What is cognitive therapy for bipolar disorder?

Cognitive therapy (CT) for bipolar disorder has been found in two trials to reduce depression, but has been labeled as probably efficacious due to lack of reduction of symptoms in at least one major study. All cognitive therapy manuals include a psychoeducation component about the biological basis of the illness, the need for psychotropic medications, and the early symptomatic warning signs of illness exacerbation. These manuals also include a focus on identifying maladaptive negative thoughts about the self and ways to challenge these overly negative thoughts. There is also a focus on how to challenge the overly positive thoughts that occur in manic episodes.

There are several manuals, and those studies that used the manual by D. Lam and others have had particularly positive outcomes. The Lam manual is distinguished by an integration of the importance of a regular sleep routine. The Lam manual is designed to be delivered in 12-18 individual weekly sessions, followed by 2 booster sessions over the next 6 months. Randomized controlled trials that used the Lam manual have shown diminished manic symptoms over time.



Lam, D. H., Hayward, P., Watkins, E. R., Wright, K., & Sham, P. (2005). Relapse prevention in patients with bipolar disorder: Cognitive therapy outcome after 2 years. American Journal of Psychiatry, 162, 324-329.

Lam, D. H., Watkins, E. R., Hayward, P., Bright, J., Wright, K., Kerr, N., et al. (2003). A randomized controlled study of cognitive therapy of relapse prevention for bipolar affective disorder: Outcome of the first year. Archives of General Psychiatry, 60, 145-152.

Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Kogan, J. N., Sachs, G. S., et al. (2007). Intensive psychosocial intervention enhances functioning in patients with bipolar depression: Results from a 9-month randomized controlled trial. American Journal of Psychiatry, 164, 1340-1347.

Scott, J., Paykel, E., Morriss, R., Bental, R., Kinderman, P., Johnson, T. et al. (2006). Cognitive behavioural therapy for severe and recurrent bipolar disorders: A randomised controlled trial. British Journal of Psychiatry, 188, 313-320.

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