Background to the manual

In recent years there has been growing recognition of the importance of psychological therapies for people with bipolar disorder (Scott & Colom, 2005). While biological and genetic factors appear to play a significant part in the etiology of the disorder (Pekkarinen et al., 1995; Hyman, 1999; Berrettini, 2000), and medication, particularly mood stabilizers, remains the first line of treatment for many clinicians, pharmacological interventions are not universally effective. Numerous reviews have found that even lithium – considered by many to be the “gold standard” of mood stabilizers – is effective in preventing relapse of symptoms for only 32–6% of people with bipolar disorder at 2-year follow-up (Prien et al., 1984; Gelenberg et al., 1989; Silverstone et al., 1998), with up to 87% of people relapsing at 5 years despite good medication adherence (Keller et al., 1993).

The heterogeneity of people with bipolar disorder, its psychosocial impact, and the complexity of the disorder itself led the US National Institute of Mental Health to conclude: “It is clear that pharmacotherapy alone does not meet the needs of many bipolar patients” (Prien & Potter, 1990, p. 419). This view has been echoed by a number of other organizations including the American Psychiatric Association (2002), the British Association for Psychopharmacology, the World Federation of Societies of Biological Psychiatry (Jones et al., 2005a), the Royal Australian and New Zealand College of Psychiatrists (2004), and the United Kingdom's National Institute for Health and Clinical Excellence (2006).