Psychotherapy has long beenrecommen

Psychotherapy has long been
recommended as adjunctive to pharmacotherapy
for bipolar disorder, but it is
unclear which interventions are effective
for which patients, over what intervals,
and for what domains of outcome. This
article reviews randomized trials of adjunctive
psychotherapy for bipolar disorder.
Method: Eighteen trials of individual and
group psychoeducation, systematic care,
family therapy, interpersonal therapy,
and cognitive-behavioral therapy are described.
Relevant outcome variables include
time to recovery, recurrence, duration
of episodes, symptom severity, and
psychosocial functioning.
Results: The effects of the treatment modalities
varied according to the clinical
condition of patients at the time of random
assignment and the polarity of
symptoms at follow-up. Family therapy,
interpersonal therapy, and systematic
care appeared to be most effective in preventing
recurrences when initiated after
an acute episode, whereas cognitive-behavioral
therapy and group psychoeducation
appeared to be most effective when
initiated during a period of recovery. Individual
psychoeducational and systematic
care programs were more effective for
manic than depressive symptoms,
whereas family therapy and cognitive-behavioral
therapy were more effective for
depressive than manic symptoms.
Conclusions: Adjunctive psychotherapy
enhances the symptomatic and functional
outcomes of bipolar disorder over
2-year periods. The various modalities differ
in content, structure, and associated
mediating mechanisms. Treatments that
emphasize medication adherence and
early recognition of mood symptoms
have stronger effects on mania, whereas
treatments that emphasize cognitive and
interpersonal coping strategies have
stronger effects on depression. The placement
of psychotherapy within chronic
care algorithms and its role as a preventative
agent in the early stages of the disorder
deserve investigation