CRiB - Cognitive Remediation in Bipolar Dafni writes about her experience of the new CRiB project at the Centre for Affective Disorders Have you ever wondered if there is a treatment for Bipolar that doesn’t involve taking medication or talking therapy? Dafni decided to take part in a trial of a new psychological treatment for people with bipolar disorder to see if it could help. CRiB - Cognitive Remediation in Bipolar Researchers from the Centre for Affective Disorders (led by Bipolar UK trustee Professor Allan Young) are running a new research project "CRiB" (Cognitive Remediation in Bipolar). This is the first time this form of Cognitive Remediation Therapy or CRT is being tested for bipolar disorder in a randomised trial, though it has shown many positive effects on thinking skills and quality of life for people with schizophrenia. People with bipolar disorder often experience cognitive difficulties, which exist not only during mood episodes but after remission of symptoms. This trial is investigating CRT compared with treatment as usual in people not currently experiencing depression or mania. Sixty people with bipolar disorder are being recruited, of whom 30 will receive 20–40 hours of CRT over a 12-week period in addition to usual treatment, and 30 will continue receiving usual treatment alone. It is hoped that this psychological intervention will help people to manage their bipolar disorder by improving cognitive functioning and transferring these skills to improve everyday functioning, which may in turn contribute to reducing the recurrence of mood episodes. Dafni was excited to give it a try “While recovering from a particularly severe period of instability and depression the psychiatrist I was working with suggested I take part in the CRT study for the treatment of bipolar disorder, not least because it does not involve medical treatment. Managing my bipolar II without medication has been a process of much trial and error and a perpetual work in progress, as with each significant peak or low the need for new strategies and tools becomes painfully apparent. The premise of the study was intriguing as it differed to any approach I had encountered to date and it appealed precisely because it offered the potential for adding to the range of ways I manage my condition. My participation involved around two sessions per week using a CRT program with a therapist and about an extra hour or so working on my own for three months. Strategies to improve skills In the beginning my expectations were rather limited as I was uncertain what effect the process would have and was reluctant to set myself up for what I might potentially see as a failure if expectations were not met by the end. This reluctance, however, may have limited the benefits the study provided in the end; in spite of my protestations, setting those goals and evaluating progress of the course over three months yielded positive changes. I left with very conscious strategies of how to improve certain cognitive skills, which I anticipate may be useful in moderating the negative impact of periods of depression and/or hypomania. This was the first time I encountered a therapeutic approach to bipolar disorder that did not involve talking therapies or medication. I have repeatedly and adamantly refused medication against medical advice, preferring instead to find my own ways of reining in the extreme edges of my perception, therefore the study’s focus on cognitive remediation very much appealed to me. As my understanding of cognitive functioning grew, I gained further insight into how to recognise changes in my thinking/processing and to relate these to my overall balance (or lack thereof). Apart from this being a fascinating process to undergo, concurrently evaluating how this happened provided a lens for the entire process that easily transfers to daily life.. Lasting impact It is too soon to tell what lasting impact this study will have on how I manage my condition; only a short time has passed since my participation ended and I have been enjoying a stable state for a while now. However, as a result of the work done, my confidence in the choice I made many years ago as a very fiery high school student has grown stronger, and I hope that such research approaches grow into an adopted model for treatment.” Find out more on the Centre for Affective Disorders website If you are interested in taking part, please contact Becci Strawbridge (study co-ordinator) or Dimosthenis Tsapekos (main study researcher) on [email protected], or call 020 7848 5305 This study has received funding from the National Institute for Health Research’s Research for Patient Benefit (RfPB) funding stream.