Psychological interventions in offspring of parents with bipolar disorder

The high risk of mental illness and concerns of affected parents make offspring of parents living with bipolar disorder an important target group for preemptive early interventions aiming to prevent the onset of major mood disorders and other types of mental illness. Since most onsets of major mood and psychotic disorders occur in the second and third decade of life, preventive interventions have to be delivered in adolescence or childhood. Because of concerns about the tolerability and acceptability of psychotropic medication in this young group, the focus has been largely on psychological intervention. An unprecedented effort is under way, with at least six clinical trials of psychological interventions initiated in the last 5 years. Family-Focused Therapy (FFT), Interpersonal and Social Rhythm Therapy (IPSRT), mindfulness-based cognitive therapy (MBCT), and several adaptations of cognitive-behavioral therapy (CBT), including CBT-Regulation (CBT-R) and Multimodal Antecedent-focused Cognitive-behavioral Training (maCBT), are being tested in small- to medium-scale randomized controlled trials that focus exclusively or partially on offspring of parents with bipolar disorder. Completed studies demonstrate feasibility of early psychological interventions and beneficial effects on mood symptoms over 6-12 months. The next stage will be to test whether psychological interventions reduce the likelihood of onset of mental illness in offspring of parents with bipolar disorder. This will require substantially larger samples and longer follow-up periods. If the present research efforts are sustained, the next 5-10 years will see an expansion of knowledge on the preventability of bipolar disorder and other mental illness through psychological means.