powered by centersite dot net
Bipolar Disorder
Resources
Basic Information
Introduction to Bipolar DisorderTypes of Bipolar and Similar DisordersCurrent Understandings and Body SystemsDiagnosis of Bipolar DisorderMedication Treatments for Bipolar DisorderPsychotherapy and Other TreatmentsSelf-Help and Helping OthersReferences and Reading List
More InformationTestsLatest NewsVideosLinksBook Reviews
Related Topics

Depression: Depression & Related Conditions
Suicide
Addictions: Alcohol and Substance Abuse

Bipolar Disorder Treatment - Psychotherapy and Cognitive Behavioral Therapy

Rashmi Nemade, Ph.D. & Mark Dombeck, Ph.D.

Bipolar Treatment - Psychotherapy

Psychotherapy is a non-medical "talking" therapy that can be very effective and helpful for some bipolar patients, but generally only as an adjunctive bipolar treatment to be provided along side medication treatment. This is in contrast to unipolar forms of depression, which can in many cases be quite adequately and safely treated with certain forms of psychotherapy alone. All depressive illnesses have complex and mixed causes and maintaining factors, both physical and psychological in nature. However, the physical components of the average bipolar illness are, for the most part, stronger and more resistant to psychological intervention than are the physical components of the average unipolar depressive illness.

therapy sessionPeople who have not experienced quality psychotherapy tend to think of it as a sort of "pep talk" providing motivation without substance, or perhaps a mystical or metaphysical sort of process. These are mistaken impressions, however. Receiving effective bipolar treatment psychotherapy is about being instructed or coached in methods of effective coping with bipolar symptoms in a non-judgmental environment. Just as athletes benefit from coaching, so too do patients.

Psychotherapy offers several kinds of benefits to patients. There are several supportive aspects to therapy. Patients typically come to regard therapy as a safe place to talk about how their bipolar illness is impacting them and their families. Patients may also benefit from the objective third party monitoring and prompting that a therapist can provide concerning patients' conditions, mood states, and capacity for self-harm. Therapists also work with patients to help them strengthen coping and social skills that are impacted by their bipolar disease, so as to help them better navigate their social and occupational worlds, and to better resist the temptations of the extreme mood states that they must contend with. Finally, therapists may also help motivate patients to maintain their bipolar medication routines, and to know when such routines require adjustment. Medically trained therapists (e.g., Psychiatrists, and some Psychologists in several states) can monitor and prescribe bipolar medications as well as provide psychotherapy. However, more typically medication monitoring and psychotherapy responsibilities are split between two different professionals.

There is no one variety of psychotherapy. Instead, multiple approaches with varying utilities have been developed. Three varieties of psychotherapy in particular have been found useful for treating bipolar disorder treatment.

Bipolar Treatment - Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT), the dominant psychotherapy bipolar treatment available today, is based on the premise that many (but certainly not all) mood problems are based less on physical brain problems, and more on habitually dysfunctional ways that people learn to appraise and interpret stressful events occurring in their lives. The stressfulness of life events becomes magnified, and certain bipolar symptoms occur or become exaggerated as a byproduct of faulty judgments.

The process of cognitive behavioral therapy involves therapists teaching patients methods they can use to become aware of and then examine their distorted thinking and perceptual processes and then perform reality testing upon their distorted judgments so as to make them more accurate. Thoughts influence patients' perceptions of the world, and in turn those perceptions become patients' reality. Distorted thoughts lead to unstable or faulty perceptions. For example, people experiencing a manic episode might falsely conclude that they have endless energy, and as a result may overexert themselves while exercising. They may take multiple aerobics classes or run for hours. Although their perception is that they are tireless, their body will soon give them a true reality check. The eventual fatigue and emotional crash can add to the physical and psychological distress they experience. Improving patients' capacity for effective reality testing helps them to become more aware of situations when they are acting in unusual or potentially self-damaging ways, and helps them to stop potentially harmful behaviors before they become truly harmful.

CBT Patients learn that they can reduce the negative impact of bipolar manic depression by learning to identify and correct habitual and automatic thought and judgment distortions that would lead them to exaggerated and harmful conclusions. Patients are taught to write down their perceptions along side the events that trigger those perceptions, and then to examine what they have recorded for evidence of bias or inaccuracy. Throughout this process of learning, exploring and testing perceptions, patients gain bipolar disorder coping strategies while improving skills of awareness, introspection and evaluation. Patients' improved coping and reality testing skills, properly applied, help them to decrease the extremeness of their mood swings (where possible), reduce the impact of their bipolar illness on their social and occupational relationships, improve their motivation to remain on bipolar medication, and generally function to help reduce their chance of catastrophic relapse.

Patients must possess a certain level of insight into their bipolar symptoms before CBT can be useful. For this reason, CBT is most appropriate for medicated and reasonably stable patients, and more specifically those medicated patients who are fairly verbal and able to reflect about their bipolar disorder. Patients who are in the midst of any sort of extreme bipolar manic depressive episode will not benefit from CBT.