Psychosocial research on the course of bipolar disorder: Appreciating its past and encouraging its future.

Abstract

Miklowitz and Johnson (2009) review the accumulating accomplishments of studies of psychosocial contributors to and treatments of bipolar disorder. Much of the initial work was influenced by paradigms that addressed predictors and treatments of unipolar depression. That personality, stress, and family factors also play an important role in the course and outcomes of bipolar disorders has now been well established, but because depression appears to be especially debilitating and difficult to manage in bipolar disorder, further challenges remain to understand and treat it. At the same time the predictors of mania, and switching/cycling mechanisms, require further conceptualization and study, with a fruitful emphasis on the behavioral activation/reward dependence systems emerging in recent research. Cutting across all manifestations of the bipolar disorder is the need for additional study of mechanisms by which stressful experiences (acute, chronic, early adversity, and the family context) have adverse effects on mood regulation and the pathophysiology of bipolar disorder. Future growth in our understanding of bipolar disorder and its treatment will increasingly require integrative, multivariate, and longitudinal research. Clinical psychology has much to contribute to the conceptualization, methodology, and design of the new generation of research on the psychosocial aspects of bipolar disorder's course and treatment.