Section Authors: Sheri L. Johnson and Daniel Fulford (University of Miami)


The defining feature of bipolar I disorder is the presence of at least one lifetime manic episodes. Mania is defined by the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) as a distinct period of abnormally and persistently euphoric or irritable mood that lasts at least 1 week (or any duration if hospitalized). According to the DSM, mood changes are accompanied by at least 3 (4 if mood is only irritable) of the following symptoms: overly confident self-esteem, racing thoughts, distractibility, excessive involvement in pleasurable activities that can result in negative consequences, excessive talkativeness, decreased need for sleep, and increases in goal-directed activity. DSM criteria specify that the symptoms lead to clear impairment. The DSM includes several milder forms of bipolar disorder, including bipolar II disorder and cyclothymia, but psychological treatment research has focused on bipolar I disorder.

Although bipolar I disorder is defined by at least one lifetime episode of mania, at least two-thirds of diagnosed persons report a history of major depressive episodes (Karkowski & Kendler, 1997; Kessler, Rubinow, Holmes, Abelson, & Zhao, 1997; Weissman & Myers, 1978). Longitudinal data suggests that subsyndromal symptoms are present during at least 47% of weeks among persons with bipolar I disorder, and that subsyndromal depressive symptoms are particularly common (Judd et al, 2002). Given these symptom patterns, there is a need for psychosocial treatments that can provide relief for mania as well as treatments that can provide relief for depression.

Treatment outcomes for mania and depression are reviewed separately. It is worth noting that some trials provided evidence that treatments could produce better medication adherence, lower relapse rates, or improvements in social domains, but did not measure or obtain effects specifically for mania versus depression (Cochran, 1984; van Gent & Zwart, 1991; Fristad et al., 2003; Volkmar et al., 1981).


Psychological Treatments

Treatment Research Support for Mania Research Support for Depression
Psychoeducation Strong Research Support Modest Research Support
Systematic Care Strong Research Support No Research Support
Cognitive Therapy (CT) Modest Research Support Modest Research Support*
Family-Focused Therapy (FFT) No Research Support Strong Research Support
Interpersonal and Social Rhythm Therapy (IPSRT) No Research Support Modest Research Support*

*Although findings of two trials indicated that these treatments lead to reduced depression, they have been labeled as having modest research support due to mixed findings.


Key References

  • Fristad, M. A., Goldberg-Arnold, J. S., & Gavazzi, S. M. (2003). Journal of Marital and Family Therapy, 29, 491-504.
  • Judd, L. L., Akiskal, H. S., Schettler, P. J., Endicott, J., Maser, J., et al. (2002). The long-term natural history of the weekly symptomatic status of bipolar I disorder. Archives of General Psychiatry, 59, 530-537.
  • Karkowski, L. M., & Kendler, K. S. (1997). An examination of the genetic relationship between bipolar and unipolar illness in an epidemiological sample. Psychiatric Genetics, 7, 159-163.
  • Kessler, R. C., Rubinow, D. R., Holmes, C., Abelson, J. M., & Zhao, S. (1997). The epidemiology of DSM-III-R bipolar I disorder in a general population survey. Psychological Medicine, 27, 1079-1089.
  • Van Gent, E. M., & Zwart, F. M. (1991). Psychoeducation of partners of bipolar-manic patients. Journal of Affective Disorders, 21, 15-18.
  • Cochran, S. D. (1984). Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. Journal of Consulting and Clinical Psychology, 52(5), 873-878.
  • Volkmar, F. R., Bacon, S., Shakir, S. A., & Pfefferbaum, A. (1981). Group therapy in the management of manic-depressive illness. American Journal of Psychotherapy, 35, 226-234.
  • Weissman, M. M., & Myers, J. K. (1978). Affective disorders in a US urban community: The use of Research Diagnostic Criteria in an epidemiological survey. Archives of General Psychiatry, 35, 1304-1311.

Note: Medications are recommended as the first treatment for bipolar disorder (American Psychiatric Association, 2002), but we do not cover medications in this website. Of course, we recommend a consultation with a mental health professional for an accurate diagnosis and discussion of various treatment options. When you meet with a professional, be sure to work together to establish clear treatment goals and to monitor progress toward those goals. Feel free to print this information and take it with you to discuss your treatment plan with your therapist.