8. Medical treatment, such as antidepressant medication, may be
iatrogenic.

Emotional-Motivational Basic Behavi{*filter*}Repertoires (e-m BBRs)

9. Bipolar emotional responses to certain stimulus situations are
excessive (i.e., nonveridical).

10. Bipolar individuals respond with positive emotional arousal to
situations that others would find threatening or anxiety provoking.
Sensory-Motor Basic Behavi{*filter*}Repertoires (s-m BBRs)

11. Bipolar individuals have above average skills for engaging in risky
types of activities, which produce short-term reinforcement and
long-term punishment. These may include persuasive conversational
techniques or social manipulativeness.

12. Bipolar individuals have deficit social skills in maintaining
adequate social support networks.

Language-Cognitive Basic Behavi{*filter*}Repertoires (I-c BBRs)

13. Bipolar individuals are deficit in estimating long-term negative
consequences.

14. Bipolar individuals tend to employ grandiose self-labeling and
denial to elevate mood.

15. Bipolar individuals have poor cognitive problem-solving skills.

In considering the variety of potential etiological factors it is
important to realize the role of interactions between these influences.
For example, genetic factors (O1) may play a role in the acquisition of
bipolar-related BBRs. They may, to some extent, underlie the finding of
slow information processing (Saccuzzo & Braff, 1986) and memory deficits
(Calev et al., 1986), emotional lability (APA, 1994), and perhaps even
conversational skills (Fraser et al., 1986). Also, there are likely to
be interactions between the BBRs and concurrent factors (O2, O3, and
S2). For example, bipolar BBRs may interact uniquely with situations of
high "expressed emotion" (Miklowitz et al., 1988) to produce bipolar
symptoms, whereas persons with healthy BBRs may simply find ways to
avoid such situations without overreacting.

One of the important gaps in the literature is in the area of
psychosocial factors. This is an important gap because for many it might
create the impression that the sole source of risk for bipolar disorder
is found in genetic factors rather than childhood learning. There is
increasing evidence that this is not the case (O'Connell, 1986). It is
not likely that genetic factors are direct determinants of all bipolar
BBR characteristics. For example, a tendency towards grandiose
self-labeling or skills required for potentially harmful activities is
difficult to explain without the notion of past learning histories. The
problem regarding bipolar etiology is discovering the type of learning
that interacts with genetic factors to increase the potential for
bipolar symptoms. According to the PB theory, such psychosocial factors
exist, and need to be identified. The resulting understanding would then
guide the development of psychological treatments and prevention
strategies for bipolar disorder as well as more accurate and useful
subclassifications.

Treatment Perspectives

The attention given to psychological variables in the PB model holds
implications for the development of psychological treatments for bipolar
disorder. The indication in this and other reviews (e.g., O'Connell,
1986) that bipolar symptoms respond to psychosocial factors suggests
that reliably effective psychological treatments and prevention
strategies may be developed. The development of an effective
psychotherapy for bipolar disorder may help lessen the problems of
medications. The available drug treatments are not universally
effective, produce side effects (Lever, 1985; O'Connell, 1986; Tyrer,
1985), and have not been evaluated systematically for children. It is
becoming apparent that bipolar disorder is not a purely biological
disturbance, and this calls for a more comprehensive approach to its
treatment.

There are presently no established psychological treatments for bipolar
disorder (Goodwin & Jamison, 1990; Lerer, 1985). However, the recently
proposed psychosocial (Craighead et al., 1998), cognitive behavi{*filter*}
(fiasco & Rush, 1996), and family (Miklowitz & Goldstein, 1997)
treatments for bipolar disorder may stimulate this type of research.
Psychological behavi{*filter*}prevention and treatment of bipolar disorder
would focus on training directed at avoiding or ameliorating BBR
deficits as well as improving concurrent organic and psychosocial
conditions. This review suggests that evaluation of prevention and