Cognitive Therapy and Research, Vol. 24, No. 5, 2000, pp. 503–520 Cognitive Therapy for Bipolar Illness—A Pilot Study of Relapse Prevention Dominic H. Lam, 1,3 Jeny Bright, 1 Steve Jones, 2 Peter Hayward, 1 Nikki Schuck, 1 Daniel Chisholm, 1 and Pak Sham 1 Twenty-five (25) bipolar patients taking mood stabilizers and yet still relapsing were recruited into a randomized controlled pilot cognitive therapy study. All subjects were taking mood stabilizers on recruitment. The control group had treatment as usual—that is, the usual outpatients and multidisciplinary team input. The therapy group received between 12 and 20 sessions of cognitive therapy adapted for bipolar illness in addition to treatment as usual. Therapy consisted of a relapse prevention approach and lasted 6 months. Independent assessments showed that the therapy group had significantly fewer bipolar episodes, higher social functioning, and better coping strategies for bipolar prodromes. Furthermore, there was evidence of less fluctuation in symptoms of mania and depression, less hopelessness, and better medi- cation compliance from subjects’ monthly self reports. There was no evidence that improvement in the therapy group was due to more medication being prescribed. In fact, there were significantly less neuroleptics being prescribed in the therapy group for the 6 months after therapy. A further study with a larger sample size and longer follow-up period is warranted. KEY WORDS: bipolar; cognitive therapy; prodrome. Bipolar affective disorder is a common and severe form of mental illness. It runs a natural course of high frequency of relapses (Solomon et al., 1995) and serious suicide risk (Regier et al., 1988). Since the early 1970s, treatment for manic depression has been predominantly pharmacotherapy. Yet clinically it has been observed that lithium as a prophylactic drug may help only a proportion of patients. The NIMH Workshop on Treatment of Bipolar Disorders (Prien & Potter, 1990) stated that lithium is ineffective for from 20% to 40% of classic bipolar patients due to either inadequate responses or side effects. Moreover, the evidence of efficacy 1 Institute of Psychiatry, London, UK. 2 Rochdale NHS Trust, UK. 3 Address all correspondence to Dr. Dominic Lam, Senior Lecturer, Psychology Department, Institute of Psychiatry, DeCrespigny Park, London, SE5 8AF, United Kingdom; e-mail: spjtdhl@iop.kcl.ac.uk. 503 0147-5916/00/1000-0503$18.00/0  2000 Plenum Publishing Corporation