Psychosocial Approaches to the Treatment of Bipolar Disorder

Abstract

Even when treated with best-practice pharmacotherapy, many patients with bipolar disorder have slow recoveries from illness episodes, high rates of recurrence, and considerable functional impairment. This article reviews randomized trials of psychotherapy as adjunctive to pharmacotherapy. There is evidence for the efficacy of family-focused interventions, group psychoeducation, interpersonal and social rhythm therapy, and cognitive-behavioral therapy in delaying or preventing relapses and stabilizing illness episodes. Although these treatments share many common strategies (e.g., psychoeducation), little is known about how they work, when in the illness progression they should be administered for maximal effect, and how to efficiently train large numbers of community clinicians. Online versions of psychoeducational care are being developed, with promising early results. Studies that identify changes in neural circuitry that mediate the effects of psychosocial intervention may be especially informative in clarifying targets of evidence-based psychosocial care.