Cognitive–behavioural therapy for severe and recurrent bipolar disorders

Declaration of interest None. Fundingdetailed in Acknowledgements. Bipolar disorders have a mean recurrence rate of about 50% at 1 year after an index episode and over 70% at 4 years (Harrow et al, 1990; Keller et al, 1993; Gitlin et al, 1995). Published treatment guidelines (American Psychiatric Association, 2002; Goodwin, 2003) advocate adding psychological therapies to medication to reduce recurrences. Recent randomised controlled trials (RCTs) of efficacy suggest that pharmacotherapy plus brief evidencebased manualised therapy may significantly reduce recurrence rates compared with treatment as usual (Perry et al, 1999; Miklowitz et al, 2000; Scott et al, 2001; Colom et al, 2003a,b; Lam et al, 2003). However, these were single-centre studies that predominantly recruited euthymic patients with relatively little psychiatric comorbidity. In our pragmatic multicentre RCT we aimed to establish whether cognitive–behavioural therapy (CBT) plus treatment as usual is more effective than treatment as usual alone in reducing recurrence rates and lowering weekly symptom levels in a clinically representative sample of individuals with recurrent bipolar disorder.