A new, common sense approach
STUDY: Nunes PV et al, Curr Opin Psychiatry 2026;39:000–000
STUDY TYPE: Review
FUNDING: Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)
Background
This review brings together recent evidence on lifestyle and psychotherapy for older adults with bipolar, highlighting a new therapy.
Recently, a small preliminary trial (n=39, mean age 67) of Recovery-focused Therapy showed benefits in mood and functioning in older adults with bipolar, and a larger randomized controlled trial (n=84) is underway with results likely in about a year.
Key Aspects of Recovery-focused Therapy
This therapy can be done with groups or individuals.
- Definition of Recovery: Unlike traditional clinical models focused solely on relapse prevention, RfT defines recovery as living a meaningful life, establishing purpose, and reclaiming identity, alongside managing symptoms.
- Personal Goals: Therapy revolves around goals chosen by the individual, which may include relationships, work, or social engagement, rather than just symptom reduction. The therapy is tailored to the person’s unique goals.
- Structure: It often includes phases such as understanding the diagnosis, building on strengths, developing coping strategies for mood shifts, and creating a personalized recovery plan.
- Strengths-based Coping Skills: Identifying existing strengths and building new ones to manage mood fluctuations.
- Early Warning Signs Planning: Developing a proactive plan to identify and manage potential relapse signs.
- Meaning of Diagnosis: Discussing the personal impact of a bipolar diagnosis and reducing self-stigmatizing language.
- Collaborative Approach: Working with therapists to set and achieve goals that matter to the patient.
- Lifestyle Routines: Incorporating structure to maintain, for example, sleep hygiene, which is crucial for stability.
How to Modify Therapy for Older Adults
Slow the pace, write stuff down, and look for ways to improve daily functioning. Help patients find social connections and meaning as they take account of their lives and reminisce on positive memories.
Lifestyle in Older Adults
The review also highlights lifestyle data from the UK Biobank, which identified relevant lifestyle risks that can worsen bipolar:
- Smoking
- Sleep dysregulation
- Sedentary behavior
- Poor diet and weight extremes
Cognition and physical activity influence each other in both directions. Lower cognitive function predicts more sedentary behavior over time, and low physical activity worsens cognition.
Practice Implications
- Recovery-focused Therapy looks promising for patients with preserved cognition who are stable enough to engage.
- Learn more lifestyle techniques for depression and bipolar.
— Chris Aiken, MD
Director, Psych Partners
Editor in Chief, Carlat Psychiatry Report
