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Recently, Functional Remediation (FR) has proven to be effective in improving the functional outcome of euthymic bipolar patients. The aim of this study was to test the efficacy of the FR program in a subsample of euthymic bipolar II patients (BPII). A post-hoc analyses were undertaken using data of 53 BPII outpatients who had participated in a multicenter, rater-blind, randomized, controlled trial exploring the efficacy of FR (n=17) as compared with a Psychoeducation group (PSY) (n=19) and a treatment as usual control group (TAU n=17). The primary outcome variable was the functional improvement defined as the mean change in the Functioning Assessment Short Test (FAST) from baseline to endpoint after the intervention. Regarding the treatment effect, data reveal a significant functional improvement from baseline to endpoint, suggestive for an interaction between program pertinence and time (pre-post). Nevertheless, Tukey׳s post-hoc test only revealed a trend in favor of a better outcome for FR when compared to the other two groups. We also found an interaction between program pertinence and time when analysing the subdepressive symptoms, with BPII patients in FR showing a significant reduction when compared to the PSY group. Our results suggest that the FR appears to be effective in improving the overall functional outcome in BPII, as well as in reducing subdepressive symptoms., (Copyright © 2014 Elsevier B.V. and ECNP. All rights reserved.)

OBJECTIVE The authors sought to assess the efficacy of functional remediation, a novel intervention program, on functional improvement in a sample of euthymic patients with bipolar disorder. METHOD In a multicenter, randomized, rater-blind clinical trial involving 239 outpatients with DSM-IV bipolar disorder, functional remediation (N=77) was compared with psychoeducation (N=82) and treatment as usual (N=80) over 21 weeks. Pharmacological treatment was kept stable in all three groups. The primary outcome measure was improvement in global psychosocial functioning, measured blindly as the mean change in score on the Functioning Assessment Short Test from baseline to endpoint. RESULTS At the end of the study, 183 patients completed the treatment phase. Repeated-measures analysis revealed significant functional improvement from baseline to endpoint over the 21 weeks of treatment (last observation carried forward), suggesting an interaction between treatment assignment and time. Tukey's post hoc tests revealed that functional remediation differed significantly from treatment as usual, but not from psychoeducation. CONCLUSIONS Functional remediation, a novel group intervention, showed efficacy in improving the functional outcome of a sample of euthymic bipolar patients as compared with treatment as usual.

Although pharmacotherapy is the mainstay of treatment for bipolar disorder, the combination of evidence-based psychological interventions and drug treatment enhances overall effectiveness, mostly by further protecting patients from relapse/recurrence. In recent years, well-designed controlled studies have added weight to evidence favoring specific psychotherapy modalities for bipolar disorders. However, critical issues that may limit the benefits of psychotherapy in day-to-day clinical practice have emerged. In this article, we critically examine the effectiveness of psychosocial approaches to bipolar illness by reviewing the literature, which has been substantially enriched during the past 5 years. Recent studies further support the fact that psychoeducation and cognitive-behavioral therapy are effective in bipolar disorder, especially the early stages. Family interventions based on a psychoeducational model are also effective. Intensive psychotherapies may be more effective than short, managed care-based ones. Group psychoeducation seems to have long-lasting effects and to be cost-effective. Future studies should focus on neurobiological markers of response to psychotherapy and tailor interventions to specific subtypes.

Cognitions in the form of mental images have a more powerful impact on emotion than their verbal counterparts. This review synthesizes the cognitive science of imagery and emotion with transdiagnostic clinical research, yielding novel predictions for the basis of emotional volatility in bipolar disorder. Anxiety is extremely common in patients with bipolar disorder and is associated with increased dysfunction and suicidality, yet it is poorly understood and rarely treated. Mental imagery is a neglected aspect of bipolar anxiety although in anxiety disorders such as posttraumatic stress disorder and social phobia focusing on imagery has been crucial for the development of cognitive behavior therapy (CBT). In this review we present a cognitive model of imagery and emotion applied to bipolar disorder. Within this model mental imagery amplifies emotion, drawing on Clark's cyclical panic model [(1986). A cognitive approach to panic. Behaviour Research and Therapy, 24, 461-470]. We (1) emphasise imagery's amplification of anxiety (cycle one); (2) suggest that imagery amplifies the defining (hypo-) mania of bipolar disorder (cycle two), whereby the overly positive misinterpretation of triggers leads to mood elevation (escalated by imagery), increasing associated beliefs, goals, and action likelihood (all strengthened by imagery). Imagery suggests a unifying explanation for key unexplained features of bipolar disorder: ubiquitous anxiety, mood instability and creativity. Introducing imagery has novel implications for bipolar treatment innovation--an area where CBT improvements are much-needed.

This paper reviews published randomized controlled treatment trials of psychological therapies added to standard psychiatric treatment vs. standard psychiatric treatment alone to explore whether adjunctive psychotherapy reduces relapse rates in individuals with bipolar disorders. Core components and characteristics of effective psychological therapies were identified from descriptions in the literature. Relapse rates were calculated for selected treatment trials and then pooled odds ratios were calculated using meta-analytical techniques that explored differences in outcome according to therapy model, type of relapse experienced and whether the subject was euthymic at entry to the study. The different therapy models have a number of similar components. A meta-analysis of eight recent studies demonstrates a significant reduction in relapse rates (of about 40%) compared to standard treatment alone. Therapies were most effective in preventing relapses in subjects who were euthymic when recruited into the treatment trial, and may be less effective in those with a high number of previous episodes (previous relapses >12). Efficacy studies demonstrate that adjunctive psychological treatments for individuals with bipolar disorders reduce relapse risk, but there is a need to undertake pragmatic effectiveness studies to determine which individuals with bipolar disorders are most likely to benefit from such interventions.

