Bipolar disorder (BD) is a mood disorder with periods of mania, hypomania and depression that deeply affects the individual’s family, work and social life. Functioning, which is the ability to meet one’s basic needs and establish relationships with others, can cause many negative effects in the lives of individuals diagnosed with bipolar disorder during episodes. One of the areas negatively affected in terms of functionality is occupational functionality. Occupational functioning is the ability of individuals to perform their profession or job effectively, to fulfill their authorities and responsibilities, and to establish harmonious relationships with the people they work with in the work environment (Frank et al., 2008). Individuals diagnosed with bipolar disorder may be absent from the workplace for long periods of time during episodes. Following manic and depressive periods, these patients are monitored during remission. While the medication treatment of patients continues, decreases in areas of functionality necessitate different interventions (Bowden, 2005). In studies aimed at enhancing the efficiency of functionality areas (such as family life, work, and social relationships, etc.) for individuals diagnosed with BD, it has been observed that they struggle to adapt to interpersonal relationships and social life, along with stigma and neurocognitive impairments (Zarate et al., 2000).

The prevalence and recurrence rates of BD are significant for the social and economic impacts it has and can have (Abdul Pari et al., 2014). Evaluation of workdays lost due to BD- related issues reveals that bipolar disorder ranks second among causes of job loss and is among the top five most common reasons for work impairment when considering work-disruptive situations. Additionally, long-term unemployment and absenteeism related to BD have been found to be associated with low job performance (Bowden, 2005; Dean et al., 2004; Grande et al., 2013; Sylvia et al., 2017; Martinez-Camarillo et al., 2019).

Individuals with BD, like in other mental health conditions, require certain specialized treatment and support mechanisms (such as psychotherapy, psychoeducation) in addition to medication treatment to strengthen functionality areas (Sylvia et al., 2015). The most crucial reason for the need to support functionality in the workplace is the recurrence of episodes in cases where work and family life are not supported in the illness picture (Simon et al., 2008). The support of functionality in the workplace is also crucial for individuals diagnosed with BD to meet their economic and social needs, continue their treatments, and cope with societal stigma (Sylvia et al., 2017). Among the problems frequently experienced by individuals diagnosed with BD in the workplace, issues such as stigma, sleep disturbances, attention deficits, difficulty coping with work stress, inability to manage interpersonal relationships, and difficulties in regulating emotions are prominent (Martinez-Camarillo et al., 2019).

Social cognition can be considered as an important mechanism that influences interpersonal relationships in terms of beliefs, desires, emotions, and thoughts. It has been noted that social cognition, which is also considered as one of the working areas of the brain, does not function adequately in individuals diagnosed with BD, regardless of symptoms. This condition may be one of the underlying reasons for difficulties in social relationships, exacerbation of illness symptoms, and triggering of episodes (Gillissie et al., 2022). Working on social cognition in psychotherapy helps individuals diagnosed with BD, who experience difficulties in focusing on their own and others’ mental states, to regulate their emotions and thoughts related to these situations (Kerr et al., 2003).

The first clinical studies on social cognition were conducted by Penn and colleagues in 2005 with schizophrenia patients in a hospital in the United States. The adaptation of the program for bipolar disorder was implemented in 2013 following its success (Penn et al., 2005; Lahera et al., 2013). Tas et al. (2012) conducted a study where the concepts of social cognition and mentalization were shared through concrete and visual examples from the workplace. This study provides an opportunity within a structured and well-defined framework. Social cognition and interaction training (SCIT), a group therapy technique that can also be conducted as individual therapy, was initially implemented in hospitals as a 15-week program. This study was developed with specific goals in mind and the program duration was shortened to 8 weeks. SCIT sessions focusing on work life in BD are planned for 8 weeks, with sessions held weekly, consisting of two 40-min sessions with a 10-min break, totaling 90 min (Zhang et al., 2019).

