Conclusions
There is accumulating evidence that the use of
psychological therapies as an adjunct to medication
is likely to be clinically and cost-effective as
well as contributing to a significant improvement
in the quality of life of individuals with BD and
indirectly that of their significant others. If further
large-scale multicentre RCTs support the findings
reported so far, it is likely that health care
provision to individuals with BD will need to be
revised in order to routinely include access to some
form of psychological support or therapy. Treatment
trials of a comprehensive whole system
approach to the collaborative psychobiosocial
management of BD are being undertaken in the
USA (18, 22) that may shed light on the most
effective way to organize health care for a group of
patients whose needs have often been overshadowed
by those of individuals with schizophrenia,
on the one hand, and those with unipolar depression,
on the other.
This review suggests psychological interventions
are effective in relapse prevention, but there are few
clues about which specific approach should be used
or the mechanism of action of these interventions.
The latter is the subject of detailed ongoing
research, but in the absence of empirical evidence,
the selection of a particular psychological
approach will be a matter of clinical judgement.
Individuals who need help with specific problems
such as adapting to BD, adhering to medication or
identifying and self-managing early warning signs
and symptoms of relapse may benefit from simple
targeted interventions such as adherence therapy
or relapse prevention training. The fundamental
difference between these technique driven interventions
and the specific models (IPSRT, CT and
FFT) is that the former are briefer than the specific
therapies (about six to nine sessions compared with
about 20–25 sessions) and usually offer a generic,
fixed treatment package rather than an individualized,
more flexible formulation-based approach of
the formal therapy models such as IPSRT. The
findings reviewed also suggest that these very brief
interventions are not as effective in treating BD
depression but offer an effective method of preventing
isolated manic symptoms evolving into a
full-blown manic episode. These technique driven
interventions appear to be potentially very useful