Trial reportThe British journal of psychiatry : the journal of mental science2016
Affective instability and the course of bipolar depression: results from the STEP-BD randomised controlled trial of psychosocial treatment.
Abstract readRandomized Controlled Trial
In one paragraph
Trial report in The British journal of psychiatry : the journal of mental science, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed
–field-weighted citation impact
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
14 citing papers in PubMed.
- Article
- Implicit learning across varying temporal scales in individuals with and without mood instability.Journal of affective disorders · 2026Article
- Effects of low-dose aspirin in bipolar disorder: study protocol for a randomised controlled trial (the A-Bipolar RCT).BMJ open · 2024Article
- Integrating dynamic psychophysiological indices across time and contexts: Elucidating mechanisms, risk markers, and intervention targets.Psychophysiology · 2024Review
- Autonomic complexity dynamically indexes affect regulation in everyday life.Journal of psychopathology and clinical science · 2023Article
- Risks and benefits of psilocybin use in people with bipolar disorder: An international web-based survey on experiences of 'magic mushroom' consumption.Journal of psychopharmacology (Oxford, England) · 2023Article
- Smartphone accelerometer data as a proxy for clinical data in modeling of bipolar disorder symptom trajectory.NPJ digital medicine · 2022Article
- The association between variability, intensity, and persistence of suicidal ideation and prospective suicidal behavior in the systematic treatment enhancement program for bipolar disorder (STEP-BD) study.International journal of bipolar disorders · 2022Article
- Developing "MinDag" - an app to capture symptom variation and illness mechanisms in bipolar disorder.Frontiers in medical technology · 2022Article
- Explaining why childhood abuse is a risk factor for poorer clinical course in bipolar disorder: a path analysis of 923 people with bipolar I disorder.Psychological medicine · 2020Article
- Using ambulatory assessment to measure dynamic risk processes in affective disorders.Journal of affective disorders · 2019Review
- Cognitive reappraisal attenuates the association between depressive symptoms and emotional response to stress during adolescence.Cognition & emotion · 2019Article
- A double-edged sword? Sub-types of psychological flexibility are associated with distinct psychiatric disorders.Journal of research in personality · 2018Article
- Let your fingers do the talking: Passive typing instability predicts future mood outcomes.Bipolar disorders · 2018Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Jonathan P StangeJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Louisa G SylviaJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Pedro Vieira da Silva MagalhãesJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
David J MiklowitzJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Michael W OttoJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Ellen FrankJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Christine YimJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Michael BerkJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Darin D DoughertyJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Andrew A NierenbergJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA.
Thilo DeckersbachJonathan P. Stange, MA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Louisa G. Sylvia, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA; Pedro Vieira da Silva Magalhães, PhD, National Institute for Translational Medicine, Hospital de Clínicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Brazil; David J. Miklowitz, PhD, Division of Child and Adolescent Psychiatry, UCLA School of Medicine, Los Angeles, California, USA; Michael W. Otto, PhD, Department of Psychology, Boston University, Boston, Massachusetts, USA; Ellen Frank, PhD, Department of Psychology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA; Christine Yim, BA, Department of Psychology, Temple University, Philadelphia, Pennsylvania, USA; Michael Berk, MD, IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Victoria and Orygen, The National Centre of Excellence in Youth Mental Health, Department of Psychiatry and The Florey Institute of Neuroscience and Mental Health, The University of Melbourne, Parkville, Australia; Darin D. Dougherty, MD, Andrew A. Nierenberg, MD, Thilo Deckersbach, PhD, Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA tdeckersbach@partners.org.
Funding
TREATMENT OF BIPOLAR DISORDER-278980001N01MH080001 · NIMH · MASSACHUSETTS GENERAL HOSPITAL · 1998 to 2003
$5.3MMAINTENANCE THERAPIES IN BIPOLAR DISORDERSR37MH029618 · NIMH · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI FRANK, ELLEN · 1992 to 2002
$3.2MCognitive-Behavior Therapy for Bipolar DisorderK23MH074895 · NIMH · MASSACHUSETTS GENERAL HOSPITAL · PI DECKERSBACH, THILO · 2007 to 2011
$973kFamily-Focused Therapy for Youth with Early-Onset Bipolar or Psychotic Disorders R33MH097007 · NIMH · UNIVERSITY OF CALIFORNIA LOS ANGELES · PI MIKLOWITZ, DAVID JAY · 2014 to 2016
$853kNutrition/Weight Loss, Exercise, Wellness Treatment for Bipolar DisorderK23MH091182 · NIMH · MASSACHUSETTS GENERAL HOSPITAL · PI SYLVIA, LOUISA · 2011 to 2015
$846k1/2-A Randomized Trial of Internet-Based Interventions for Bipolar DisorderR34MH091384 · NIMH · UNIVERSITY OF MELBOURNE · PI BERK, MICHAEL · 2011 to 2014
$437kMedical Comorbidity, Medical Burden and Biopolar DisorderR01MH029618 · NIMH · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI KUPFER, DAVID J · 1985 to 2006
$262kInflexibility and Vulnerability to DepressionF31MH099761 · NIMH · TEMPLE UNIV OF THE COMMONWEALTH · PI STANGE, JONATHAN P · 2012 to 2014
$87kFAMILY FACTORS AND OUTCOME IN BIPOLAR DISORDERR29MH043931 · NIMH · UNIVERSITY OF COLORADO AT BOULDER · PI MIKLOWITZ, DAVID JAY · 1991 to 1995
–INTEGRATED FAMILY/INDIVIDUAL THERAPY OF BIPOLAR DISORDERR21MH055101 · NIMH · UNIVERSITY OF COLORADO AT BOULDER · PI MIKLOWITZ, DAVID JAY · 1996 to 1998
–NHLBI NIH HHS HR01MH093676NIMH NIH HHS 1K23MH074895-01A2NIMH NIH HHS 1K23MH91182-1A1NIMH NIH HHS 1R34MH091384-01A1NIMH NIH HHS F31 MH099761NIMH NIH HHS F31MH099761NIMH NIH HHS K23 MH074895NIMH NIH HHS K23 MH091182NIMH NIH HHS MH29618NIMH NIH HHS MH43931NIMH NIH HHS MH55101NIMH NIH HHS N01 MH080001NIMH NIH HHS N01MH80001-01NIMH NIH HHS R01 MH029618NIMH NIH HHS R33MH097007NIMH NIH HHS R34 MH091384NIMH NIH HHS R37 MH029618
Abstract
backgroundLittle is known about predictors of recovery from bipolar depression.
aimsWe investigated affective instability (a pattern of frequent and large mood shifts over time) as a predictor of recovery from episodes of bipolar depression and as a moderator of response to psychosocial treatment for acute depression.
methodA total of 252 out-patients with DSM-IV bipolar I or II disorder and who were depressed enrolled in the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) and were randomised to one of three types of intensive psychotherapy for depression (n= 141) or a brief psychoeducational intervention (n= 111). All analyses were by intention-to-treat.
resultsDegree of instability of symptoms of depression and mania predicted a lower likelihood of recovery and longer time until recovery, independent of the concurrent effects of symptom severity. Affective instability did not moderate the effects of psychosocial treatment on recovery from depression.
conclusionsAffective instability may be a clinically relevant characteristic that influences the course of bipolar depression.
Indexed as
AffectPsychotherapyAdultBipolar DisorderFemaleHumansMalePsychiatric Status Rating ScalesTreatment OutcomeYoung Adult
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