A Mixed Methods Pilot Feasibility Study of the Unified Protocol Group Psychotherapy for Early Bipolar Disorder

Magnus Johan Engen^1*Siv Hege Lyngstad¹Erlend Eikenæs¹Jon Vøllestad²Margrethe Collier Høegh³Trine Vik Lagerberg^4,5Sofie Ragnhild Aminoff⁶

• ¹Nydalen District Psychiatric Center, Oslo University Hospital, Oslo, Norway
• ²Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Hordaland, Norway
• ³Section for Psychosis Research, Oslo University Hospital, Oslo, Norway
• ⁴Department of Research and Development, Clinic of Mental Health and Addiction, Oslo University Hospital, Nydalen, Oslo, Norway
• ⁵Department of Psychology, Faculty of Social Sciences, University of Oslo, Oslo, Oslo, Norway
• ⁶Early Intervention in Psychosis Advisory Unit for South East Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway

In this pilot study we explored the feasibility and acceptability of “The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders” (UP) in a group format for individuals with early bipolar disorder (BD). Using a mixed methods design we integrated quantitative assessments and qualitative interviews to examine the practical application of UP in a clinical setting with a focus on how participants experienced the treatment. Nine participants with BD diagnoses completed the 12-session group intervention with modules focusing on emotion regulation through skills in non-judgmental awareness, cognitive flexibility, and exposure strategies.Quantitative findings indicated significant improvements in affective lability, overall functioning, and well-being. Qualitative findings highlighted participants’ appreciation for the structured format and peer support from the group, which facilitated exploration of emotional experiences and skills practice. Participants reported particular benefit from non-judgmental awareness exercises, notably the "three-point check," and valued the group’s role in reducing isolation and promoting shared learning. The study underscores UP’s potential adaptability for individuals with BD in a group format. Possible adjustments are discussed, such as strengthening the focus on affective symptoms as well as increasing session duration and customizing exposure exercises for BD-specific challenges. Overall, the UP group format shows promise as a feasible, acceptable, and potentially effective adjunct treatment for BD, with room for targeted refinements to optimize outcomes.