Nearly half of people diagnosed with bipolar disorder experience problems with thinking that can make day-to-day life difficult. But now, a new intervention designed by 2014 NARSAD Independent Investigator grantee Carla Torrent, Ph.D., and colleagues at the Hospital Clinic of Barcelona, Spain may improve cognitive functioning in such patients––that is, their ability to think and process information efficiently.

The intervention educates and teaches life skills to patients when they are in a stable or “euthymic” mood state. The goal is for patients to mobilize these skills to reverse functional impairments after “affective episodes.” An affective episode could be an extended period of mania or elevated mood to the point of delusion, depression or sadness, or a mix of manic and depressive symptoms.  

“The program uses a neuro-cognitive-behavioral approach to train patients in strategies for coping with the challenges and difficulties of daily life,” says Dr. Torrent. People who took part in a clinical trial were evaluated on a scale that assessed disability across several distinct areas: the ability to make decisions, hold down a job, manage finances, maintain successful relationships with friends and family, and engage in activities. Cognitive abilities such as concentrating, problem solving, and learning and remembering new information were also assessed.

Seventy-seven patients with bipolar disorder received the 21-week intervention. They showed overall functional improvements when compared to two other groups of patients who received either treatment as usual or a 21-week-long psychoeducation program.

Dr. Torrent’s paper, appearing in the November/December 2014 issue of the Harvard Review of Psychiatry, describes the intervention in detail. It involved 90-minute weekly sessions, each of which focused on a different topic or skill set. In the first weeks, patients and their family members learned about the brain and behavioral basis for bipolar disorder and factors that could affect cognitive impairment. After that, the sessions focused on training different aspects of cognition through various exercises.

Throughout the program, patients learned strategies that helped them cope with everyday cognitive challenges. The strategies included making greater use of external aids such as notebooks and clocks, as well as developing time management and organizational skills. Patients also completed exercises and homework that aimed to improve different aspects of attention and memory. Role-playing was also used in the program’s later sessions to help patients with problem solving and coping with stressful situations they might face outside the clinical environment.

This study is a follow-up to Dr. Torrent’s 2013 research published in the American Journal of Psychiatry in which she and colleagues showed that the intervention improved functional outcomes for euthymic patients with bipolar disorder.

Read the abstract.