Nutrition, Exercise, and Wellness Treatment (NEW Tx) for Bipolar Disorder
Nutrition, Exercise, and Wellness Treatment (NEW Tx) for Bipolar Disorder
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in bipolar
 disorder, yet no empirically validated psychosocial interventions to manage risk factors for
 CVD in BD have been developed. The purpose of this study is to develop and test the
 feasibility of an integrated treatment to decrease CVD risk factors, while exploring whether
 the intervention improves overall functioning and mood symptoms. The designed treatment
 integrates theories on Nutrition strategies, Exercise interventions, and Wellness Treatment
 (NEW Tx) to address risk factors for CVD that co-occur with bipolar disorder. NEW Tx includes
 novel intervention strategies in each of these three modules, as well as modified and
 tailored empirically-supported strategies for bipolar disorder. The primary hypotheses are
 that NEW Tx will be feasible to deliver, acceptable to this population, and associated with
 improvements in CVD risk factors (i.e., waist circumference). Exploratory analyses will
 examine predictors of treatment response and the effect of NEW Tx on mood symptoms and
 overall functioning.
The purpose of the Nutrition, Exercise, and Wellness Treatment (NEW Tx) research is to
 develop and test the feasibility and acceptance of a theoretically integrated treatment to
 address the impact of medical comorbidity of individuals with bipolar disorder (BD), while
 exploring its efficacy, whether it improves overall functioning and symptoms, as well as
 examine a potential moderator and mediator of treatment response.

 A.Primary Aims

 Aim 1: Feasibility and Acceptance of NEW Tx in the Nonrandomized Trial.

 Hypothesis 1a: A preliminary study of whether NEW Tx will be feasible with regards to
 recruitment, retention, blinded assessments, and therapist adherence to NEW Tx.

 Hypothesis 1b: Participants will report high satisfaction with the treatment and
 acceptability over the study duration in a nonrandomized trial.

 Aim 2: Feasibility and Acceptance of NEW Tx and its Evaluation in the Randomized Pilot Trial.

 Hypothesis 2a: A pilot study of whether NEW Tx will be feasible with regards to recruitment,
 randomization, retention, blinded assessments, and therapist adherence to NEW Tx.

 Hypothesis 2b: Participants will report high satisfaction with the treatment and
 acceptability over the study duration in the randomized pilot trial.

 B. Exploratory Aims

 Aim 3a: Reducing Medical Burden in the Randomized Pilot Trial. Pilot test the efficacy of NEW
 Tx in improving medical burden using the Framingham Risk Score (FRS).

 Hypothesis 3a: Over the course of 20-weeks (18 sessions) the NEW Tx group will have a lower
 FRS compared to treatment as usual (TAU) in the randomized pilot trial.

 Aim 3b: Symptoms and Functioning in the Randomized Pilot Trial. Examine the efficacy of NEW
 Tx in improving functioning and symptoms of BD.

 Hypothesis 3b: Over the course of 20-weeks (18 sessions) the NEW Tx group will improved
 functioning and mood symptoms compared to TAU in the randomized pilot trial.

 Aim 3c: Moderator and Mediator of NEW Tx in the Randomized Pilot Trial. Investigate a
 potential moderator and mediator of treatment response.

 Hypothesis 3c.1: Individuals with higher baseline Body Mass Index (BMI) > 30 will moderate
 the between treatment effect size for medical burden (FRS) in the randomized pilot trial,
 such that of NEW Tx will have lower FRSs.

 Hypothesis 3c.2: Mastery of the diet and exercise modules of NEW Tx will mediate the
 association of NEW Tx and improvement in medical burden (FRS).
Inclusion Criteria:

 -  Diagnosis of Bipolar Disorder (Type I or II), which is the primary focus of treatment

 -  Ability to give informed consent

 -  Currently ill (CGI-BP ≥ 3)

 -  Age > 18 years and < 65 years

 -  Overweight individuals (BMI > 25)

 Exclusion Criteria:

 -  Unwilling/unable to comply with study procedures

 -  Endorsed item, confirmed by patient's physician, on the PAR-Q

 -  Euthymic (CGI-BP < 3)

 -  Diagnosis of an eating disorder (e.g., anorexia nervosa, bulimia nervosa) in the past
 month

 -  Diagnosis of substance dependence in the past month

 -  Active suicidality (MADRS item 9 score > 4)

 -  Pregnant (as analyzed by a urine pregnancy test)

 -  Currently receiving another psychosocial treatment

 -  Exercising regularly (i.e., 5 days per week for 30 min)

 -  Neurologic disorder or history of head trauma

 -  Contraindications to exercise or diet interventions (e.g., co-morbid nutritional and
 metabolic diseases, physical injuries)