Anxiety (particularly panic disorder) has been found in overseas studies to be a common comorbid problem for people with bipolar disorder.  We also know that having a comorbid anxiety problem tends to be related to worse outcomes for people with bipolar disorder.  However, we don't yet have enough information to understand the mechanisms of the relationship between bipolar disorder and anxiety or how this relationship changes over time.  The aim of this research project is to understand more about these relationships and eventually to develop effective psychosocial treatments for people with bipolar disorder and anxiety.

Individuals with social anxiety disorder (SAD) have a tendency to demonstrate a heightened preoccupation with their internal responses and thoughts, thus neglecting other, external information. As a result, their processing of information concerning social events may involve biases in their judgement before, during and after the event. This results in difficulties accurately disputing their maladaptive cognitions and increases the likelihood of avoiding subsequent social situations.

The general consensus in the treatment of anxiety disorders is for the use of exposure. However, clinical researchers have stipulated that exposure alone is not sufficient and have included cognitive restructuring within their treatment protocol. A potentially maladaptive cognitive process which has received minimal study in SAD is thought suppression. Individuals with S.A.D may experience great difficulty in controlling intrusive thoughts and as a result may not objectively and realistically process this information. Thus although SAD is associated with considerable disability, evidence based treatment exist in which as clinicians we are fine tuning its effectiveness, with the awareness that cognitive factors represent an important facet.

The purpose of this project is to begin to examine some of the cognitive mechanisms involved in the maintenance of SAD. This will have relevance to better understanding how cognitions are processed and tailoring treatment so as to provide the best interventions for our patients.

In a study that we have completed, self-efficacy has been identified as a possible mediating factor that may help to explain, in part, why bipolar patients continue to experience episode recurrences and psychosocial impairment.  The results of that study indicated that bipolar patients do not believe they can predict the onset of a mood episode, or that they have any control of the mood episodes once they have begun to experience the associated symptoms.  While studies have shown that, in general, bipolar patients are able to detect prodromal symptoms, the fact that they are not confident that they can do so might mitigate against actually recognising any of the early warning signs, heeding those signs, and taking action.  According to self-efficacy theory, if bipolar patients are not confident in their ability to predict or have any influence on a mood episode, it is unlikely that they would aim to look out for early warning signs, develop an action or a contingency plan, and expend effort towards, or persist in, this endeavour.

The purpose of this current project is to investigate bipolar patients' specific self-efficacy beliefs concerning their management of their illness and evaluating the role of these beliefs on illness outcome.  We have developed a Bipolar Self-Efficacy Scale and are investigating its psychometric properties.  This scale is also being used as an outcome measure for the adjunctive treatment we provide for bipolar patients.

The aim of this project was to prospectively examine the effect of homework quality and quantity on psychotherapy outcome for a sample of anxious and depressed patients.  Preliminary findings were presented at the 2003 APS conference in Perth, and were published in the conference proceedings (Rees, McEvoy, Juniper, Nathan, & Smith, 2003).  We are in the process of building upon this study and preparing a manuscript for publication, which further examines the role of specific types of homework on different treatment outcomes. Please click on the title to see more information about this project (PDF document).

The purpose of the project being conducted by CCI is to examine the effectiveness of mixed, group CBT for anxious and depressed clients. Importantly, there has been no research on the effectiveness of CBT in mixed groups of anxious and depressed clients, with previous studies tending to focus on patients with a primary diagnosis of anxious or depressed clients. This project uses a benchmarking strategy to compare the effectiveness of group CBT for mixed groups compared to the documented efficacy and effectiveness of CBT in studies of groups that only include individuals with the same primary diagnosis (i.e. anxiety or depression). The CCI treatment program has achieved effect sizes comparable to, or better than, international best-practice efficacy and effectiveness research. Please click on the title to see more information (PDF document).

Patients seeking treatment for psychological distress often experience ambivalence towards behaviour change (Miller & Rollnick, 1991). Prochaska and DiClemente’s (e.g. 1998) transtheoretical model suggests that the process of change initially involves contemplation that one has a problem, preparation to achieve behaviour change, taking action to change and, finally, maintaining behaviour change. Movement along the stages typically results from the cons of a particular behaviour increasing relative to, and ultimately outweighing, the pros of the behaviour. Attitudinal ambivalence can be defined as the point at which the pros and cons intersect and thus are equally activated. A recent ambivalence model in the substance abuse literature (Breiner, Stritzke and Lang, 1999) operationalises ambivalence as coactivated inclinations to approach and avoid alcohol. Breiner et al. suggest that as long as the inclination to avoid alcohol is maintained, even in the face of an inclination to approach the substance, then an individual will likely be in a state of inaction (i.e. will not drink). Only when the inclination to avoid a substance is reduced, and thus the person only has their inclination to approach the substance activated, will the person use the substance. The project at CCI attempts to apply Breiner et al.’s (1999) ambivalence model to patients’ attitudes towards, engagement in, and outcome from treatment.

Patients seeking treatment for anxiety or depression were asked about the costs and benefits that they expected from undertaking treatment and of achieving behaviour change. It is hypothesised that those who expect mainly benefits will do better than those who expect both costs and benefits (i.e. ambivalent). Those who expect only costs, or neither costs nor benefits, are expected to perform more poorly on a variety of outcome measures, including compliance, attendance, dropout, and symptom change.