Current State of Evidence-Based Psychotherapies for Bipolar Disorder

Bipolar disorder is characterized by recurrent mood episodes and severe functional impairments. Earlier onsets of bipolar disorder are associated with a more severe course of the illness. Treatment guidelines across age groups include pharmacotherapy plus bipolar disorder–specific psychotherapies. Evidence supporting the use of adjunctive psychotherapies is strongest for long-term maintenance of bipolar disorder, including relapse prevention and restoring function and quality of life, for youths and adults with bipolar disorder. When given in combination with pharmacotherapy, family-focused treatment (FFT) and group psychoeducation (including functional remediation methods) have the strongest support among adults. Individual psychotherapies (interpersonal and social rhythm therapy [IPSRT] and cognitive-behavioral therapy [CBT]) are associated with improvements in clinical functioning similar to intensive psychoeducational or supportive therapies. For adolescent bipolar patients there is evidence for FFT and dialectical behavior therapy in stabilizing symptoms and enhancing quality of life, whereas in younger-age patients (i.e., ages 7–14), there is evidence for multifamily group formats that combine psychoeducation with CBT strategies. Finally, there is preliminary evidence that FFT, multifamily psychoeducation, and IPSRT have effects on symptom control in youths at high risk for bipolar disorder. Future research directions include identifying mechanisms of change in current psychotherapies, establishing best-practice treatments for more severe forms of bipolar disorder, examining clinically significant outcomes (e.g., suicidal behaviors, school dropout, unemployment), and developing technology-driven treatment strategies.