Study shows Cognitive Remediation Therapy leads to improvement in cognitive skills and well-being in people with bipolar disorder

Researchers have found promising results in a proof-of-concept clinical trial targeted at improving cognition in people with bipolar disorder.

Researchers found that adding cognitive remediation therapy (CRT) to treatment programmes for 12 weeks led to an improvement in a wide range of cognitive skills (spanning memory, attention, processing speed, multitasking, verbal fluency, and learning), as well as enhanced well-being.

The study was funded by the National Institute of Health Research and has been published in Bipolar Disorders.

Bipolar Disorder

Bipolar disorder is a severe and relatively common condition, with many patients also suffering from impaired cognitive skills, such as difficulty concentrating, recalling information, problem-solving and planning. These cognitive impairments can prevent individuals from working, socialising and carrying out everyday chores, even during periods of recovery. 

Currently, there is no known treatment for cognitive impairments in patients with Bipolar disorder. However, the researchers chose to trial CRT as a potential treatment as it has proved useful in treating cognitive difficulties in people with schizophrenia.

CIRCuiTS programme

The study used an evidence-based CRT programme called CIRCuiTS (Cognitive Interactive Remediation of Cognition and Thinking Skills), which was pioneered by Professor Dame Til Wykes at the Institute of Psychology, Psychiatry & Neuroscience, King’s College London.

The CIRCuiTS programme is partly computerised and partly therapist-guided, and it allows participants to practice multiple cognitive skills closely related to real-life activities that become progressively more difficult. 

A critical feature of the programme is that it also targeted ‘metacognitive skills’, which is the knowledge of one’s cognitive abilities and strategies that one can use to improve these abilities.

This knowledge allowed participants to capitalise on their strengths and develop unique strategies to overcome weaknesses, which they could apply in everyday situations. By the end of the 12 weeks, patients developed a broad range of compensatory strategies, complemented by an improvement in cognitive functioning. Additionally, their well-being improved across a range of measures, including the achievement of their own goals and functioning in everyday life.

Dr Rebecca Strawbridge, post-doctoral research associate within the Centre for Affective Disorders at the Institute of Psychiatry, Psychology & Neuroscience, King's College London, first author of the study, said

“If CRT reliably enhances cognitive and everyday functioning it could have profound and long-lasting benefits for people who have bipolar disorder. These benefits could even include improving their overall quality of life and perhaps even reducing the risk of relapse into acute illness.” 

This trial was a proof-of-concept study, meaning it is the first randomised-controlled clinical trial to test the benefit of adding CIRCuiTS onto standard treatment for patients with bipolar disorder, as well as assessing the feasibility and practical use of the therapy programme in clinical settings.

Professor Allan Young, Chair of Mood Disorders at King’s College London and the Novel Therapeutics cluster lead for the NIHR Maudsley Biomedical Research Centre (BRC), senior author of the study, said,

“CRT has the potential to deliver real benefits to patients and improve functional outcomes. More research is needed to replicate these findings, and we hope that our results are confirmed in larger studies to allow this innovative approach to become more generally available to patients.” 

Looking ahead

The researchers are now planning a larger study, using the CIRCuiTS programme and incorporating additional measures to assess mood stability, the stress hormone cortisol and metacognitive skill development that may contribute to the effectiveness of the therapy in patients with bipolar disorder.

The study was published on the 24 June in Bipolar Disorders.

Professor Allan Young spoke about bipolar, CRT and the CIRCuiTS programme on BBC Radio 4's All in the Mind.