As Fleischaker & Goodwin (2009) have observed, the
closer to real life an effectiveness study becomes, the less it
offers in confidence of efficacy. The findings from this feasibility
study suggest that a pragmatic study of the clinical
effectiveness of disorder-specific interventions for bipolar
disorder needs to address the issue of patient choice to
engage in therapy. Attention to the timing of therapy is
needed whereby therapy maybe more effective to instigate
when the patient is not in a current mood episode. It may
also mean that any disorder-specific psychosocial intervention
needs to be integrated into the model of service delivery,
not an adjunct delivered in parallel. An integrated team
approach that utilizes a structured disorder-specific psychosocial
intervention with proven efficacy in acute and maintenance
stages of the disorder, e.g. interpersonal social
rhythm therapy (Frank et al. 2005), may be more effective
for this group of patients. An integrated approach that
provides an integrated pharmacological and psychosocial
treatment would potentially promote patient willingness to
engage in therapy.