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Cognitive therapy as an adjunct to medication in bipolar disorder

  • Jan Scott (a1)

There is increasing support for the use of cognitive behaviour therapy as an adjunct to medication for patients with bipolar disorder.


To explore current psychological models of bipolar disorder, describing the clinical rationale for using cognitive therapy and providing a brief overview of the approach.


Results from outcome studies are discussed.


Preliminary findings indicate that cognitive therapy may be beneficial for patients with bipolar disorder. The collaborative, educational style of cognitive therapy, the use of a stepwise approach and of guided discovery is particularly suitable for patients who wish to take an equal and active role in their therapy.


Randomised, controlled trials of cognitive therapy in bipolar disorder are required to establish the short-term and long-term benefits of therapy, and whether any reported health gain exceeds that of treatment as usual.

Corresponding author
Professor Jan Scott, Division of Psychiatry, University Department of Psychological Medicine, Gartnavel Royal Hospital, Glasgow G12 0XH, UK. Tel: +44 (0) 141 211 3937; fax: +44 (0) 141 3574899; e-mail:
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Declaration of interest

J. S. is the Principal Investigator of a multicentre trial of cognitive therapy for bipolar disorders funded by the Medical Research Council.

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Basco, M. & Rush, A. (1995) Cognitive-Behavioural Treatment of Manic-Depressive Disorder. New York: Guilford Press.
Bauer, M. & McBride, R. (1997) Structured Group Psychotherapy for Bipolar Disorder – The Life Goals Program. New York: Springer.
Beck, A. T. (1996) Beyond belief: a theory of modes, personality and psychopathology. In Frontiers of Cognitive Therapy (ed. Salkovskis, P.). New York: Guilford Press.
Beck, A. T., Rush, A. J., Shaw, B., et al (1979) Cognitive Therapy of Depression. New York: Wiley.
Chor, P., Mercier, M. & Halper, I. (1980) Use of cognitive therapy for treatment of a patient suffering from a bipolar affective disorder. Journal of Cognitive Psychotherapy, 2, 5158.
Cochran, S. (1984) Preventing medical non-adherence in the outpatient treatment of bipolar affective disorder. Journal of Consulting and Clinical Psychology, 52, 873878.
Dickson, W. & Kendall, R. (1986) Does maintenance lithium therapy prevent recurrence of mania under ordinary clinical conditions. Psychological Medicine, 16, 521530.
Lam, D. & Wong, G. (1997) Prodromes, coping strategies, insight and social functioning in bipolar affective disorders. Psychological Medicine, 27, 10911100.
Lam, D., Jones, S., Bright, J., et al (2001) A randomized controlled trial of cognitive therapy for bipolar disorders. Cognitive Theory and Research, in press.
Miklowitz, D. & Goldstein, M. (1990) Behavioural family treatment for patients with bipolar affective disorder. Behaviour Modification, 14, 457489.
Palmer, A. & Scott, J. (2001) Cognitive therapy for bipolar disorders. In Psychological Interventions in Bipolar Disorders (eds George, S. & Birchwood, M.). Chichester: John Wiley & Sons.
Palmer, A., Williams, H. & Adams, M. (1995) Cognitive behaviour therapy in a group format for bipolar affective disorder. Behavioural and Cognitive Psychotherapy, 23, 153168.
Perry, A., Tarrier, N., Morriss, R., et al (1999) Randomized controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. British Medical Journal, 318, 149153.
Scott, J. (1995a) Psychotherapy for bipolar disorder: an unmet need? British Journal of Psychiatry, 167, 581588.
Scott, J. (1995b) Cognitive therapy for clients with bipolar disorder: a case example. Cognitive and Behavioural Practice, 3, 123.
Scott, J. (1995c) Psychological treatments for depression. An update [editorial]. British Journal of Psychiatry, 167, 289292.
Scott, J. (1999) Cognitive and behavioural approaches to medication adherence. Advances in Psychiatric Treatment, 5, 338347.
Scott, J. & Wright, J. (1997) Cognitive therapy with severe and chronic mental disorders. In Review of Psychiatry, vol. 16 (eds Frances, A. & Hales, R.). Washington, DC: American Psychiatric Association Press.
Scott, J., Stanton, B., Garland, A., et al (2000) Cognitive vulnerability to bipolar disorder. Psychological Medicine, 30, 467472.
Scott, J., Garland, A. & Moorhead, S. (2001) A randomized controlled trial of cognitive therapy for bipolar disorders. Psychological Medicine, in press.
Wehr, T., Sack, D. & Rosenthal, N. (1987) Sleep reduction as a final common pathway in the genesis of mania. American Journal of Psychiatry, 144, 201203.
Winters, K. & Neale, J. (1985) Mania and low self-esteem. Journal of Abnormal Psychology, 94, 282290.
Wright, J. & Schrodt, R. (1992) Combined cognitive therapy and pharmacotherapy. In Handbook of Cognitive Therapy (eds Freeman, A., Simon, K., Beutler, L., et al). New York: Plenum.
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The British Journal of Psychiatry
  • ISSN: 0007-1250
  • EISSN: 1472-1465
  • URL: /core/journals/the-british-journal-of-psychiatry
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Cognitive therapy as an adjunct to medication in bipolar disorder

  • Jan Scott (a1)
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