Imagery-Focused Cognitive Therapy (ImCT) for Mood Instability and Anxiety in a Small Sample of Patients with Bipolar Disorder: a Pilot Clinical Audit

Abstract

Background: Despite the global impact of bipolar disorder (BD), treatment success is limited. Challenges include syndromal and subsyndromal mood instability, comorbid anxiety, and uncertainty around mechanisms to target. The Oxford Mood Action Psychology Programme (OxMAPP) offered a novel approach within a cognitive behavioural framework, via mental imagery-focused cognitive therapy (ImCT).

Aims: This clinical audit evaluated referral rates, clinical outcomes and patient satisfaction with the OxMAPP service.

Method: Eleven outpatients with BD received ImCT in addition to standard psychiatric care. Mood data were collected weekly from 6 months pre-treatment to 6 months post-treatment via routine mood monitoring. Anxiety was measured weekly from start of treatment until 1 month post-treatment. Patient feedback was provided via questionnaire.

Results: Referral and treatment uptake rates indicated acceptability to referrers and patients. From pre- to post-treatment, there was (i) a significant reduction in the duration of depressive episode relapses, and (ii) a non-significant trend towards a reduction in the number of episodes, with small to medium effect size. There was a large effect size for the reduction in weekly anxiety symptoms from assessment to 1 month follow-up. Patient feedback indicated high levels of satisfaction with ImCT, and underscored the importance of the mental imagery focus.

Conclusions: This clinical audit provides preliminary evidence that ImCT can help improve depressive and anxiety symptoms in BD as part of integrated clinical care, with high patient satisfaction and acceptability. Formal assessment designs are needed to further test the feasibility and efficacy of the new ImCT treatment on anxiety and mood instability.

Keywords: anxiety; bipolar disorder; mental imagery; mood instability.

Conflict of interest statement

Conflict of interest

EAH held a Wellcome Trust Clinical Fellowship (WT088217) supporting SAH and KY. EAH and SEB were also supported by the Medical Research Council (United Kingdom) intramural programme (MC-A060-5PR50 to EAH) including a Medical Research Council Career Development Fellowship to MDS. JRG is a NIHR Senior Investigator. Biomedical Research Centre Programme. CGF holds a Principal Research Fellowship from the Wellcome Trust (046386). LI was supported by the National Institute for Health Research (NIHR-DRF-2011-04-076 to LI). GMG holds a grant from Wellcome Trust, holds shares in P1vital and has served as consultant, advisor or CME speaker for AstraZeneca, MSD, Eli Lilly, Lundbeck (/Otsuka or /Takeda), Medscape, P1Vital, Pfizer, Servier. The remaining authors declare no conflict of interest.

Figures

Figure 1

Mean duration of depressive episodes during 6 months of baseline period and 6 months of follow-up period after OxMAPP treatment completion per each patient with Bipolar Disorder. Data from 1 patient (Patient 1) were not available due to discharge from the clinic. Patients 2*, 8* and 10* had no depressive episode during baseline or follow-up.

Figure 2

Mean scores on anxiety measure (BAI) collected weekly during 1 month assessment period and 1 month follow-up period after OxMAPP treatment completion in 11 patients with Bipolar Disorder.