Le taux de comorbidité est élevé chez les patients bipolaires, en particulier avec les troubles anxieux (TA). Les TA comorbides sont associés à un pronostic plus sombre, à un moins bon fonctionnement et à un risque suicidaire plus élevé. Parmi les TA, la comorbidité entre le trouble bipolaire (TB) et le trouble d’anxiété généralisée (TAG) est fréquente. L’objectif principal de la présente étude est d’explorer l’efficacité de la thérapie cognitive comportementale (TCC) pour le traitement du TAG chez des patients présentant un TB stabilisé.

Quatre participants ont été recrutés dans un protocole à cas unique expérimental ABA à niveaux de base multiples. Ils ont suivi une TCC de 12 semaines et ont été évalués en ce qui a trait aux symptômes anxieux et aux symptômes du trouble de l’humeur.

Pour trois participants sur quatre, la TCC a produit des changements cliniquement significatifs au niveau des symptômes du TAG. Une baisse des symptômes dépressifs a été observée chez tous les participants à l’évaluation post-traitement.

Ces résultats préliminaires indiquent qu’un traitement spécifique pour le TAG peut être efficace chez des patients bipolaires. Le traitement devrait, en revanche, être adapté aux clientèles plus sévères.

People with bipolar disorder (BD) often have comorbid disorders, the most common being anxiety disorders (AD). Among ADs, comorbidity with generalized anxiety disorder (GAD) is frequent. In addition to being highly prevalent, comorbid ADs have a significant impact on the development and treatment of BD. Several authors agree on the clinical importance of specifying the pharmacological and psychosocial therapies to treat this disorder. With regard to pharmacotherapy, certain characteristics of BD can limit the use of medication commonly prescribed for ADs (e.g. manic episodes on antidepressants). In this context, psychotherapy is an interesting avenue of treatment, but very few studies have examined the effectiveness of psychotherapy adapted to ADs in bipolar patients (Provencher et al., 2011 [18Provencher M.D., Hawke L.D., Thienot E. Psychotherapies for comorbid anxiety in bipolar spectrum disorders J Affect Disord 2011 ;  133 : 371-380 [cross-ref]

Cliquez ici pour aller à la section Références]). The main objective of this study is to explore the effectiveness of cognitive-behavioral therapy (CBT) in the treatment of GAD in patients with stabilized BD.

The sample was made up of three women and one man with a main diagnosis of BD and a comorbid GAD. The participants completed a semi-structured diagnostic interview (SCID-I), questionnaires on depressive (BDI-II) and mania symptoms (YMRS), as well as questionnaires measuring pathological worry (PSWQ), somatic symptoms in GAD (QIA), general anxiety symptoms (BAI) and a self-report notebook where they daily wrote down the number of minutes spent worrying. The participants were assessed four times: during the initial evaluation, immediately before the start of treatment, immediately post-treatment and 4 months later. The treatment, lasting 12 meetings, was conducted by a psychologist using the Treatment Manual for GAD, which mainly targets intolerance of uncertainty, correction of positive beliefs about worry, negative problem orientation, and cognitive avoidance.

Three out of four participants seemed to show a decrease in their tendency to worry (PSWQ) and somatic symptoms in GAD (QIA). In addition, all of the participants seemed to improve in terms of general somatic anxiety symptoms (BAI). Three out of four participants no longer had a diagnosis of GAD after therapy. They met the criteria of clinically significant change according to the C index of Jacobson and Truax (1991) [19Jacobson N.S., Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research J Consult Clin Psychol 1991 ;  59 : 12-19 [cross-ref]

Cliquez ici pour aller à la section Références] adapted to GAD (Provencher et al., 2006 [20Provencher M.D., Ladouceur R., Dugas M.J. La comorbidité dans le trouble d’anxiété généralisée : prévalence et évolution suite à une thérapie cognitivo-comportementale Rev Can Psychiatr 2006 ;  51 (2) : 91-99

Cliquez ici pour aller à la section Références]). Depressive symptoms decreased post-treatment in three participants. As expected, the mania symptoms remained stable in all participants throughout the duration of the study. With regard to time spent worrying, missing data from the self-report notebooks of three participants meant that it was not possible to analyze changes in slope or level. A visual inspection of the data still allowed us to observe that for three of the four participants, the number of minutes spent worrying decreased on average during treatment.

For three of the four participants, CBT was associated with changes in relation to the symptoms of GAD and a slight decrease in self-reported depressive symptoms. These encouraging preliminary results are congruent with those of a recent literature review (Provencher et al., 2011 [18Provencher M.D., Hawke L.D., Thienot E. Psychotherapies for comorbid anxiety in bipolar spectrum disorders J Affect Disord 2011 ;  133 : 371-380 [cross-ref]

Cliquez ici pour aller à la section Références]) identifying the impact of psychosocial interventions in the treatment of comorbid anxiety in bipolar disorder. Compared with studies on the treatment of GAD as the main disorder, the reduction in anxiety symptoms seems more modest in the current study (Ladouceur et al., 2000 [33Ladouceur R., Dugas M.J., Freeston M.H., Léger E. Efficacy of a cognitive-behavioural treatment for Generalized Anxiety Disorder: evaluation in a controlled clinical trial J Consult Clin Psychol 2000 ;  68 (6) : 957-964 [cross-ref]

Cliquez ici pour aller à la section Références]). It is possible that normal treatment is not as effective in patients who are more seriously affected (presence of BD/comorbidity) (Durham et al., 2003 [34Durham R.C., Chambers J.A., MacDonald R.R., Power K.G., Major K. Does cognitive-behavioural therapy influence the long-term outcome of generalized anxiety disorder? Psychol Med 2003 ;  33 : 499-509 [cross-ref]

Cliquez ici pour aller à la section Références]). As this study is an exploratory clinical case series, the results should be considered as preliminary. Due to the limited number of participants, it is difficult to generalize the results to all patients with bipolar disorder. In addition, the daily data is difficult to analyze because of missing data for three participants. These results are more modest than in studies of treatment of GAD, which suggests that treatment should be adapted to respond to the needs of more seriously affected patients.