Bipolar disorder, which was called manic-depressive illness in the past, is a type of mental disorder in which the sufferer has recurring episodes of elevated or depressed mood. These mood episodes in bipolar disorder can go on for weeks and even months at a time.
These changes in the sufferer’s mood are much more serious than normal ups and downs that people experience in their day-to-day life. These mood episodes affect their thinking patterns, energy, and activity levels, and hinder their social and occupational functioning by impairing their ability to perform daily tasks.
Bipolar disorder affects 2% of the world’s population. The silver lining in this situation is that, with the help of proper mood stabilizers and anti-psychotic drugs, the symptoms of bipolar disorder can be managed. Various studies have also found that appropriate therapy, along with medications, significantly improves bipolar symptoms.
Cognitive behavioral therapy, commonly known as CBT, is one of the most effective psychotherapies used in the treatment of the bipolar disorder. Cognitive behavior therapy works around the central idea that our thoughts impact our feelings and our feelings impact our behaviors.
Cognitive behavior therapy helps change problematic behaviors by targeting the unhealthy thought patterns driving those behaviors. Adding CBT to the treatment regimen helps the patient keep their thoughts, moods, and behaviors in check.
We will talk more about what cognitive behavioral therapy is, how it works, and how it fits into the treatment for bipolar disorder, but first, let’s have a look at what a manic and depressive episode of bipolar disorder is like.
What is a manic episode?
Mania or manic episodes refer to periods of abnormally elevated or irritable mood, with bursts of energy and hyperactivity. The patient may suddenly become very self-confident and may experience feelings of grandiosity. Patients during a manic episode have flights of bold and bizarre ideas, a reduced need for sleep, increased interest in risky behaviors and activities, and more arguments or fights with other people.
They may talk excessively and get easily distracted, jumping from one idea or topic to another. They may also experience delusions, indicative of psychosis, during their manic episode.
What is a depressive episode?
Depressive episodes in bipolar disorder refer to periods of low and depressed mood, loss of interest in daily activities and tasks that the patient used to enjoy previously, problems falling asleep, loss of appetite, trouble paying attention and focusing, feeling of worthlessness, and guilt.
Patients may spend more time in isolation than with their friends and family. The severity of depressive episodes can vary from person to person.
What is cognitive behavior therapy?
Cognitive behavior therapy was developed by Aaron Beck in the 1960s, primarily for the treatment of depression. He noticed that individuals with depression have a negative way of interpreting things about themselves and about the world.
Today, CBT is a scientifically proven method, widely used for the treatment of a wide variety of mental health problems and disorders, such as anxiety, post-traumatic stress disorder, phobias and panic disorder, bipolar disorder, insomnia, etc.
How does cognitive behavioral therapy work?
Cognitive behavior therapy teaches a person to identify their distorted thinking patterns and maladaptive ways of perceiving information. It revolves around the central idea that the distorted thought patterns of a person negatively impact their judgments and feelings about the world, and these distorted judgments and emotions then become the patient’s reality. Cognitive behavior therapists target such faulty thinking patterns, ultimately improving the patient’s emotions and behaviors.
Cognitive behavior therapy, unlike typical psychodynamic therapies, focuses on the present issues and problems, rather than delving deep into the patients’ childhood repressed thoughts and emotions. New and adaptive thought processes and coping mechanisms are taught to the patients to help them move forward in life with ease.
Main goals for the management of the bipolar disorder
Three major goals are focused on during the treatment of the bipolar disorder
Early identification of a mood episode
Successful management of depressive or manic episodes when they occur
Preventing new episodes
How does cognitive behavioral therapy fit into the plan?
CBT treatment for bipolar disorder starts with the therapist providing psychoeducation to the patient, providing insight into the depressive and manic symptoms, the biological and social factors that contribute to the illness, and the rationale for treatment. the patient learns the basic principles of cognitive behavior therapy, and how it proposes to tackle the problems.
As the therapy progresses, the patients learn how to identify the negative thoughts that lead to a depressive episode, or the overly positive ones that may be present at the onset of a manic episode.
