Bipolar affective disorder: Does psychosocial treatment add to the efficacy of drug therapy?

Given the efficacy of mood-stabilizing medications as prophylactic agents, what role does psychosocial intervention play in the treatment of bipolar affective disorder? Evidence is reviewed that (1) psychosocial stressors are associated with increased cycling of the disorder, and (2) the addition of psychosocial treatment to mood-stabilizing medications leads to improvements in the longitudinal course of adult bipolar disorder. Empirically supported psychosocial treatments include family-focused psychoeducational treatment, interpersonal and social rhythm therapy, and cognitive-behavioral therapy approaches. Randomized controlled studies suggest that these approaches, when combined with mood-stabilizing medications, can help reduce the likelihood of recurrences over 1- to 2-year periods of follow-up. Future studies should examine the cost-effectiveness of these treatments in community care settings and their applicability to child- and adolescent-onset bipolar patients.