Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis
Open accessAbstract
Background: Psychological interventions may be beneficial in bipolar disorder. Aims: To evaluate the efficacy of psychological interventions for adults with bipolar disorder. Method: A systematic review of randomised controlled trials was conducted. Outcomes were meta-analysed using RevMan and confidence assessed using the GRADE method. Results: We included 55 trials with 6010 participants. Moderate-quality evidence associated individual psychological interventions with reduced relapses at post-treatment (risk ratio (RR) = 0.66, 95% CI 0.48–0.92) and follow-up (RR = 0.74, 95% CI 0.63–0.87), and collaborative care with a reduction in hospital admissions (RR =0.68, 95% CI 0.49–0.94). Low-quality evidence associated group interventions with fewer depression relapses at post-treatment and follow-up, and family psychoeducation with reduced symptoms of depression and mania. Conclusions: There is evidence that psychological interventions are effective for people with bipolar disorder. Much of the evidence was of low or very low quality thereby limiting our conclusions. Further research should identify the most effective (and cost-effective) interventions for each phase of this disorder.
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Individual psychoeducation of at least five sessions is a first-line intervention for relapse prevention based on level 2 evidence.
“individual psychoeducation of at least five sessions would still be a first‐line intervention for relapse prevention, based on level 2 evidence.75, 79, 80”
From Canadian Network for Mood and Anxiety Treatments ( <scp>CANMAT</scp> ) and International Society for Bipolar Disorders ( <scp>ISBD</scp> ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [79]
The Individual psychological interventions section reports moderate-quality evidence that individual interventions, including psychoeducation among other therapies, reduced relapse risk. The Discussion likewise reports reduced relapse risk for individual psychological interventions. Neither passage establishes a minimum of five psychoeducation sessions, designates individual psychoeducation as first-line, or assigns it level 2 evidence. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPsychological interventions for bipolar disorders typically produce mixed outcomes and modest effects.
“Psychological interventions for bipolar disorders typically produce mixed outcomes and modest effects.”
From What are People's Experiences of a Novel Cognitive Behavioural Therapy for Bipolar Disorders? A Qualitative Investigation with Participants on the TEAMS Trial. (2017) · cites this paper as Oud et al., 2016
The Discussion reports mixed outcomes: some, but not all, interventions reduced relapse or hospital admissions, while effects on mania and several other outcomes were limited or inconclusive. It describes the reduction in depressive symptoms as possibly small, but also reports a 34% reduction in relapse risk for individual interventions and a substantial reduction with family psychoeducation. Thus, 'modest effects' overgeneralizes the findings. (LLM, conf=0.85)
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The Role of Common Factors in Psychotherapy Outcomes
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“Concerns still remain about the strength of the evidence base for psychological interventions (Goodwin et al., 2016; Murray, 2018; Oud et al., 2016), but best practice treatment of BD clearly involves the combination of medication and psychological treatment.”
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“stabilizing episodes, and reducing episode length (Miklowitz, 2008; Miziou et al., 2015; Oud et al., 2016).”
BackgroundMorriss, R., Lobban, F., Riste, L., Davies, L., Holland, F., Long, R., Lykomitrou, G., Peters, S., Roberts, C., Robinson, H., et al. (2016) · The Lancet Psychiatry · doi:10.1016/s2215-0366(16)30302-9 · Cited by 77 · see citing works
Self-citationEvidence-Based Psychotherapies for Bipolar Disorder
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“The evidence basesupporting the ef fi cacy of bipolar disorder – speci fi c psychotherapies is substantial (4, 16, 93, 94).”
Improving functional outcome in bipolar disorder: A pilot study on metacognitive training
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A comparative study of engagement in mobile and wearable health monitoring for bipolar disorder
Til, K. V., McInnis, M. G., & Cochran, A. L. (2019) · Bipolar Disorders · doi:10.1111/bdi.12849 · Cited by 48 · see citing works
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A systematic review on sleep alterations anticipating the onset of bipolar disorder
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“Two large Veterans Administration (VA) studies reported that approximately 50% of bipolar patients miss ≥20% of prescribed maintenance medication (Sajatovic et al.”
BackgroundImpact of Childhood Trauma and Attachment on Resilience in Remitted Patients with Bipolar Disorder.
Citak, C., & Erten, E. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.11.025 · Cited by 31 · see citing works
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“Cognitive-behavioral therapy has efficacy for improving symptoms of psychosis, bipolar disorder, and severe depression.(20,83,101,115) There is clear overlap in the use of cognitive-behavioral therapy for these disorders and evidencebased cognitive-behavioral methods for pain, including facilitating use of adaptive st…”
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“Only 16% of the total sample experienced any relapse, compared with expected levels of 50-70% [37].”