In a study evaluating the role of social cognition in the global functioning of optimally bipolar patients along with other relevant clinical variables and general cognitive measurements, it was concluded that social cognition could play a significant role in the clinical-functional differences of bipolar patients (Lahera et al., 2013). Another study conducted with schizophrenia in remission found that SCIT could be an applicable and promising method for improving social cognition and social functioning (Wang et al., 2013). In another study examining the effectiveness of SCIT among individuals with severe mental illness, SCIT plus social mentoring provides preliminary evidence that SCIT improves social cognition and functioning among individuals with severe mental illness living in the community (Hasson-Ohayon et al., 2014). Significant positive developments in patients’ life skills were found with SCIT in individuals with schizophrenia spectrum disorder receiving care through a public mental health service (Gordon et al., 2018). Another study investigating the effectiveness of family-focused therapies on individuals diagnosed with BD found that SCIT reduced cognitive distortions, increased cognitive flexibility, facilitated understanding of people’s perspectives in social communication by changing cognitive biases, and consequently led to reduced internalized stigma. Additionally, it was noted that SCIT reduced cognitive distortions in perceiving and understanding emotions in social relationships and provided a broader perspective on communication issues, particularly within the family (Tabas et al., 2023).

When examining the research conducted within the scope of SCIT from its inception in 2005 to the present day, it is observed that it has been widely applied not only with schizophrenia spectrum patients but also with those diagnosed with BD and depression. Particularly in the areas of social cognition and functionality, effective results have been achieved in patients undergoing SCIT (Penn et al., 2005; Lahera et al., 2013; Hasson-Ohayon et al., 2014; Gordon et al., 2018). Within the scope of this study, the effectiveness of SCIT in improving occupational functioning in work life in people diagnosed with BD type I was investigated. For this purpose, a significant increase in the levels of occupational functioning and social cognition and a significant decrease in stigmatization in the intervention group were hypothesized. As far as we can see from the literature, there is a limited number of studies examining the effectiveness of SCIT in improving occupational functioning in individuals diagnosed with BD-I. In this context, our study, which aims to improve the occupational functioning of patients with BD-I through SCIT, is a research issue of unique value. This study will provide a basic perspective for the development of similar studies and studies in different areas of functioning.

The aim of this study was to evaluate the effectiveness of social cognition and interaction therapy (SCIT) as an additional intervention to standard treatments in individuals diagnosed with BD-I. After 8 weeks of psychosocial treatment of BD-I patients in randomly assigned SCIT and control groups The aim of this study was to evaluate the effectiveness of SCIT as an adjunct intervention to standard treatments for individuals diagnosed with BD-I. Over an 8-week psychosocial treatment period, BD-I patients were assigned to either SCIT or control groups through randomization, which was conducted using a computer-based software to ensure equal allocation probabilities. During this process, researchers and evaluators were blinded to the group assignments, minimizing the risk of evaluator bias. Analysis of the findings obtained at the end of the measurements revealed that the SCIT group showed significant improvements in functioning and subdomains of functioning compared to the control group. In this study investigating the effect of the SCIT intervention on occupational functioning, functioning was assessed using the FAST. The FAST scale evaluates individuals’ functionality levels across six key domains: autonomy, occupational functioning, cognitive functioning, financial issues, interpersonal relationships, and leisure activities. The individual analyses in the study reflected the improvements achieved through SCIT intervention in these areas, supported by subjective reports. For instance, participants who experienced difficulties fulfilling responsibilities at work, maintaining focus, or managing social relationships before therapy showed improvements in these areas following SCIT, which was reflected in decreased scores. Subjective accounts further supported these developments, highlighting that FAST is not only a numerical evaluation tool but also an instrument that captures the positive changes occurring in individuals’ lives. For example, one participant reported frequently procrastinating on tasks and encountering challenges in teamwork prior to therapy but stated that they took on a more active role and received positive feedback from colleagues after SCIT. This improvement was reflected in a reduction of their FAST score from 3 to 1. These findings emphasize that SCIT has a particularly significant impact on occupational functioning and interpersonal relationships. Significant differences were found in occupational and other areas of functioning in the SCIT group compared to the control group.

