Psychosocial treatments for bipolar disorder: cost‐effectiveness, mediating mechanisms, and future directions
Open accessAbstract
Objectives: Randomized trials of adjunctive psychotherapy for bipolar disorder are reviewed, in tandem with discussion of cost‐effectiveness, mediating mechanisms, and moderators of effects. Methods: Systematic searches of the MEDLINE and PSYCHLIT databases yielded 19 randomized controlled trials of individual family and group therapies. Outcome variables included time to recovery, relapse or recurrence, symptom severity, medication adherence, and psychosocial functioning. Results: Meta‐analyses consistently show that disorder‐specific psychotherapies [cognitive‐behavioral therapy (CBT), interpersonal, family, and group] augment mood stabilizers in reducing rates of relapse (OR = 0.57; 95% CI: 0.39–0.82) over 1–2 years. Specific mediating mechanisms include, but are not limited to, increasing medication adherence, teaching self‐monitoring and early intervention with emergent episodes, and enhancing interpersonal functioning and family communication. All therapies have strengths and weaknesses. One group psychoeducation trial, demonstrated effect sizes for recurrence that are at least equivalent to individual therapies, but findings await replication. Family interventions have been successfully administered in both single and multi‐family formats, but no studies report the comparative cost‐effectiveness of these formats. The best‐studied psychotherapy modality, CBT, can have beneficial effects on depression, but findings are inconsistent across studies and vary with sample characteristics and comparison treatments. Conclusions: Adjunctive psychotherapies can be cost‐effective when weighed against observed reductions in recurrence, hospitalization and functional impairments. Future trials need to (i) clarify which populations are most likely to benefit from which strategies; (ii) identify putative mechanisms of action; (iii) systematically evaluate costs, benefits, and generalizability; and (iv) record adverse effects. The application of psychosocial interventions to young‐onset populations deserves further study.
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Psychosocial therapies incorporating mood and sleep strategies can reduce symptoms and prevent relapse/recurrence.
“there is evidence that psychosocial therapies which incorporate these strategies can reduce symptoms and prevent relapse/recurrence (Miklowitz and Scott 2009).”
From Evaluating the quality, safety, and functionality of commonly used smartphone apps for bipolar disorder mood and sleep self-management (2022) · cites this paper as Miklowitz and Scott 2009
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“Particular emphasis is placed on detecting and responding to changes in two symptom domains, mood and sleep, as there is evidence that psychosocial therapies which incorporate these strategies can reduce symptoms and prevent relapse/recurrence (Miklowitz and Scott 2009).”
Background
- Authors
- Miklowitz, D. J., & Scott, J.
- Affiliations
- University of Colorado Boulder (US)
- Newcastle University (GB)
- Corresponding author
- Miklowitz, David J
- Venue
- Bipolar Disorders
- Publisher
- Wiley
- Published
- 2009-06
- Volume
- 11
- Issue
- s2
- Pages
- 110-122
- ISSN
- 1398-5647 (ISSN-L)
- 1399-5618
- OpenAlex
- W2066760211
- Cited by
- 180
- References
- 75
- Citations by year
- 2026: 3 · 2025: 6 · 2024: 9 · 2023: 4 · 2022: 9 · 2021: 12 · 2020: 8 · 2019: 5 · 2018: 5 · 2017: 11 · 2016: 11 · 2015: 13 · 2014: 17 · 2013: 16 · 2012: 14
- FWCI
- 2.06
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Bipolar Disorders (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institutes of Health
- National Institute of Mental Health (MH077856, R01MH073871, MH073871, R34MH077856)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Bipolar Disorder and Treatment
- Social Sciences › Psychology › Clinical Psychology › Personality Disorders and Psychopathology
- Health Sciences › Medicine › Psychiatry and Mental health › Schizophrenia research and treatment
- Keywords
- bipolar disorder, adjunctive psychotherapy, cost-effectiveness, relapse prevention, family therapy, group therapy, cognitive behavioral therapy, interpersonal psychotherapy, medication adherence, self-monitoring, mood stabilizers, psychosocial functioning, treatment moderators
- MeSH terms
- Bipolar Disorder, Cost-Benefit Analysis, Humans, Social Support, Cognitive Behavioral Therapy, Treatment Outcome, Medication Adherence
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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