes with a diagnosis of BD ascertained using the SCID (Structured Clinical Interview for DSM). An A–B design with Multiple baseline measures was conducted and the effects associated with treatment was examined at post-treatment and follow-up and 6 and 12 months. The primary outcome was Beck’s Depression Inventory II (BDI-II), rumination time and change in metacognitive beliefs were also assessed using the Cognitive Attentional Syndrome Scale (CAS 1).

Results/conclusion

The results demonstrated improvements in depressive symptoms, rumination time and metacognitive beliefs after 7–12 sessions of MCT. Two out of three patients needed 1–3 booster sessions after approximately six months follow-up. However, the effects persisted at 12- months follow-up and all patients were recovered and did not meet the BD diagnosis according to the SCID. Limitations to the findings include the small number of participants and a decreasing baseline score in two of the participants. Nevertheless, it appears that metacognitive therapy is a feasible treatment for BD that might have potential positive effects. Larger studies and randomized controlled trials are now needed to investigate this further.