In previous studies, it has been reported that social functioning can be improved after the application of SCIT to patients with schizophrenic and psychotic disorders. Our findings for the improvement of functioning are consistent with other studies in the literature (Lahera et al., 2008; Wang et al., 2013; Roberts et al., 2014; Voutilainen et al., 2016; Zhang et al., 2019). In our study, in addition to occupational functioning on the FAST scale, functioning was assessed in the areas of autonomy, financial issues, interpersonal relationship, cognitive functioning and leisure time activities. Our findings in the areas of occupational functioning, cognitive functioning, interpersonal relationship, and leisure time activities showed that the SCIT group was superior to the control group. In some studies in the literature, it has been reported that patients with BD have impaired occupational functioning even in later life (Mehta et al., 2014; Samalin et al., 2016). It was observed that there was no significant difference in the autonomy and financial issues dimension among the general functionality areas of the participants. Since conditions such as domestic responsibilities and socio-economically independent life from the family come to the fore in the evaluation of autonomy, it can be said that it is an area where progress will be made in a long time (Weinstock and Miller, 2008). SCIT was found to be effective in identifying negative emotions and enhancing areas of functioning in BD patients. In the literature, there are very few studies examining the difficulties experienced by patients diagnosed with BD in work life other than clinical symptoms (Michalak et al., 2007; O’Donnell, 2017).

Our findings indicated that SCIT may play an effective role in improving the occupational functioning of BD-I patients. This suggests that SCIT may offer a valuable therapeutic approach for addressing the interpersonal and cognitive challenges faced by individuals with BD-I. The observed enhancements in social cognition among SCIT recipients are consistent with previous research highlighting the role of social cognitive deficits in BD-I and the potential benefits of targeted interventions in this domain (Voutilainen et al., 2016; Zhang et al., 2019). By focusing on enhancing skills such as perspective-taking, emotion recognition, and social problem-solving, SCIT may help individuals with BD-I navigate social interactions more effectively, thereby improving their interpersonal relationships and overall quality of life. Moreover, the improvements in occupational functioning following SCIT are particularly noteworthy, as occupational impairment is a common and significant outcome of BD-I. By addressing underlying social cognitive deficits and enhancing interpersonal skills, SCIT may empower individuals with BD-I to better manage workplace challenges, communicate effectively with colleagues and supervisors, and maintain stable employment, ultimately fostering greater independence and productivity.

Considering the socio-demographic data, it was observed that the factors of age, duration of illness and number of episodes related to the social cognitive level of patients diagnosed with bipolar disorder did not yield statistically significant results within the scope of this study, contrary to other studies in the literature (Bora et al., 2008; Budak et al., 2019). The socio-demographic and clinical characteristics of the experimental and control groups were compared in detail. It was found that there were no significant differences between the groups in factors such as age, gender, education level, and illness duration. This indicates that the groups were equivalent in their baseline conditions. This may be due to the small number of both intervention and control groups. On the other hand, it was determined that social cognition levels were affected by educational status. There are similar findings that the level of social cognition is related to educational level (Lahera et al., 2012; Rakoczy, 2022). The educational levels of the participants differ in terms of social cognition, and accordingly, it is understood that social cognition increases as the educational level increases.

It has been reported that medication adherence, which is another important part of treatment in bipolar disorder, is effective in reducing symptoms, but it is insufficient in the areas of prevention of recurrence of bipolar episodes, stigmatization dimension of the disorder and functionality (Kerr et al., 2003). Stigmatization is one of the most challenging areas related to mental illness in work life. Findings related to stigmatization revealed a significant difference only in the sub-dimension of resistance to stigmatization (Pischel and Felfe, 2023). In this sub- dimension, in which reverse scoring method was used in the scoring phase, it can be said that the fact that the participants can be together with people with the same diagnosis as themselves in group experiences helps them to strengthen against stigmatization. In another study, the effects of the feeling of stigmatization that started after being diagnosed with bipolar disorder on functionality were examined and it was concluded that stigmatization negatively affected socialization with the destruction it caused in self-esteem (Aydemir et al., 2013). In our study, according to the findings of the ISMI administered to the intervention and control groups before and after SCIT, a positive and significant difference was observed only in the sub-dimension of resistance to stigmatization. It was understood that the scores observed in the social withdrawal sub-dimension were also effective in the functionality of the participants. The resistance to stigmatization sub-dimension evaluates the individual’s resistance to stigmatization by reverse scoring. In this sub-dimension of the scale, an increase in resistance to stigmatization was observed compared to the pre-intervention period. The effect size of the resistance to stigmatization subscale was also found to be strong. Studying stigmatization and the internalized. Dimension at the same time can help this negative process to reach a manageable point (Perich et al., 2022; Post et al., 2018). The findings show that stigmatization is an area that needs to be studied in the long term, as no significance was observed in other sub-dimensions. From a clinical perspective, it is important to increase research to strengthen the areas of stigmatization and social cognition that make it difficult to integrate into work life in the treatment of mental illness.