Self-citationPsychological mechanisms and the ups and downs of personal recovery in bipolar disorder
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Self-citationSystemic challenges in bipolar disorder management: A patient‐centered approach
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“Pharmacological therapy is often the first-line treatment for BD, followed by psychological (Oud et al., 2016) and psychosocial interventions (Goodwin et al., 2008).”
BackgroundHales, S. A., Simplicio, M. C. D., Iyadurai, L., Blackwell, S. E., Young, K., Fairburn, C. G., Geddes, J. R., Goodwin, G. M., & Holmes, E. A. (2018) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465818000334 · Cited by 31 · see citing works
“…intervention for overall relapse prevention in BD, see Miura et al., 2014) reduces the risk of relapse by only 34% (Severus et al., 2014), while individual psychological interventions (in addition to medication) for BD are associated with a 26% reduction in risk at follow-up (Oud et al., 2016).”
BackgroundResultBaruch, E., Pistrang, N., & Barker, C. (2018) · Journal of Affective Disorders · doi:10.1016/j.jad.2018.04.077 · Cited by 45 · see citing works
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Belief updating in bipolar disorder predicts time of recurrence
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“Maintenance treatment in bipolar disorder relies on mood stabilizers and psychological programs aimed at increasing treatment compliance, educating the patients and identifying prodromal sub-syndromic symptoms, which provide clues for an upcoming episode (Oud et al., 2016; Scott et al., 2007).”
BackgroundJones, B. D. M., Umer, M., Kittur, M. E., Finkelstein, O., Xue, S., Dimick, M. K., Ortiz, A., Goldstein, B. I., Mulsant, B. H., & Husain, M. I. (2023) · International Journal of Bipolar Disorders · doi:10.1186/s40345-023-00288-6 · Cited by 24 · see citing works
“The limitations of pharmacotherapy alone have led to an increasing interest in the development and adaptation of BD–specific psychotherapies (Oud et al. 2016).”
BackgroundEnrique, Á., Duffy, D. J., Lawler, K., Richards, D., & Jones, S. H. (2020) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2480 · Cited by 24 · see citing works
Self-citationThe lived experience of caring for someone with bipolar disorder: A qualitative study
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“Online CBT interventions have been found to be effective for people with BD [40] but have not yet been developed for carers.”
BackgroundHanssen, I., Huijbers, M. J., van Bennekom, M. L., Regeer, E. J., Stevens, A. W. M. M., Evers, S., Wensing, M., Kupka, R., & Speckens, A. E. M. (2019) · BMC Psychiatry · doi:10.1186/s12888-019-2115-6 · Cited by 23 · see citing works
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“These findings do not suggest that yoga is superior to psychoeducation, but they do provide support for its benefit in improving residual symptoms of depression, along with other proven interventions including psychoeducation.(34,35) In light of the overall improvement in symptoms and function, it is suggested that yo…”
BackgroundMethodJones, S. H., Akers, N., Eaton, J., Tyler, E., Gatherer, A., Brabban, A., Long, R., & Lobban, F. A. (2018) · Behaviour Research and Therapy · doi:10.1016/j.brat.2018.09.006 · Cited by 21 · see citing works
“Oud et al (Oud et al., 2016) reported on a meta-analysis of all of the structured psychological intervention”
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“…behaviour therapy, family therapy) for improving symptoms (Wykes et al. , 2008; Jauhar et al. , 2014), reducing relapse (Bucci et al. , 2016; Oud et al. , 2016), improving medication adherence (Barkhof et al. , 2012) and modifying health risk behaviours (Baker et al. , 2009; Banham and…”
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Self-citationUnderstanding who uses Reddit: Profiling individuals with a self-reported bipolar disorder diagnosis
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“Currently, psychoeducation is recognized as an additional strategy to improve symptoms and reduce relapse rates in mood disorders (Oud et al., 2016; Tursi et al., 2013).”
BackgroundJohansen, K. K., Hounsgaard, L., Frandsen, T. F., Fluttert, F., & Hansen, J. P. (2020) · Journal of Psychiatric and Mental Health Nursing · doi:10.1111/jpm.12716 · Cited by 17 · see citing works
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“There is accumulating evidence for the effectiveness of psychological treatments for bipolar depression and long-term management [7].”
BackgroundSelf-citationA Unified Model of Behavioral Health Integration in Primary Care
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“A meta-analysis (Oud et al., 2016) found reduced relapse rates and hospital admissions, with group interventions linked to fewer symptoms of depression.”
