Bipolar disorder is a common, severe, and chronic disorder. It is often life-threatening with approximately 1 in 5 individuals completing suicide1. The lifetime prevalence of Bipolar I and II is 1% and 0.5%, respectively2, although more liberal definitions of hypomania identify many more patients with bipolar spectrum disorder. Bipolar disorder type I is defined by the presence of at least one manic or mixed episode. Bipolar II requires at least one hypomanic episode and at least one major depressive episode2. The impact that episodes of mania or depression have on the person’s life is enormous. After the onset of the disorder, individuals with bipolar disorder who have been hospitalized spend approximately 20% of their life in episodes3 and approximately 50% of their time unwell4. Not surprisingly, bipolar disorder is ranked as one of the top 10 leading causes of disability worldwide.
There have been important advances in pharmacological and nonpharmacological treatments for bipolar disorder. However, even with continued adherence a high proportion of patients are seriously symptomatic in the inter-episode period5 and the risk of relapse over five years is as high as 73%6. In response to these high relapse rates, research continues to try to improve pharmacotherapy and also to develop adjunctive psychosocial treatments7. The latter include interpersonal and social rhythm therapy (IPSRT), family therapy, psychoeducation and cognitive behavior therapy (CBT) administered individually or in groups, as well as combination approaches. Even with the combination of pharmacological and adjunctive interventions the rates of relapse remain of concern and many individuals remain highly symptomatic between episodes