ABSTRACT
Bipolar affective disorder has long been considered to be the most ‘‘biological’’ of the mood disorders and, perhaps because of this perception, research investigating the role of psychotherapy historically has been relatively short lived. Indeed, whereas there has been evidence that several forms of psychotherapy are effective treatments of major (unipolar) depressive disorder formore than two decades (see, e.g., Refs. 1, 2), comparable evidence of the utility in bipolar disorder has only begun to emerge within the past 5 years. Increased interest in studying this application of psychotherapy has been driven in part by evidence that psychosocial risk factors (such as level of social support or exposure to adverse life events) affect the longitudinal course of bipolar affective disorder (3-5). The importance ofmedication non-adherence to longer-term treatment outcomes and the obvious link between patients’ thoughts and feelings about their condition and medication non-compliance provided another rationale (6-9). Ultimately, the limited efficacy of standard pharmacological strategies provided the most compelling rationale for taking seriously the potential role of adjunctive psychotherapies. In this respect, it should be kept inmind that the utility of various focused forms of adjunctive psychotherapy had been well established in schizophrenia by themid-1980s (10-12). The results of these controlled trials, no doubt, helped to put to rest overly reductionistic approaches to the therapeutics of severe mental disorders.
