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CLINICAL SYNTHESIS   |    
Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence
Holly A. Swartz, M.D.; Joshua Swanson
FOCUS 2014;12:251-266. doi:10.1176/appi.focus.12.3.251
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Author Information and Disclosure

Holly A. Swartz, M.D., Associate Professor of Psychiatry, Department of Psychiatry, University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, 3811 O’Hara St., Pittsburgh, PA 15213

Joshua Swanson, Undergraduate Student, Carnegie Mellon University, Pittsburgh, PA

The authors report no financial relationships with commercial interests.

Dr. Swartz is supported by National Institute of Mental Health grant MH-84831.

Send correspondence to Dr. Swartz; e-mail: swartzha@upmc.edu

Abstract

Although pharmacotherapy is the mainstay of treatment for bipolar disorder, medication offers only partial relief for patients. Treatment with pharmacologic interventions alone is associated with disappointingly low rates of remission, high rates of recurrence, residual symptoms, and psychosocial impairment. Bipolar-specific therapy is increasingly recommended as an essential component of illness management. This review summarizes the available data on psychotherapy for adults with bipolar disorder. We conducted a search of the literature for outcome studies published between 1995 and 2013 and identified 35 reports of 28 randomized controlled trials testing individual or group psychosocial interventions for adults with bipolar disorder. These reports include systematic trials investigating the efficacy and effectiveness of individual psychoeducation, group psychoeducation, individual cognitive-behavioral therapy, group cognitive-behavioral therapy, family therapy, interpersonal and social rhythm therapy, and integrated care management. The evidence demonstrates that bipolar disorder-specific psychotherapies, when added to medication for the treatment of bipolar disorder, consistently show advantages over medication alone on measures of symptom burden and risk of relapse. Whether delivered in a group or individual format, those who receive bipolar disorder-specific psychotherapy fare better than those who do not. Psychotherapeutic strategies common to most bipolar disorder-specific interventions are identified.

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Table 1.Summary of Psychotherapy Trials for Adults with Bipolar Disorder
Table Footer Note

BPNOS=bipolar disorder not otherwise specified; CBT: cognitive-behavioral therapy; CBGT: cognitive-behavioral group therapy; CD: cyclothymic disorder; CESD: Center for Epidemiological Studies for Depression Scale; FFT: family-focused therapy; HPI: health-promoting intervention; HAM-D: Hamilton Depression Rating Scale; ICM: integrated care management; IPSRT: interpersonal and social rhythm therapy; MBCT: mindfulness-based cognitive therapy; MSI: mood sensitivity index; PE: psychoeducation; SCM: systematic care management; SUD: substance use disorder; TAU: treatment as usual; WLC: wait-list control; YMRS: Young Mania Rating Scale.

Table Footer Note

a Includes exercises for memory, executive functions, and functioning in daily routines.

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b Based on a cognitive behavioral relapse prevention model with focus on interaction of bipolar disorder and substance abuse.

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c Developed using the collaborative therapy framework and integrates strategies for monitoring mood, assessing prodromes, preventing relapse, and setting goals (Castle et al., “Pilot of group intervention for bipolar disorder.” [Int J Psychiatry Clin Pract 2007; 11:279–284]).

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Table 2. Description of Evidence-Based, Bipolar-Specific Psychotherapies
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Table 3.Core Strategies of Bipolar-Specific Psychotherapies
Table Footer Note

CBT: cognitive behavioral therapy; FT: family therapy; IPSRT: interpersonal and social rhythm therapy; PE: psychoeducation; ICM: integrated care management.

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CME Activity

Add a subscription to complete this activity and earn CME credit.
Sample questions:
1.
Which of the following best represents the role of psychotherapy in the treatment of bipolar disorder?

See Swartz and Swanson; Results, p 252
2.
An evidence-based psychotherapy that has not been tested as treatment for individuals with bipolar disorder is which of the following:

See Swartz and Swanson; Table 2: Description of Evidence-Based, Bipolar Specific Psychotherapies, p 259
3.
How does psychopathology develop within the framework of metacognitive theory?

See Mundy and Hofmann; Meta-Cognitive Therapy, p 267
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