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Feasibility and Acceptability of a Lifestyle Intervention For Individuals With Bipolar Disorder


Journal of Psychiatric Practice: November 2019 - Volume 25 - Issue 6 - p 451–460
doi: 10.1097/PRA.0000000000000426

Individuals with bipolar disorder are at greater risk for cardiovascular disease and are less likely to adhere to lifestyle interventions than the general population. To decrease cardiovascular risk and improve adherence to lifestyle interventions, we developed the Nutrition Exercise and Wellness Treatment (NEW Tx). NEW Tx is an 18-session, 20-week cognitive behavioral therapy–based treatment comprising 3 modules: Nutrition, Exercise, and Wellness. To evaluate the feasibility and acceptability of this intervention as well as predictors of treatment satisfaction and expectations, 38 adult outpatients with bipolar disorder were randomized to either NEW Tx or a waitlist control condition. There was no statistically significant difference in dropout rates between the groups (26.3% in NEW Tx, 31.6% in the control condition). In the NEW Tx condition, participants attended a mean of 66.7% of sessions and reported moderate to high satisfaction. There were no study-related adverse events. We also found that expectations, but not perceived credibility (or believability), of NEW Tx (as measured by the Credibility/Expectancy Questionnaire) at baseline predicted treatment satisfaction (as measured by the Care Satisfaction Questionnaire) posttreatment. Manic symptoms at baseline predicted treatment satisfaction, and marital status predicted one’s expectations of lifestyle interventions. Data suggest that NEW Tx is a feasible and acceptable intervention for individuals with bipolar disorder and that further research is warranted to explore potential moderators of treatment expectations and credibility in this clinical population.

SYLVIA, ELLARD, NIERENBERG, DECKERSBACH: Massachusetts General Hospital and Harvard Medical School, Boston, MA

JANOS, WALSH, DUFOUR, DAVIS: Massachusetts General Hospital, Boston, MA

CHANG: Women’s Treatment Program, McLean Hospital, Belmont, MA

BERNSTEIN: Harvard University, Cambridge, MA

Supported by the National Institute of Mental Health award K23 MH091182 awarded to L.G.S.

L.G.S.: has served in the past year as a consultant for United Biosource Corporation, Clintara, Bracket, and Clinical Trials Network and Institute; has received royalties from New Harbinger; and has received grant/research support from NIMH, PCORI, AFSP, and Takeda. T.D.: has received funding for his research from NIH, NIMH, NARSAD, TSA, IOCDF, Tufts University, DBDAT, Cogito Corporation, Sunovion, Otsuka Pharmaceuticals, and Harvard Medical School; has received honoraria, consultation fees and/or royalties from the MGH Psychiatry Academy, Brain Cells Inc., Clintara LLC, Systems Research and Applications Corporation, Boston University, the Catalan Agency for Health Technology Assessment and Research, the National Association of Social Workers Massachusetts, the Massachusetts Medical Society, Tufts University, NIDA, NIMH, Oxford University Press, Guilford Press, and Rutledge; and has also participated in research funded by DARPA, NIH, NIMH, NIA, AHRQ, PCORI, Janssen Pharmaceuticals, The Forest Research Institute, Shire Development Inc., Medtronic, Cyberonics, Northstar, and Takeda. A.A.N.: is a consultant for Abbott Laboratories, Alkermes, American Psychiatric Association, Appliance Computing Inc. (Mindsite), Basliea, Brain Cells Inc., Brandeis University, Bristol-Myers Squibb, Clintara, Corcept, Dey Pharmaceuticals, Sumitomo Dainippon (now Sunovion), Eli Lilly and Company, EpiQ, L.P./Mylan Inc., Forest, Genaissance, Genentech, GlaxoSmithKline, Hoffman LaRoche, Infomedic, Intra-Cellular Therapies, Lundbeck, Janssen Pharmaceutica, Jazz Pharmaceuticals, Medavante, Merck, Methylation Sciences, Naurex, NeuroRx, Novartis, Otsuka, PamLabs, Parexel, Pfizer, PGx Health, Ridge Diagnostics Shire, Schering-Plough, Somerset, Sunovion, Takeda Pharmaceuticals, Targacept, and Teva; has consulted through the MGH Clinical Trials Network and Institute (CTNI) for Astra Zeneca, Brain Cells Inc., Sumitomo Dainippon/Sepracor, Johnson and Johnson, Labopharm, Merck, Methylation Science, Novartis, PGx Health, Shire, Schering- Plough, Targacept and Takeda/Lundbeck Pharmaceuticals; receives grant/research support from American Foundation for Suicide Prevention, AHRQ, Brain and Behavior Research Foundation, Bristol-Myers Squibb, Cederroth, Cephalon, Cyberonics, Elan, Eli Lilly, Forest, GlaxoSmithKline, Janssen Pharmaceutica, Intra-Cellular Therapies, Lichtwer Pharma, Marriott Foundation, Mylan, NIMH, PamLabs, PCORI, Pfizer Pharmaceuticals, Shire, Stanley Foundation, Takeda, and Wyeth-Ayerst; and has received honoraria from Belvoir Publishing, University of Texas Southwestern Dallas, Brandeis University, Bristol-Myers Squibb, Hillside Hospital, American Drug Utilization Review, American Society for Clinical Psychopharmacology, Baystate Medical Center, Columbia University, CRICO, Dartmouth Medical School, Health New England, Harold Grinspoon Charitable Foundation, IMEDEX, Israel Society for Biological Psychiatry, Johns Hopkins University, MJ Consulting, New York State, Medscape, MBL Publishing, MGH Psychiatry Academy, National Association of Continuing Education, Physicians Postgraduate Press, SUNY Buffalo, University of Wisconsin, University of Pisa, University of Michigan, University of Miami, University of Wisconsin at Madison, World Congress of Brain Behavior and Emotion, APSARD, ISBD, SciMed, Slack Publishing and Wolters Klower Publishing ASCP, NCDEU, Rush Medical College, Yale University School of Medicine, NNDC, Nova Southeastern University, NAMI, Institute of Medicine, CME Institute, ISCTM. He was currently or formerly on the advisory boards of Appliance Computing Inc., Brain Cells Inc., Eli Lilly and Company, Genentech, Johnson and Johnson, Takeda/Lundbeck, Targacept, and InfoMedic. He owns stock options in Appliance Computing Inc., Brain Cells Inc., and Medavante; has copyrights to the Clinical Positive Affect Scale and the MGH Structured Clinical Interview for the Montgomery Asberg Depression Scale exclusively licensed to the MGH Clinical Trials Network and Institute (CTNI). The remaining authors declare no conflicts of interest.

Please send correspondence to: Louisa G. Sylvia, PhD, Dauten Family Center for Bipolar Treatment Innovation, 50 Staniford Street, Suite 580, Boston, MA 02114 (e-mail:

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