The study has a number of limitations. First, the small sample size represents a significant constraint, as the structure of group therapy inherently requires a limited number of participants to maintain effective group dynamics and foster meaningful interpersonal interactions. Additionally, the strict inclusion and exclusion criteria further narrowed the pool of eligible participants, which in turn limits the generalizability of the findings. In addition to this, the lack of sessions that directly addressed patients’ emotions and stigmatization limited the study, according to the results of individual interviews with participants. The content that can be prepared for emotions such as anxiety, anger and paranoia, which are difficult to control, can contribute to the development of the emotional control that people with BD. Future adaptations of SCIT could incorporate supplementary sessions specifically tailored to address anxiety and stigma more directly. These sessions might include evidence-based approaches such as emotion regulation techniques and psychoeducational modules on stigma, thereby expanding the intervention’s focus to encompass these emotional dimensions. Such refinements have the potential to enhance the overall efficacy of SCIT by simultaneously targeting social cognition and emotional well-being in a more comprehensive manner.

As the control of emotions increases, it is expected that people diagnosed with BD will have less need for hospitalization and treatment costs will decrease. Second, the possible effects of mood stabilizers on cognitive performance between SCIT and control groups were not considered. Third, the study sample was small and the intervention was relatively short. Future research with larger, more diverse samples and longer follow-up periods is needed to further elucidate the long-term effects of SCIT on functioning and to explore the potential effects of treatment outcomes.

In conclusion, the findings of this study suggest that SCIT holds promise as an effective adjunctive intervention for improving social cognition and occupational functioning in individuals with BD-I. By addressing core deficits in social cognition and interpersonal skills, SCIT may help individuals with BD-I lead more fulfilling and functional lives. However, efforts to reduce stigma and promote social inclusion remain critical components of comprehensive treatment approaches for BD-I and other mental health conditions.

Our study demonstrates the promising efficacy of social cognition and interaction therapy (SCIT) as a complementary intervention in enhancing the social cognition and occupational functioning of individuals diagnosed with bipolar disorder type I (BD-I). At the end of an eight-week group intervention, significant improvements in clinical symptoms, occupational functioning and various other aspects of functioning were observed among participants receiving SCIT compared to those in the control group. These findings align with existing literature highlighting the positive impact of SCIT on social functioning in psychiatric populations, underscoring its potential as a valuable therapeutic approach for individuals with BD-I. Notably, our study adds to the growing body of evidence by revealing specific enhancements in occupational functioning, an area often significantly impaired in individuals with BD-I. The small sample size has been acknowledged as a limitation that restricts the generalizability of the findings, and the study has been identified as a pilot investigation. Future research with larger sample sizes has been recommended. Moreover, our research sheds light on the importance of addressing stigmatization, a pervasive challenge in mental health care, and highlights the potential of SCIT in bolstering resistance to stigmatization among individuals with BD-I. While our study focused on short-term outcomes, it underscores the need for future research with larger sample sizes and longer follow-up periods to comprehensively assess the lasting effects of SCIT on functionality and treatment outcomes. In sum, our findings support the integration of SCIT into comprehensive treatment approaches for BD-I, offering hope for improved social cognition, enhanced interpersonal skills, and ultimately, greater quality of life for individuals grappling with this complex disorder. However, we emphasize the ongoing importance of holistic interventions that address not only symptomatology but also broader psychosocial challenges, including stigma reduction and social inclusion, to optimize outcomes for individuals living with BD-I and other mental health conditions.