Clinical Psychology: Research and Practice Innovations

Clinical Psychology: Research and Practice Innovations"

Effectiveness of Cognitive-Behavioral Therapy on Non-Suicidal Self-Injury, Internalized Stigma, Positive Affect, Negative Affect and Mania Symptoms in Bipolar Patients

Document Type : Original Article

Authors
Zahra Heidary 1
Hagar Torkan 2
1 Master's student in clinical psychology, Islamic Azad University, Isfahan, Iran
2 Assistant Professor, Department of Clinical Psychology, Islamic Azad University, Isfahan, Iran
10.22075/jcp.2023.29792.2588
Abstract
Objective: The objective of the current investigation was to evaluate the efficacy of cognitive-behavioral therapy (CBT) on non-suicidal self-injury, internalized stigma, positive affect, negative affect, and mania symptoms in bipolar patients.
Method: This research was conducted using a semi-experimental design of pre-test, post-test, and follow-up with experimental and control groups. The statistical population of this research included all patients with bipolar disorders who had been referred to Isfahan counseling centers in 2021 and were treated with mood stabilizers. The sample included 24 people (18 females, 6 males) who were selected using available sampling method and were randomly assigned to two experimental and control groups. The control group was placed on a waiting list, while the experimental group received cognitive-behavioral treatment for 12 sessions of 60 minutes each, one session per week. The research data were collected using Sanson's self-injury scale, King's internalized stigma scale, Watson's positive and negative affect scale, and Young's mania scale. Descriptive statistics (mean and standard deviation) and inferential statistics (variance analysis with repeated measures) were used to analyze the data.
Findings: The findings of the research showed that the cognitive-behavioral therapy caused a significant decrease in the mean scores of the post-test and follow-up stages for non-suicidal self-injury (p<0.01, F=46.639, η2=0.679), internalized stigma (p<0.01, F=6.460, η2=0.227), negative affect (p<0.01, F=8.849, η2=0.287), and mania symptoms (p<0.01, F=27.519, η2=0.556) in bipolar patients. Results indicated significant differences between experimental and control groups for non-suicidal self-injury, internalized stigma, negative affect and mania symptoms in the post-test and follow-up stages.
Keywords
Bipolar disorder
Cognitive-behavioral therapy Non-suicidal self-injury Internalized stigma
Positive affect
Negative affect
Mania symptoms
Subjects

  1. . Novick DM. Swartz HA. Psychosocial interventions for bipolar II disorder. Am J Psychother. 2019; 72(2):47 57.

