Cognitive-behavioral strategies for improving medication adherence in patients with bipolar disorder

Bipolar disorder can have serious effects on patients' social and occupational functioning. Effective pharmacotherapies are available, but many patients have difficulties adhering to prescribed regimens. This paper presents a cognitive-behavioral program designed to improve medication adherence. The program focuses on three goals: prevention of suicide, stabilization of mood, and achievement of individual personal and occupational goals. The treatment consists of behavioral, cognitive, and interpersonal interventions. Behavioral interventions include goal setting, task analysis, and self-monitoring. These interventions provide the framework for therapy and include methods for evaluating the effectiveness of the pharmacological treatment. Cognitive interventions are directed at the shame, defensiveness, and fear that can prevent patients from adhering to treatment recommendations. Interpersonal interventions provide the context in which the behavioral and cognitive interventions are implemented. Case examples illustrate key concepts.