Third-Wave Therapies for Bipolar Disorder

May 12, 2026by Chris Aiken, MD0

Steve Hayes developed Acceptance and Commitment Therapy (ACT) in the 1980s

Mindfulness, ACT, and DBT for bipolar?

STUDY: Khafif TC et al, Bipolar Disorders 2026

STUDY TYPE: Editorial

FUNDING: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (Brazilian federal research agency)

Background

Third-wave therapies include Acceptance and Commitment Therapy (ACT), Dialectical Behavior Therapy (DBT), and Mindfulness-Based Cognitive Therapy (MBCT), shift the target from symptom reduction toward psychological flexibility and values-based living. This editorial from the International Society for Bipolar Disorders asks whether these approaches can be adapted for the unique demands of bipolar disorder.

Results

The evidence is early but encouraging. A randomized trial of DBT in 100 adolescents with bipolar disorder found that a 36-session program cut suicide attempts, with emotion regulation as the key mediator. In adults, MBCT produced the strongest antidepressant effect in those with high depression and anxiety, while a values-based intervention worked better for those with milder symptoms.

The authors caution that off-the-shelf third-wave manuals don’t translate directly to bipolar disorder. They miss several bipolar-specific needs:

Early recognition of manic prodromes
Medication adherence strategies
Management of rapid cycling and subthreshold mood swings
Trauma, shame, and perfectionism, which are common in bipolar disorder and not addressed by some standard protocols

Another caution: Intensive mood monitoring and meditation can occasionally provoke distress or rumination in some patients.

Practice Implications

This is a step in the right direction.
Much of the research on therapy in bipolar has focused on CBT and behavioral approaches, but those don’t click with some patients, and third-wave approaches provide a needed alternative.
My bias: I’ve seen good success with them with bipolar.