    1. Barlow DH. Durand VM. Abnormal psychology: an integrative approach. 7th ed. Boston:  Cengage Learning; 2014.
    2. Miklowitz DJ. The bipolar disorder survival guide. 3rd ed. New York: The Guilford Press; 2019.
    3. Hett D. Etain B. Marwaha S. Childhood trauma in bipolar disorder: new targets for future interventions. BJPsych Open. 2022; 8(4): e130.
    4. Pulcu E. Saunders KEA. Harmer CJ. Harrison PJ. Goodwin GM. Geddes., et. all. Using a generative model of affect to characterize affective variability and its response to treatment in bipolar disorder. PNAS. 2022; 119(28): e2202983119.
    5. Llamocca EN. Fristad MA. Bridge JA. Brock G. Steelesmith DL. Axelson DA., et. all. Correlates of deliberate self-harm among youth with bipolar disorder. J Affect Disord. 2022; 302:376-384.
    6. Ganiger FB. Safeekh AT. Bijjal S. Sharma M. Risk factors for deliberate selfharm in bipolar affective disorder patients presenting to tertiary care center- a crosssectional study. NJNS. 2022; 19(1):38-44.
    7. Nock MK. Why do people hurt themselves? New insights into the nature and functions of self-injury. Curr Dir Psychol Sci. 2009; 18(2):78-83.
    8. Goodwin FK. Jamison KR. Manic-depressive illness: bipolar disorders and recurrent depression. 2nd ed. Oxford: Oxford University Press; 2007.
    9. Nordentoft M. Mortensen P. Pedersen C. Absolute risk of suicide after first hospital contact in mental disorder. JAMA Psychiatry. 2011; 68(10):1058–1064.
    10. Clements C. Morriss R. Jones S. Peters S. Roberts C. Kapur N. Suicide in bipolar disorder in a national English sample, 1996–2009: frequency, trends, and characteristics. Psychol Med. 2013; 43(12):2593–2602.
    11. Filippis R. Menculini G. D'Angelo M. Carbone EA. Tortorella A. De Fazio P., et. all. Internalized-stigma and dissociative experiences in bipolar disorder. Front Psychiatry. 2022; 13: 953621.
    12. King M. Dinos S. Shaw J. Watson R. Stevens S. Passetti F., et. all. The stigma scale: development of a standardised measure of the stigma of mental illness. BJPsych. 2007; 190: 248-254.
    13. Hawke LD. Parikh SV. Michalak EE. Stigma and bipolar disorder: a review of the literature. J Affect Disord. 2013; 150(2):181-191.
    14. Sadighi G. Khodaei MR. Fadaie F. Mirabzadeh A. Sadighi A. Self-stigma among people with Bipolar-I disorder in Iran. Iran Rehabil J. 2015; 13(1):32-38.
    15. Vassilev BA. Overcoming self-stigma in bipolar disoder: an intervention [Dissertation]. USA: University of California; 2022.
    16. Leibenluft E. Charney DS. Towbin KE. Bhangoo RK. Pine DS. Defining clinical phenotypes of juvenile mania. Am J Psychiatry. 2003; 160(3):430-437.
    17. Dodd A. Lockwood E. Mansell W. Palmier-Claus J. Emotion regulation strategies in bipolar disorder: A systematic and critical review. J Affect Disord. 2019; 246:262-284.
    18. Gruber J. Johnson SL. Oveis C. Keltner D. Risk for mania and positive emotional responding: Too much of a good thing? Emotion. 2008; 8(1), 23–33.
    19. Johnson SL. Gruber J. Eisner L. Emotion in bipolar disorder. In: Rottenberg J. Johnson SL editor. Emotion and psychopathology: bridging affective and clinical science. Washington, DC: American Psychological Association; 2007. p. 123-150.
    20. Gruber J. Can feeling too good be bad? Positive emotion persistence (PEP) in bipolar disorder. Curr Dir Psychol Sci. 2011; 20(4):217-221.
    21. Kishi T. Ikuta T. Matsuda Y. Sakuma K. Okuya M. Nomura I., et. all. Pharmacological treatment for bipolar mania: A systematic review and network meta-analysis of double-blind randomized controlled trials. Mol Psychiatry. 2022; 27(2), 1136-1144.
    22. Aghaei E. Abedi A. Jamali S. meta-analysis of the effectiveness of cognitive-behavioral interventions on the level of depression symptoms. Clinical Psy & Personality. 2012; 19(6):69-80. [Persian]