BackgroundWhy doesn't God say “enough”? Experiences of living with bipolar disorder in rural Ethiopia
Demissie, M., Hanlon, C., Ng, L. C., Fekadu, A., & Mayston, R. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113625 · Cited by 12 · see citing works
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“These diseases are associated with great personal costs to patients, their relatives (Morriss et al., 2013; Oud et al., 2016) and society in general, due to mood fluctuations, varying treatment needs and working capacity (Miziou et al.”
BackgroundPersonal recovery in psychological interventions for bipolar disorder: a systematic review
Hancock, J., & Perich, T. (2022) · Australian Psychologist · doi:10.1080/00050067.2022.2083484 · Cited by 10 · see citing works
“A number of studies have systematically reviewed the effectiveness of adjunctive psychosocial interventions for bipolar disorder (Beynon et al., 2008; Fountoulakis & Vieta, 2008; Miklowitz et al., 2021; Miziou et al., 2015; Oud et al., 2016).”
BackgroundCasellas‐Pujol, E., Raventós, B., Piñeiro-Ríos, M., Navarro-Martínez, H., Castillón-Espezel, M., Portella, M. J., & Martín‐Blanco, A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18095019 · Cited by 11 · see citing works
Psychotherapy over the Last Four Decades
Weissman, M. M., & Cuijpers, P. J. (2017) · Harvard Review of Psychiatry · doi:10.1097/hrp.0000000000000165 · Cited by 10 · see citing works
“Psychological treatments of bipolar disorder show that these therapies have small but significant effects on depression, and result in considerably lower rates of relapse.(18)”
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Azevedo, J., Swales, M. A., Carreiras, D., Guiomar, R. N. R. M., Macedo, A., & Castilho, P. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.04.033 · Cited by 8 · see citing works
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Interventions for helping people recognise early signs of recurrence in bipolar disorder
Gupta, S., Onwuchekwa, O., Alla, L. R., Morriss, R. K., Steele, R., & Gupta, N. (2022) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd015343 · Cited by 9 · see citing works
Self-citationHanssen, I., ten Klooster, P. M., Kraiss, J. T., Huijbers, M. J., Regeer, E. J., Kupka, R., Bohlmeijer, E. T., & Speckens, A. E. M. (2024) · Journal of Affective Disorders · doi:10.1016/j.jad.2024.05.110 · Cited by 7 · see citing works
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“Therefore, the management of depression requires additional psychological interventions (Oud et al., 2016) to the target patients to reduce depression relapse.”
BackgroundLau‐Zhu, A., Tuxen, N., Roerne, M. L., & Simplicio, M. C. D. (2023) · Psychiatry Research Case Reports · doi:10.1016/j.psycr.2023.100124 · Cited by 7 · see citing works
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“Various psychosocial interventions have been adopted as a complementary approach to drug therapy (Oud et al., 2016; Swartz and Kupfer, 2006): cognitivebehavior therapy (CBT), interpersonal and social rhythm therapy (IPSRT), family-focused therapy (FFT), and psychoeducation (PE).”
MethodA cognitive behavioural group therapy for bipolar disorder using daily mood monitoring
Henken, H. T., Kupka, R., Draisma, S., Lobbestael, J., van den Berg, K. C., Demacker, S. M. A., & Regeer, E. J. (2020) · Behavioural and Cognitive Psychotherapy · doi:10.1017/s1352465820000259 · Cited by 7 · see citing works
“A meta-analysis of 55 trials with n = 6010 participants suggests that both individual and group psychological interventions were associated with reduced relapse rates at post-treatment and follow-up (Oud et al., 2016).”
BackgroundSelf-citationDevelopment of an Emotion-Sensitive mHealth Approach for Mood-State Recognition in Bipolar Disorder
Daus, H., Blocher, T., Egeler, R., Klerk, R. D., Stork, W., & Backenstraß, M. (2020) · JMIR Mental Health · doi:10.2196/14267 · Cited by 7 · see citing works
“In particular, the high relapse rates within bipolar disorder are unsettling for all parties concerned: Even with pharmacological treatment [4] and different psychological approaches [5,6], these relapses cannot completely be prevented in many cases.”
BackgroundProbing the impact of psychoanalytic therapy for bipolar disorders: A scoping review
Stefana, A., D’Imperio, D., Dakanalis, A., Vieta, E., Fusar‐Poli, P., & Youngstrom, E. A. (2022) · International Forum of Psychoanalysis · doi:10.1080/0803706x.2022.2097307 · Cited by 7 · see citing works
“Indeed, there is evidence that psychological interventions are effective for adults with BD (Oud et al., 2016), especially when combined with pharmacotherapy or psychoeducation (Chatterton, Stockings, Berk, Barendregt, Carter, & Mihalopoulos, 2017; Miklowitz et al., 2006), and are capable of…”
BackgroundWoods, C., Richardson, T., & Palmer-Cooper, E. (2023) · British Journal of Clinical Psychology · doi:10.1111/bjc.12442 · Cited by 3 · see citing works
“In recent years there has been growing evidence for the efficacy of psychological therapies in bipolar disorder (BD; Oud et al., 2016 ).”