Although pharmacotherapy is the mainstay of treatment strategies for bipolar disorder, research over the last 5 years suggests that combining psychologic interventions with drug treatment increases overall effectiveness, mostly by further protecting from relapse or recurrence. We aimed at critically examining the relevance and effectiveness of psychosocial approaches to bipolar illness by doing a systematic review of the current literature. Currently, most studies show that patients receiving psychologic treatments have significantly fewer relapses, reduced hospitalization rates, and increased treatment adherence. Psychoeducation, family-focused psychoeducation, and cognitive-behavioral therapy seem to be the most efficacious interventions in the prophylaxis from recurrences in medicated bipolar patients. Recent studies have shown that psychologic approaches do not have the same "weight" in all bipolar patients. Pharmacologic treatment and psychologic interventions are complementary and share many goals, such as avoiding recurrences and improving clinical outcome. A wise combination of these two approaches may help bipolar patients to achieve a better symptomatic and functional recovery. Further research should focus on determining the therapeutic value of each ingredient of the tested psychologic interventions.

Bipolar depression is poorly understood and researched, yet it is has a huge impact on functioning in bipolar disorder. This review explores the current status of research regarding the phenomenology, natural history, neuropsychology, psychosocial predictors and cognitive style of bipolar depression. The current status of pharmacotherapy and psychological treatment of bipolar depression is also described. In particular, the manner in which cognitive behaviour therapy for bipolar depression has been adapted from CBT for unipolar depression is critically evaluated. It is concluded that there appears to be a considerable overlap between the features of unipolar and bipolar depression, yet there is also emerging evidence for specific elements. The ability of current psychological theories of bipolar disorder to account for the findings are compared, and as a consequence, a new preliminary integrative model is proposed to direct future hypothesis-led research, which will need to incorporate more suitable populations and utilise more objective methods of assessment.

Objectives: Although pharmacological treatment is at present essential for treating bipolar patients, a number of psychological interventions have recently been shown to be efficacious as add-on therapies for the prophylactic treatment of bipolar illness. The study aimed critically to examine the efficacy of several tested patient-focused therapies., Methods: A systematic review of the literature on this topic was performed, using MEDLINE, PSYCLIT and CURRENT CONTENTS. 'Bipolar', 'Psychotherapy', 'Psychoeducation', 'Interpersonal' and 'Cognitive-behavioral' were entered as keywords., Results: To date, psychoeducation and cognitive-behavioral therapy are the psychological interventions that have been shown to be more efficacious in the prophylaxis of new recurrences. There remains a need for studies investigating the role and efficacy of psychological interventions during acute phases of the illness., Conclusions: As their therapeutic goals are complementary, a combination of psychotherapy and pharmacotherapy may allow patients to achieve better symptomatic and functional recovery. Further research is needed to determine which patients may be better candidates for psychological interventions and to estimate the relative effects of the different components of psychological approaches on outcome., (Blackwell Munksgaard, 2004)

The present paper addresses the efficacy of psychoeducation and related strategies in bipolar disorders. Recently, several randomised clinical trials have shown the efficacy of psychological interventions--namely identification of prodromal signs, cognitive-behavioral therapy, psychoeducation and family-focused interventions--as a prophylactic add-on to medication. All these studies are presented hereby, together with the pioneer studies in the field. There are several topics that every psychoeducational program should include to ensure its usefulness, and they will be summarized in twelve points. Roughly, psychoeducation should contain general information about bipolar illness, compliance enhancement elements, teaching on early recognition of relapses and lifestyle regularity issues. Nowadays, several treatment guidelines include psychoeducation as a crucial prophylactic tool. Clinicians should be aware of this and start performing psychoeducation in their everyday clinical practice.

Background: The authors review and criticize the different roles developed by psychotherapy in the treatment of bipolar disorder, from psychodynamic conceptions to a biopsychosocial model., Methods: The main computerized database (Medline, Current Contents, Psychological Abstracts) have been consulted, using the terms 'psychotherapy', 'psychosocial' and 'bipolar disorder' as key words., Results: Psychoanalysis, psychoeducation, family therapy, cognitive-behavioral therapy and interpersonal therapy have been used in the treatment of bipolar patients. To date, none have established efficacy in controlled clinical trials regarding aspects such as hospitalization, recurrences or suicidal behavior, as medication alone does. Research on this issue usually undergoes methodological pitfalls. Nonetheless, the psychoeducative approach combined with several cognitive-behavioral techniques, either in group or individually, seem to be the most promising, focusing on information, treatment compliance, and illness management skills., Conclusions: There is a need for systematic clinical research on psychotherapy applied to bipolar disorder in order to show its true usefulness. Psychoeducation should prove its positive influence on the course and outcome of bipolar disorder.