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. Some cognitive therapy programs also emphasize the importance of a regular sleep routine. Cognitive therapy can be delivered in either a group setting or individually.