Theoretical Background and Clinical Aspects of the Use of EMDR in Patients With Bipolar Disorder
Valiente-Gómez, A., Moreno‐Alcázar, A., Gardoki-Souto, I., Masferrer, C., Porta, S., Royuela, O., Hogg, B., Lupo, W., & Amann, B. L. (2019) · Journal of EMDR Practice and Research · doi:10.1891/1933-3196.13.4.307 · Cited by 6 · see citing works
“They have been increasingly studied and added to the individual treatment plan in order to improve the prognosis of this complex and often refractory disorder (Bonnin et al., 2016; Miklowitz & Chung, 2016; Oud et al., 2016; Reinares, SánchezMoreno, & Fountoulakis, 2014; Secades-Álvarez & Fernández-Rodríguez, 2017).”
BackgroundMediation analysis of recovery-focused therapy for recent-onset bipolar disorder
Jones, S. H., Knowles, D., Howarth, E., Lobban, F. A., & Emsley, R. (2021) · Journal of Affective Disorders Reports · doi:10.1016/j.jadr.2021.100175 · Cited by 6 · see citing works
Self-citationPsychosocial interventions in bipolar disorders: A guidelines’ review
Ventriglio, A., Ricci, F., Giallanella, D., Gaggiano, C., Torales, J. C., Castaldelli-Maia, J. M., Smith, A. J., Liebrenz, M., Caycho‐Rodríguez, T., & Bellomo, A. (2025) · International Journal of Social Psychiatry · doi:10.1177/00207640251333296 · Cited by 5 · see citing works
“Psychoeducation of at least five sessions remains a first-line intervention for relapse prevention, supported by level 2 of evidence (Bond & Anderson, 2015; Oud et al., 2016; Salcedo et al., 2016).”
Reducing mental health emergency visits: population-level strategies from participatory modelling
Vacher, C., Ho, N., Skinner, A., Crosland, P., Hosseini, S. H., Huntley, S., Song, Y. J. C., Lee, G. Y., Natsky, A. N., Piper, S., et al. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-06066-7 · Cited by 5 · see citing works
“This intervention could be extended to a wider group of people with psychotic or severe mood disorders and carers, who can also benefit from family psychosocial education [28].”
BackgroundEfficacy of cognitive behavioural therapy for bipolar disorder: A systematic review
Valdivieso-Jiménez, G. (2023) · Revista Colombiana de Psiquiatría (English ed ) · doi:10.1016/j.rcpeng.2021.05.009 · Cited by 5 · see citing works
Jagfeld, G., Lobban, F. A., Davies, R. A. I., Boyd, R. L., Rayson, P., & Jones, S. H. (2023) · PLoS ONE · doi:10.1371/journal.pone.0291369 · Cited by 3 · see citing works
Self-citationPilot effectiveness trial of Mood Lifters for individuals who self-report bipolar disorder
Pokowitz, E. L., Menzies, C., Votta, C. M., Ye, H., O’Donnell, L. A., & Deldin, P. J. (2023) · Mental Health Review Journal · doi:10.1108/mhrj-12-2022-0077 · Cited by 4 · see citing works
Meditation for treating adults with bipolar disorder II: A multi‐city study
Pandya, S. P. (2018) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2347 · Cited by 4 · see citing works
Friedman, R. H., Giampaolo, J., Vanhaecke, L., & Jarrett, R. B. (2021) · Journal of Affective Disorders · doi:10.1016/j.jad.2021.07.024 · Cited by 4 · see citing works
Riemann, G., Chrispijn, M., Weisscher, N., Regeer, E. J., & Kupka, R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.725381 · Cited by 4 · see citing works
Self-citationScott, J. L., Bentall, R. P., Kinderman, P., & Morriss, R. K. (2022) · International Journal of Bipolar Disorders · doi:10.1186/s40345-022-00259-3 · Cited by 4 · see citing works
Self-citationBailey, B. C., Tabone, J. K., Early, T. J., Wen, S., Leber, A., & Swartz, H. A. (2025) · Journal of Affective Disorders · doi:10.1016/j.jad.2025.120121 · Cited by 3 · see citing works
Kazempour, V., Ebrahimi, H., Jafarabadi, M. A., Nourazar, S. G., & Zamani, H. (2018) · Iranian Red Crescent Medical Journal · doi:10.5812/ircmj.61555 · Cited by 3 · see citing works
“In a systematic review of RCTs, it was found that the efficacy of some, but not all, psychological interventions to treat patients with BD in closely related conditions was promising and the findings were more in favor of the reduction of relapse rate and hospital re-admission variables (31).”
