Stabilizing Circadian Rhythm Tied to Lower Suicide Risk in Bipolar Disorder

January 13, 2022 — Early research shows that Social Rhythm Therapy (SRT), which uses behavioral strategies to support healthy sleep and other routines, is associated with improved mood and a reduced risk of suicide in young people with bipolar disorder. A small study has also shown that CRT is feasible and acceptable for this patient population. The results showed that SRT, which mainly was administered via telemedicine sessions, began showing results after about six weeks of the 12-week program, the researchers note.

“Improving the regularity of daily rhythms, such as sleep, physical activity, and social activity, can be a really reliable means of improving mental health and even reducing the risk of suicide,” says researcher Hilary P. Bloomberg, MD, John and Hope Firth Professor of Psychiatric Neuroscience. . at the Yale School of Medicine.

The results are published in the December issue of the journal. American Journal of Psychotherapy.

Trigger for depression, mania

Previous research has shown that unstable circadian rhythms can cause depressive and manic symptoms and are risk factors for suicidal thoughts and actions. Although Interpersonal and Social Rhythm Therapy (IPSRT) has shown promising results in patients with affective disorders, there are few studies addressing only the social rhythm aspect of therapy.

The researchers only studied CRT modified to create a therapeutic program designed for adolescents and young adults.

The study included 13 people (mean age 20 years) with bipolar disorder and a score of 15 or more on the Hamilton Depression Rating Scale (HDRS-29) and/or 12 or more on the Young Mania Rating Scale (YMRS). They were enrolled in the National Institute of Mental Health’s Targeted Brain Self-Control and Emotion Regulation Scheme (BE-SMART) program, which requires MRI sessions at three in-person visits to assess brain changes during therapy. All but one patient were taking mood-stabilizing drugs.

SRT was carried out over 12 weekly sessions. Most of them took place on a secure video platform. Three were held in person.

Working with a therapist, patients were taught to follow a daily routine. Bloomberg points out that it’s not just about going to bed and waking up at the same time every day but also carefully analyzing the details of all daily activities and routines, including who and when participants eat their exercise schedule. And social obligations.

Each week, participants completed a five-item version of the Social Rhythm Metric. At the end of the intervention, they also completed a Customer Satisfaction Questionnaire (CSQ). Points on

the CSQ range is 8 to 32, with scores of 26 to 32 indicating “excellent” satisfaction.

In addition, participants and therapists completed the Work Alliance Inventory, which assesses the relationship between client and therapist by asking questions about things like comfort and respect.

Before and after the intervention, patients reported the regularity of their social rhythms on the Minimal Social Rhythms Scale (BSRS) and the risk of suicidal behavior on the Concise Health Risk Tracking (CHRT) subscale.

High retention rate, “Excellent Satisfaction”

The results showed that 10 out of 13 study participants completed all study procedures. Satisfaction with treatment was excellent.

Both therapists and participants scored high on all aspects of the working alliance scale.

“High treatment retention, excellent client satisfaction, and strong working alliance scores support the feasibility and acceptability of this intervention for adolescents and young adults with bipolar disorder,” the researchers write.

Participants showed a significant improvement in the regularity of the social rhythm and a reduction in symptoms of depression and mania, as well as suicidal tendencies. The effect size ranged from moderate to high.

By the middle of therapy, there were significant improvements in the regularity of the social rhythm and suicidal tendencies, as well as a decrease in the level of depression, which indicates the possibility of an early positive effect.

Bloomberg notes that it is difficult to find a therapy that helps with symptoms of depression and mania. “Antidepressants can reduce depression but can sometimes make manic symptoms worse,” she says.

Impact on the emotional circuitry of the brain?

The association between improved regularity of social rhythms and reduced suicidality persisted even after adjusting for changes in mood symptoms.

“The risk of suicide decreased not only because the subjects were less depressed. There is something about regularizing rhythms that can reduce the risk of suicide,” Bloomberg says.

The reviewers note that remote CRT improves accessibility and that this intervention is “well suited to the future delivery of psychotherapy, which will undoubtedly include remote treatment.”

They also note that the small number of patients in the study means that the results should be interpreted with caution.

Now researchers have early brain scan results. “Preliminary evidence suggests that the intervention appears to benefit the brain’s emotional circuitry,” Bloomberg says.

“Promising” results

Michael Teize, MD, professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine, praised the study.

“This is a very, very promising initial study because, despite the absence of a control group, it shows that the participants liked the program, the majority completed it, and on average, people got a little better,” says Theis, who was not involved in the study.

The treatment may be especially beneficial for younger patients with bipolar disorder, who experience lifestyle disruptions due to their age, Taze said. The results of a previous study of the therapeutic approach in adults showed that “probably half of the adults didn’t take it,” he says.

However, not everyone in this new study also benefited, as some dropped out. “No one form of intervention is right for everyone,” he says.

The research was supported by grants from the National Institute of Mental Health, the AIM Youth Mental Health Foundation, the Klingenstein Third Generation Foundation, the American Foundation for Suicide Prevention, the International Foundation for Bipolar Disorder, the MQ Brighter Futures Program, the Travis Love Foundation, and the John and Hope Firth Foundation. Blumberg and These do not report their respective financial relationships.


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