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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 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 ( CANMAT ) and International Society for Bipolar Disorders ( ISBD ) 2018 guidelines for the management of patients with bipolar disorder (2018) · cites this paper as [79]
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“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
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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
Camardese, G., Vasale, M., D'Alessandris, L., Mazza, M., Serrani, R., Travagliati, F., Walstra, C., Zaninotto, L., Leone, B., Nicola, M. D., et al. (2018) · The Journal of Nervous and Mental Disease · doi:10.1097/nmd.0000000000000795 · Cited by 7
“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
“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
“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
“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. H., & Palmer-Cooper, E. C. (2023) · British Journal of Clinical Psychology · doi:10.1111/bjc.12442 · Cited by 6
“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
“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
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
“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 6
“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
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
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
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
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
Riemann, G., Chrispijn, M., Weisscher, N., Regeer, E. J., & Kupka, R. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.725381 · Cited by 4
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
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 4
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 4
“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 3
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
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 4
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 3
Self-citationMeyer, T. D., & Bauer, M. (2020) · Springer eBooks · doi:10.1007/978-3-662-61814-1_45 · Cited by 2
Watson, S., & Dodd, A. (2017) · Evidence-Based Mental Health · doi:10.1136/eb-2017-102648 · Cited by 2
Carr, L., Awenat, Y. F., Ray, S., & Tai, S. (2024) · Clinical Psychology & Psychotherapy · doi:10.1002/cpp.2946 · Cited by 1
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
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
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
“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
Metadata
- 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
- 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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