    23. Beck JS. Beck AT. Cognitive behavior therapy: basics and beyond. 2nd ed. New York: The Guilford Press; 2011.
    24. Molavi P. Salvat H. Salmani Aghdam N. Nader Mohammadi M. The efficacy of cognitive-behavioral therapy (CBT + TAU) on reducing Type-I bipolar disorder symptoms. Shenakht Journal of Psychology and Psychiatry. 2020; 7(2):92-103. [Persian]
    25. Chiang KJ. Tsai JC. Liu D. Lin CH. Chiu HL. Chou KR. Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: a meta-analysis of randomized controlled trials. PLoS One. 2017; 12: e0176849.
    26. Goudarzi M. Ghasemi N. Mirderikvand F. GholamreZaei S. The Effectiveness of cognitive therapy based on mindfulness on positive affect, psychological flexibility and mind-awareness components of people with depression symptoms. Shenakht Journal of Psychology and Psychiatry. 2018; 5(5):53-68. [Persian]
    27. Arki M. Abasi Esfajir A. Naderi H. Determination the efficacy of cognitive– behavior therapy group with role- playing in patients with bipolar disorder. J North Khorasan Univ Med Sci. 2013; 5(3):527-548. [Persian]
    28. Shimotsu S. Horikawa N. Emura R. Ishikawa SI. Nagao A. Ogata A. Hiejima S., et. all. Effectiveness of group cognitive-behavioral therapy in reducing selfstigma in Japanese psychiatric patients. Asian J Psychiatr. 2014; 10:39-44.
    29. Goldstein TR. Axelson DA. Birmaher B. Brent DA. Dialectical behavior therapy for adolescents with bipolar disorder: A 1-years open trial. J Am Acad Child Adolesc Psychiatry. 2007; 46(7):820–830.
    30. Sansone RA. Wiederman MW. Sansone LA. The self-harm inventory (SHI): development of a scale for identifying self-destructive behaviors and borderline personality disorder. J Clin Psycholy. 1998; 54(7):973–983.
    31. Tahbaz Hoseinzadeh S. Ghorbani N. Nabavi M. Comparison of self-destructive tendencies and integrative self-knowledge among multiple sclerosis and healthy people. Contemp Psychol. 2011; 6(2):35-44. [Persian]
    32. Wilkinson PO. Qiu T. Neufeld S. Jones PB. Goodyer IM. Sporadic and recurrent nonsuicidal self-injury before age 14 and incident onset of psychiatric disorders by 17 years: prospective cohort study. BJPsych. 2018; 212(4):222-226.
    33. Sohrabi F. Saed G, Abdollahi N. Ramezani G. The Relationship with Suicidal thought and stigma and self-esteem in psychiatric patients. IJPN. 2019; 7(3):48-54. [Persian]
    34. Watson D. Clark LA. Tellegen A. Development and validation of a brief measure of positive and negative affect: The PANAS scales. J Pers Soc Psychol. 1988; 54(6):1063-1070.
    35. Bakhshipour A. Dezhkam M. Confirmatory factor analysis of positive and negative affect scale. J Psychol. 2006; 9(4):351-365. [Persian]
    36. Hakkak M. Mousavi Nejad H. Explaining the role of organizational silence and happiness at work in reducing employee job burnout. J Organ Behav. 2016; 1(12):97-121. [Persian]
    37. Young RC. Biggs JT. Ziegler VE. Meyer DA. A rating scale for mania: reliability, validity and sensitivity. BJPsych. 1978; 133:429-435.
    38. Baratian H. Barekatain M. Molavi H. Mosavi N. A six months follow up of symptom severity and quality of life in bipolar I patients after discharge. J Res Behav Sci. 2013; 11(1):10-17. [Persian]
    39. Otto MW. Reilly-Harrington N. Knauz RO. Henin A. Kogan JN. Sachs GS. Living with bipolar disorder: a guide for individuals and families. Oxford: Oxford University Press; 2011.
    40. Abbaspour Gharekand Z. Compilation and evaluation of the effectiveness of Internet-based psychological education program on the internalized stigma of the mentally ill and the attitude towards medication in people with bipolar disorder [Dissertation]. Tehran: Alzahra University; 2020.
