ABSTRACT: 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 strategies for bipolar prodromes. Furthermore, there was evidence of less fluctuation of symptoms of mania and depression, less hopelessness, and better medication 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 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.