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Focus (Am Psychiatr Publ). Summer 2019; 17(3): 238–248.
PMCID: PMC6999214
PMID: 32047369
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This literature review focuses on randomized controlled trials of psychotherapy for bipolar disorder. Evidence-based psychotherapies are shown to play an important role in the development of skills needed to manage the persistent and lifelong consequences of bipolar disorder.
Keywords: Mood Disorders-Bipolar, Psychotherapy, cognitive-behavioral therapy, interpersonal and social rhythm therapy, psychoeducation
Bipolar disorder is a recurrent psychiatric disorder marked by waxing and waning affective symptoms and impairment in functioning. Some of the morbidity and mortality associated with the illness may be reduced with evidence-based psychotherapies (EBPs) along with pharmacotherapy. To enhance clinicians’ understanding of which therapy modalities have evidence supporting their use, the authors conducted a systematic literature review to identify randomized controlled trials (RCTs) of psychotherapy for adults with bipolar disorder. A strong evidence base exists for psychoeducation, cognitive-behavioral therapy, family-focused therapy, interpersonal and social rhythm therapy, and peer-support programs. Promising modalities include functional remediation, mindfulness-based cognitive therapy, illness management and recovery, and technology-assisted strategies. RCTs demonstrate a consistent advantage of these psychotherapies plus pharmacotherapy, compared with the use of pharmacotherapy alone. Adjunctive EBPs hasten time to remission, delay time to recurrence, and improve functional outcomes. EBPs play an important role in helping individuals develop skills needed to manage the persistent and lifelong psychosocial, neurocognitive, vocational, and interpersonal consequences of bipolar disorder. Continued efforts to improve the effectiveness of EBPs for adults with bipolar disorder are warranted.
Keywords: Mood Disorders-Bipolar, Psychotherapy, cognitive-behavioral therapy, interpersonal and social rhythm therapy, psychoeducation
Bipolar disorder is a recurrent psychiatric disorder that is marked by waxing and waning affective symptoms and impairment in functioning, even during well intervals (1, 2). Approximately 2.4% of the world’s population is affected, resulting in a staggering disease burden and substantial years lost to disability (3, 4).
Over the past few decades, there has been increasing attention to the development of bipolar disorder–specific psychotherapies (5). In part, this resurgence is related to disappointingly low remission and recovery rates, despite more pharmacotherapy options and growing efforts to personalize treatment (4, 6). Pharmacological interventions are essential to the management of bipolar disorder, needed for all except a subset of individuals with bipolar disorder type II, for whom psychotherapy may be an adequate monotherapy (7). However, even when pharmacotherapy follows best-practice guidelines, it is effective in reducing only some symptoms, some relapses, and some suicides (8–10). A comprehensive treatment approach that includes pharmacotherapy and an evidence-based psychotherapy (EBP) may provide the strongest foundation for increasing self-efficacy, reducing symptoms and recurrences, and restoring functioning and quality of life.
In this clinical synthesis, we present the rationale for psychotherapy’s integration in the management of bipolar disorder. We then discuss the results of a systematic literature review focused on randomized controlled trials (RCTs) of psychotherapy for bipolar disorder. For modalities with the strongest level of evidence, as defined by the Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines (4), we review their core objectives and strategies and summarize the data supporting their efficacy. Next, we highlight promising psychotherapy modalities, including technology-assisted strategies. We conclude with a discussion of recommendations for clinical practice and future directions.