Examining the Role of Psychotherapy in the Management of Bipolar Disorder

Introduction

Bipolar affective disorder is commonly thought of as the most "biological" form of mood disorder and, perhaps for this reason, the role of psychotherapy historically has received relatively short shrift.^[1] However, several factors came together in the 1990s that fueled a renewed interest in examining the role of psychotherapy in bipolar affective disorder, particularly if used in combination with pharmacotherapy.^[1-3] Perhaps of greatest importance, there was a recognition that even medications with well-established preventive efficacy, such as lithium salts, often failed to protect patients from relapse and recurrence.^[4,5] Other research established that psychosocial risk factors, including inadequate social support, adverse life events, and medication nonadherence, were often linked to the relapse risk.^[6-8] It was proposed that psychosocial interventions that targeted these risk factors could have the potential to complement the effects of pharmacotherapy. Although development of even more effective and better-tolerated pharmacotherapies remained a high public health priority, the time is ripe to evaluate the utility of focused forms of psychotherapy in combination with the existing standard medications.

It was not necessary to develop psychotherapies for bipolar disorder from scratch. Drawing upon research conducted in patients with schizophrenia, therapies focusing on improving family support and psychoeducation were available.^[9-11] Likewise, in the area of nonbipolar depression, there were well-developed, procedurally specified interventions that focused on cognitive, behavioral, and interpersonal aspects of depression.^[12,13] Thus, in relatively short order, manuals for psychoeducational,^[14] family-dyadic,^[15] cognitive-behavioral,^[16] and interpersonal^[17] models of treatment for bipolar affective disorder were developed. A number of studies evaluating these therapies now have been completed and, in the following sections, the evidence pertaining to each of these models will be examined.