Cognitive behavior therapy brings those distorted thoughts to a normal level, closer to reality. The patients learn to replace their negative automatic thoughts with alternative thoughts that are adaptive and healthy.
For example, a bipolar patient in the midst of a manic episode may feel like he has an unlimited supply of energy, as a result of which he may overexert himself in physically challenging activities, tiring himself out. This physical and emotional crash at the end of a manic episode may lead to another mood episode, or just cause extreme distress to the patient.
A cognitive behavior therapist would help such a person by making him understand the limits of his energy, helping him stay grounded in reality and be more aware of his own thoughts and emotions. The therapist would help the patient identify his cognitive distortions, and make him see reality from a healthier perspective. The patient will learn to keep emotions and behaviors in check and be aware of situations that trigger manic or depressive thoughts/episodes.
Cognitive behavior therapy also focuses on teaching the patients some basic skills in order to reduce the risk of future mood episodes. These skills may include conflict resolution, problem-solving, stress reduction, and mood regulation exercises, and sleep management skills. Family members are also invited to be a part of the treatment process.
All of these measures combined can help in the early identification, management, and future prevention of mood episodes.
What to expect in cognitive behavior therapy sessions?
The first thing your therapist will do is help you accept your diagnosis. Some people stay in denial and have difficulty accepting that they might have bipolar disorder. Therapists help their patients embrace their condition, and make them believe that they are not alone in this.
Aside from helping you manage the depressive and manic symptoms of bipolar disorder through cognitive restructuring, your therapist will help you address the feelings of shame and guilt that surround the diagnosis of a mental condition like bipolar disorder. Your therapist will eliminate any negative or false beliefs you may have regarding your symptoms.
Your therapist will provide you with a safe space to talk about the loss of friendships or relationships that came with the disorder, and help you navigate through those feelings. You will learn to move on from closed doors, and accept reality as it is, and your therapist will be there to support you throughout this process.
Your therapist may also invite your family members for a few sessions, which will help develop a sense of understanding between everyone regarding the symptoms of bipolar disorder.
You will learn about relaxation and stress management techniques, such as progressive muscle relaxation, deep breathing or mental imagery, etc., to improve your mental, emotional and physical well-being. You may also be given worksheets to track your mood or homework assignments by your therapist. These homework assignments will help you stay in touch with yourself.
Your therapist will help you in stabilizing your routine through activity scheduling, which is a very common technique used in cognitive behavior therapy. Engaging in activities on a daily basis according to a stable and predictable routine will bring rhythm to your life, keep your mood stable, and enhance your social and occupational functioning
Effectiveness of cognitive behavior therapy for bipolar disorder
Various studies have proven the effectiveness of cognitive behavior therapy for bipolar disorder. A study published in The British Journal of Psychiatry advocated that cognitive behavior therapy should be a part of the treatment of the bipolar disorder. The authors of this study compared two groups of patients diagnosed with bipolar disorder, one group received the usual treatment that included support groups and standard medication, while the other group received cognitive behavior therapy in addition to all that.
As expected, the group that received CBT showed better improvements in their symptoms and showed long-lasting recovery as compared to the other group.
Similarly, another study showed that cognitive behavior therapy sessions of 90 minutes or more improve the psychosocial functioning of the patient, reduce the rate and chances of relapse and decrease the severity of manic and depressive symptoms.
Benefits of CBT for bipolar disorder
As shown by the studies mentioned above, there is no doubt that cognitive behavior therapy is extremely effective for the treatment of the bipolar disorder. Let’s talk about a few other benefits that bipolar patients can obtain from cognitive behavior therapy.
Bipolar disorder does not just affect a person, it affects that person’s whole family. Therapists provide a safe space for people to talk freely about how this disorder is impacting their close relationships and friendships, and address any cognitive distortions the patients may have regarding this aspect.
The therapist acts as a third party and provides an objective account of the patient’s situation. They keep a safety check on the patients’ moods, behaviors, and their capacity for self-harm. They help the patients acquire healthy coping mechanisms and conflict-resolution strategies to tackle their daily tasks successfully.
The patients can learn how to avoid manic or depressive episodes by controlling their emotions. Therapists also help the patient stay motivated throughout their treatment journey by assisting them in constructing and maintaining a healthy and stable routine.