    41. Ghaderi D. Maroufi M. Ebrahimi A. Effect of cognitive behavioral therapy on reducing symptoms and modifying dysfunctional attitudes in patients with type I and II bipolar disorder. J Isfahan Med Sch. 2016; 33(358):1936-42
    42. Keshavarzpir Z. Seyedfatemi N. Mardani-Hamooleh M. Esmaeeli N. Boyd JE. The effect of psychoeducation on internalized stigma of the hospitalized patients with bipolar disorder: A quasi-experimental study. Issues Ment Health Nurs. 2020; 42(1):79-86.
    43. Soo SA. Zhang ZW. Khong SJ. Low JEW. Thambyrajah V. Alhabsyi SH., et. all. Randomized controlled trials of psychoeducation modalities in the management of bipolar disorder: a systematic review. J Clin Psychiatry. 2018; 79(3): 17r11750.
    44. Inder ML. Crowe MT. Luty SE. Carter JD. Moor S. Frampton CM., et. all. Prospective rates of suicide attempts and nonsuicidal self-injury by young people with bipolar disorder participating in a psychotherapy study. Aust N Z J Psychiatry. 2016; 50(2):167-173.
    45. Cuhadar D. Cam MO. Effectiveness of psychoeducation in reducing internalized stigmatization in patients with bipolar disorder. Arch Psychiatr Nurs. 2014; 28(1):62-66.
    46. Rashedi E. Sohrabi F. Shams J. The effectiveness of cognitive behavioral therapy in preventing relapse of bipolar disorder. Clinical Psy & Personality. 2011; 3(5):49-64. [Persian]
    47. Richardson T. White L. The impact of a CBT-based bipolar disorder psychoeducation group on views about diagnosis, perceived recovery, self-esteem and stigma. Cogn Behav Ther. 2019; 12:1-9.
    48. Suymoto KL. The functions of self-mutilation. Clin Psychol Rev. 1998; 18(5):531-554.
    49. Lloyd-Richardson EE. Perrine N. Dierker L. Kelley ML. Characteristics and functions of nonsuicidal self-injury in a community sample of adolescents. Psychol Med. 2007; 37(8):1183-1192.
    50. Oexle N. Waldmann T. Staiger T. Xu Z. Rusch N. Mental illness stigma and suicidality: The role of public and individual stigma. Epidemiol Psychiatr Sci. 2018; 27(2):169–178.
    51. Rüsch N. Angermeyer MC. Corrigan PW. Mental illness stigma: concepts, consequences, and initiatives to reduce stigma. Eur Psychiatry. 2005; 20(8):529-539.
    52. Jones S. Psychotherapy of bipolar disorder: a review. J Affect Disord. 2004; 80(2-3):101–114.
    53. Henken HT. Kupka RW. Draisma S. Lobbestae J. van den Berg K. Demacker SMA., et. all. A cognitive behavioural group therapy for bipolar disorder using daily mood monitoring. Behav Cogn Psychother. 2020; 48(5):515-529.
    54. Tari-Barazin N. Babapour kheyradin J. Aghdasi A. Comparison of the effectiveness of social skills training and training of cognitive emotion regulation strategies on social adjustment and positive and negative emotions in patients with type I bipolar disorder. J Fam Ther. 2022; 2(4):137-157. [Persian]
    55. Celano CM. Gomez-Bernal F. Mastromauro CA. Beale EE. DuBois CM. Auerbach RP., et. all. A positive psychology intervention for patients with bipolar depression: a randomized pilot trial. J Ment Health. 2020; 29(1):60-68.
    56. Guillén V. García-Palacios A. Baños R. Standard dialectical behavioral therapy for bipolar I disorder: A case study with two- year follow-up. Rev Argentina de Clin Psicol. 2018; 27(1):24-35.
    57. Deckersbach T. Hölzel BK. Eisner LR. Stange JP. Peckham AD. Dougherty DD., et. all. Mindfulness-based cognitive therapy for nonremitted patients with bipolar disorder. CNS Neurosci Ther. 2012; 18(2):133-141.

    59. Watson AC. Corrigan P. Larson JE. Sells M. Self-stigma in people with mental illness. Schizophr Bull. 2007; 33(6):1312-1318

  • Receive Date 01 February 2023
  • Revise Date 28 May 2023
  • Accept Date 07 June 2023
  • First Publish Date 07 June 2023
  • Publish Date 21 March 2023