BackgroundBipolar Disorder: An Update on Neurobiology and Treatment
Soliman, M. A., Khafif, T. C., Sylvia, L. G., & Nierenberg, A. A. (2026) · American Journal of Psychiatry · doi:10.1176/appi.ajp.20260051 · Cited by 2 · see citing works
Eficacia de la Terapia Cognitiva Conductual Para el Trastorno Bipolar: una Revisión Sistemática
Valdivieso-Jiménez, G. (2021) · Revista Colombiana de Psiquiatría · doi:10.1016/j.rcp.2021.05.006 · Cited by 3 · see citing works
Differences in beliefs about mood between people with and without bipolar disorder
Robinson, H., Jones, S. H., Fanshawe, T. R., & Lobban, F. A. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2391 · Cited by 2 · see citing works
Self-citationA guide to behavioural experiments in bipolar disorder
Palmier‐Claus, J. E., Wright, K. A., Mansell, W., Bowe, S. E., Lobban, F. A., Tyler, E., Lodge, C., & Jones, S. H. (2019) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2415 · Cited by 2 · see citing works
Self-citationMeyer, T. D., & Bauer, M. (2020) · Springer eBooks · doi:10.1007/978-3-662-61814-1_45 · Cited by 2 · see citing works
Watson, S., & Dodd, A. (2017) · Evidence-Based Mental Health · doi:10.1136/eb-2017-102648 · Cited by 2 · see citing works
Carr, L., Awenat, Y. F., Ray, S., & Tai, S. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2946 · Cited by 1 · see citing works
Personal Recovery With Bipolar Disorder: A Network Analysis
Glossop, Z., Campbell, C., Ushakova, A., Dodd, A., & Jones, S. H. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.70001 · Cited by 1 · see citing works
Self-citationDigital Diagnostic and Therapeutic Approaches in Bipolar Disorder
Faurholt‐Jepsen, M., & Kessing, L. V. (2025) · Springer eBooks · doi:10.1007/978-3-031-85519-1_38 · Cited by 1 · see citing works
Yilmaz, S., Huguet, A., Kisely, S. R., Rao, S., Wang, J., Price, M., Morriss, R. K., Inder, M., Perich, T., & Wright, K. A. (2025) · Psychological Medicine · doi:10.1017/s0033291725001023 · Cited by 1 · see citing works
“The findings are in line with the results of our and other authors ’ previous meta-analyses of aggregate data (Miklowitz et al., 2021; Oud et al., 2016; Yilmaz et al., 2022).”
Self-citation
- Authors
- Oud, M., Mayo-Wilson, E., Braidwood, R., Schulte, P., Jones, S. H., Morriss, R., Kupka, R., Cuijpers, P., & Kendall, T.
- Affiliations
- University of Nottingham (GB)
- Corresponding author
- Oud, Matthijs
- ORCID
- Venue
- British Journal of Psychiatry
- Publisher
- Royal College of Psychiatrists
- Published
- 2016-03
- Volume
- 208
- Issue
- 3
- Pages
- 213-222
- ISSN
- 0007-1250 (ISSN-L)
- 1472-1465
- OpenAlex
- W2318692336
- Cited by
- 144
- References
- 92
- Citations by year
- 2026: 7 · 2025: 13 · 2024: 11 · 2023: 14 · 2022: 11 · 2021: 13 · 2020: 15 · 2019: 18 · 2018: 18 · 2017: 17 · 2016: 4 · 2015: 2
- FWCI
- 2.70
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The British Journal of Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion, other-oa)
- Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
- VU Research Portal (publishedVersion, other-oa)
- Lancaster EPrints (Lancaster University) (acceptedVersion)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Nottingham ePrints (University of Nottingham) (submittedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion, other-oa)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Funders
- Trimbos-instituut
- National Institutes of Health
- 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, psychological intervention, relapse prevention, collaborative care, group intervention, family psychoeducation, depression, mania, hospitalization, treatment efficacy
- MeSH terms
- Bipolar Disorder, Counseling, Depression, Family, Family Therapy, Humans, Mental Health, Recurrence, Cognitive Behavioral Therapy, Randomized Controlled Trials as Topic, Treatment Outcome
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