Objective: This project evaluates changes in mood and behavioral functioning and qualitative interviews following cognitive behavioral treatment (CBT) or treatment as usual (TAU) in a diverse sample of youths with research diagnoses of bipolar disorder.

Methods: Investigated effectiveness of manualized CBT for youth ages 7-18 years with BPSD (BPI, BPII, Bipolar NOS, and Cyclothymia) treated in community mental health. Clients were assessed via KSADS and randomly assigned to CBT or TAU.
19 CBT and 25 TAU cases were evaluated prior to treatment, after treatment, and 4 months later. Age ranges from 7 to 17 years, participants are 73% African-American, 16% European-American, 7% Latin-American, and 5% Other ethnicities; 52% are male. Mood and behavioral ratings were completed by: parent, youths age 11 or older, and clinician interview. Qualitative semi-structured interviews were conducted with a subset of clients and guardians about skills, therapist alliance, and barriers to treatment.

Results: CBT and TAU groups improved significantly with large effect size reductions in mood severity by parent and clinician (ps < .05). Outcomes were not significantly different between CBT and TAU as rated by clinician, parent, or youth, ps > .05. In qualitative interviews, both CBT and TAU groups reported strong clinical relationships, characterized by open and supportive communication. Communication skills and de-escalation techniques were reportedly most useful skills.

Conclusion: Similarities across qualitative interviews revealed possible reasons similarities in amount of improvement. The dimensions of treatment considered by clients/guardians to be most helpful—strong clinical relationships and improved communication skills—cross-cut both CBT and TAU approaches.