Balancing hype and hope: are third-wave cognitive behavioral therapies a good fit for bipolar disorder? An ISBD psychological interventions taskforce editorial paper

Abstract

Bipolar disorder (BD) is a chronic psychiatric condition, which requires lifelong medical care. There is considerable evidence of the superior efficacy of treatments combining psychotherapy adjunct to pharmacotherapy. Recently emerged, third-wave cognitive behavioral therapies (CBTs) pose a contrasting new paradigm to traditional CBT approaches, by shifting focus away from cognitive restructuring and symptom reduction and by targeting processes of change. Over the last few decades, third-wave CBTs have accumulated evidence of efficacy across psychiatric disorders, for multiple outcomes, while sustaining CBTs efficacy for symptom reduction and illness stabilization. Nonetheless, research on third-wave CBTs for BD is incipient; and manuals crafted for other psychiatric disorders may overlook critical aspects of BD, due the singularity of its episodic course. In this context, a subgroup of members from the International Society for Bipolar Disorders’ Psychotherapy Taskforce (ISBD-PITF), aimed deliberate over third-wave CBT’s possible benefits for BD by detangling specific aspects concerning the feasibility of adapting its frameworks and mechanisms of change, to BD’s specificities. The examination of conceptual aspects and the emerging evidence within BD, suggests that third-wave CBTs may provide a theoretically coherent framework for addressing the complex and cyclical course of BD. When combined with psychoeducation and tailored to BD-specific features, these approaches could hold promise for mechanisms and processes still understudied and insufficiently addressed by the existing evidence-based psychotherapies for BD. Thus, moving forward, the research community, funding bodies, and clinical stakeholders should collaborate to advance third-wave interventions for BD.

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ORCID for Thomas Richardson: orcid.org/0000-0002-5357-4281

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