Involvement of family members in treatment
Bipolar disorder does not just affect the patient experiencing the symptoms, but it also affects the members of their family and friends’ circle. Mood episodes can be especially difficult to manage for close family members, and this may harm their relationship with the sufferer. Therefore, it is advised that family members should also be an active part of the treatment process.
Psychoeducation is provided to the family members regarding bipolar disorder by the therapist, which may help them understand the patient’s situation better. The therapist provides a safe space for family members to release their frustrations and may teach them vital CBT exercises and techniques that they can practice on themselves or on the patient.
Early identification and management of bipolar episodes through cognitive behavior therapy
Mood episodes in bipolar disorder can go on for weeks and even months on end, disrupting the social and occupational functioning of the patient for so long. Once the episode ends, it is important to prevent another episode from taking place, allowing the patient a chance to recover from the repercussions of the previous episode. If the episode cannot be prevented entirely, its early identification helps significantly in the timely management of the symptoms.
Cognitive behavior therapy teaches patients what signs and symptoms to look out for and what to do if they identify any early indications of an upcoming mood episode. It teaches the patients basic personal and social skills for the effective management of the symptoms on their own until their next therapy session.
What to do if I notice bipolar symptoms in myself?
If you suspect that you or a loved one of yours is experiencing symptoms of bipolar disorder, reach out to a licensed therapist or a clinical psychologist for help. Trained mental health professionals help you clear out any confusions you may have regarding your symptoms, and assist you in the management of your problems.
How to gain maximum benefit from CBT for the treatment of bipolar disorder?
To gain maximum benefits from your cognitive behavior therapy sessions, you should definitely consider the following points:
Come to terms with your diagnosis. Accept the fact that you have bipolar disorder. But, remember that it is not the end of the world to be diagnosed with a mental illness. Millions of people across the globe are going through the same thing as you. You are not alone.
Sticking with the prescribed medications is extremely important for a successful outcome. Only after you have accepted your diagnosis will you be able to follow your therapist’s instructions properly and stick to your medications and treatment. You should be willing to put in the commitment and hard work that is required for the management of the bipolar disorder.
Homework is an important part of any CBT treatment. Your therapist will give you different homework assignments and tasks, based on the CBT techniques taught during the therapy sessions. Studies have shown that commitment to homework is a big predictor of the success of cognitive behavior therapy.
Last but not the least, keep educating yourself about your condition. Nobody knows you better than yourself. Keep your symptoms and moods in check. Read articles and self-help books about bipolar disorder. You can also join different support groups to keep yourself hopeful and motivated to get better. Be an active part of your treatment journey.
Why is lifelong treatment important?
Bipolar disorder often requires ongoing treatment because it is a lifelong condition, the symptoms cannot be cured completely, but they can be managed. Continuous treatment is required to keep mood fluctuations in check. When a mood episode is severe, additional medications or therapy sessions may be required to deal with the symptoms accordingly.
Since bipolar disorder also impacts the sufferer’s social and occupational life, ongoing treatment may help the person improve and sustain their normal functioning in both these areas. It may also help in the early identification and prevention of future mood episodes.
Which kind of patients can benefit from cognitive behavior therapy?
To benefit from cognitive behavior therapy, the patient must have some level of insight into their problem. Cognitive behavior therapy is not very effective if the patient is not in their senses, is extremely unstable (for example in the middle of a manic episode), or unwilling to show any kind of cooperation.
For cognitive behavior therapy to be effective, the patient must have some understanding of his or her symptoms and should be able to communicate that to the therapist.
Can I receive cognitive behavior therapy for bipolar disorder online?
If you are experiencing any difficulty finding a suitable therapist in your locality, you can always opt for online therapy providers. BetterHelp has a team of licensed psychologists and CBT practitioners that provide therapy online, starting from $60 a session per week. You can receive therapy from the psychologist of your choice, in the comfort of your own house.
Simply head over to their website by clicking here. BetterHelp will ask you to answer a series of questions, on the basis of which you will be matched with suitable therapists. Book a session with BetterHelp today, and take the first step towards the improvement of your mental health.