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. 2024 Jan 5;12(1):1.
doi: 10.1186/s40345-023-00321-8.

Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series

Barbara Pavlova  1   2 , Emma Warnock-Parkes  3   4 , Martin Alda  5   6 , Rudolf Uher  5   6 , David M Clark  3
Affiliations

Cognitive behavioural therapy for social anxiety disorder in people with bipolar disorder: a case series

Barbara Pavlova et al. Int J Bipolar Disord. .

Abstract

Background: Social anxiety disorder increases the likelihood of unfavourable outcomes in people with bipolar disorder. Cognitive behavioural therapy (CBT) is the first-line treatment for social anxiety disorder. However, people with bipolar disorder have been excluded from the studies that this recommendation is based on. METHOD: We completed a case series to obtain initial data on whether CBT is an acceptable, safe, and effective treatment for social anxiety disorder in people with bipolar disorder.

Results: Eleven euthymic participants with bipolar disorder attended up to sixteen treatment and three follow-up sessions of CBT for social anxiety disorder. Participants attended on average 95% of the offered CBT sessions. No adverse events were reported. Participants' mean score on the Social Phobia Inventory decreased from 46.5 (SD 6.6) before the treatment to 19.8 (SD 11.9) at the end of the sixteen-session intervention and further to 15.8 (SD 10.3) by the end of the 3-month follow-up. This degree of improvement is equivalent to the effect observed in studies of CBT for social anxiety disorder in people without severe mental illness.

Conclusions: This case series provides preliminary evidence that CBT is acceptable, safe, and effective for treating social anxiety disorder in people with bipolar disorder during euthymia. A randomized controlled trial is needed to confirm these findings, and to establish whether treatment for social anxiety disorder improves the course of bipolar disorder.

Keywords: Bipolar disorder; Cognitive therapy; Social anxiety disorder.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The score on the Social Phobia Inventory (SPIN) before treatment, after treatment and at a 3-month follow-up (FU3). The finer lines denoted as A to K show the SPIN scores of the individual participants. The thick black line is the SPIN average score of all eleven participants
Fig. 2
Fig. 2
The score on the Leibowitz Social Anxiety Scale Self-Report (LSAS) before treatment, after treatment and at a 3-month follow-up (FU3). The finer lines denoted as A to K show the LSAS scores of the individual participants. The thick red line is the average LSAS score of all eleven participants
Fig. 3
Fig. 3
Average score on the Social Phobia Inventory (SPIN) before treatment, after treatment and at a 3-month follow-up (FU3). The blue line is the average SPIN score of the four participants who remained euthymic throughout the treatment. The orange line is the average SPIN score of the seven participants who experienced clinical levels of depression during the treatment
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