An evidence-based review of psychosocial treatments for bipolar disorder

Because somatotherapy for bipolar disorder (BD) has led to only modest improvements in outcome in general clinical practice, increasing attention has been paid to psychosocial interventions as adjuvants to standard medical-model treatment. This article complements and extends other recent reviews of this area by (1) evaluating psychotherapy studies according to the evidence rating criteria of the Agency for Health Care Policy and Research; (2) analyzing which outcome domains are impacted by which types of psychotherapy; (3) reviewing studies of care organization (contexts of care) for BD, tracing the roots of this area from descriptions of lithium clinics in the early 1970s through the recent federally funded controlled trials; and (4) identifying a core agenda common across most psychosocial interventions. The psychotherapy literature indicates that a broad array of modalities may be effective in improving clinical outcome, functional outcome, and disease management skills, with Class A studies supporting at least some couples/partners, cognitive-behavioral, family, and psychoeducational interventions. Controlled studies of context of care interventions are in their infancy, but are built on principles similar to those used in disease management programs for chronic medical illnesses. Despite the diversity of psychosocial interventions, there is substantial convergent validity for the importance of a common agenda of a collaborative approach to illness management that includes education about the illness, and identification of patient-specific symptom patterns, and development of action plans for response to relapse. A research agenda focusing on interventions that are sustainable in general clinical practice is of the highest priority.