There is increasing recognition that pharmacotherapy alone cannot prevent recurrences of bipolar disorder or fully alleviate postepisode symptoms or functional impairment.¹ Psychotherapy, when provided at all, is viewed as an adjunctive treatment.² Evidence from randomized clinical trials (RCTs) indicates that combining pharmacotherapy with manualized psychotherapies—including cognitive behavioral therapy (CBT), family-focused therapy, interpersonal and social rhythm therapy (IPSRT), and group psychoeducation—is more effective than pharmacotherapy alone in stabilizing symptoms and reducing recurrences among outpatients with bipolar disorder.^1,3,4 The comparative effectiveness of these approaches, however, has received scant attention.

Family‐focused therapy (FFT) is an evidence‐based intervention for adults and children with bipolar disorder (BD) and their caregivers, usually given in conjunction with pharmacotherapy after an illness episode. The treatment consists of conjoint sessions of psychoeducation regarding bipolar illness, communication enhancement training, and problem‐solving skills training. This paper summarizes over 30 years of research on FFT and family processes in BD. Across eight randomized controlled trials with adults and adolescents with BD, FFT and mood‐stabilizing medications have been found to hasten recovery from mood episodes, reduce recurrences, and reduce levels of symptom severity compared to briefer forms of psychoeducation and medications over 1–2 years. Several studies indicate that the effects of FFT on symptom improvement are greater among patients with high‐expressed emotion relatives. New research focuses on FFT as an early intervention for youth at risk for BD, neuroimaging as a means of evaluating treatment mechanisms, and progress in implementing FFT in community mental health settings.

Impulsive risk taking contributes to deleterious outcomes among clinical populations. Indeed, pathological impulsivity and risk taking are common in patients with serious mental illness, and have severe clinical repercussions including novelty seeking, response disinhibition, aggression, and substance abuse. Thus, the current study seeks to examine self-reported impulsivity (Barratt Impulsivity Scale) and performance-based behavioral risk taking (Balloon Analogue Risk Task) in bipolar disorder and schizophrenia. Participants included 68 individuals with bipolar disorder, 38 with schizophrenia, and 36 healthy controls. Self-reported impulsivity was elevated in the bipolar group compared with schizophrenia patients and healthy controls, who did not differ from each other. On the risk-taking task, schizophrenia patients were significantly more risk averse than the bipolar patients and controls. Aside from the diagnostic group differences, there was a significant effect of antipsychotic (AP) medication within the bipolar group: bipolar patients taking AP medications were more risk averse than those not taking AP medications. This difference in risk taking because of AP medications was not explained by history of psychosis. Similarly, the differences in risk taking between schizophrenia and bipolar disorder were not fully explained by AP effects. Implications for clinical practice and future research are discussed.