CBT for Bipolar Disorder Overview

A type of therapy aimed at helping manage bipolar disorder. Progress in this area has been slower compared to other types of psychological treatment.

National guidelines recommending psychological interventions for bipolar depression in adults. High-intensity interventions like CBT, IPT, and behavioral couples therapy are advised.

Collaborative goal setting, symptom relief, achieving better manageable mood states, restoration of psychosocial functioning and relapse/recurrence prevention.

A consequence of differing and extreme interpretations of internal state changes (e.g., energy levels).

Psychosocial problems (e.g., losing a job) can trigger manic or depressive episodes, leading to internal struggle to control mood.

Strategies, like a traffic light system (early, middle, late symptoms) are used to anticipate and limit future mood episodes. Identifying unhelpful and helpful responses are key.

Educating patients about bipolar, sticking to coping routines, monitoring symptoms, and maintaining good sleep hygiene.

Collaboration between family members and the patient to better manage bipolar. Aims to limit 'expressed emotion'.

A review of studies aimed to determine effective interventions and for prevention of recurrence of bipolar.

Cognitive restructuring and managing daily routines prove helpful in managing manic symptoms.

Techniques to manage mood swings and prevent relapse in bipolar disorder, including active coping, stress management, sleep/eating/activity regulation, mood monitoring, behavioral interventions, and cognitive interventions to challenge negative thoughts.

Internal evaluations of situations and feelings that influence behaviour and mood in bipolar disorder, such as how individuals perceive and interpret their internal/external states and circumstances.

Maladaptive responses to mood fluctuations in bipolar disorder, marked by behaviors that either increase agitation (ascent) or decrease engagement (descent), such as risk-taking or withdrawal.

A type of Cognitive Behavioral Therapy approach focusing on helping individuals with bipolar disorder set personal recovery goals, understand the meaning of their diagnosis, and practice coping skills.

A therapy targeting distressing imagery and mood instability in bipolar disorder through rescripting, positive imagery, and competing tasks.

Modern approaches to CBT that are broader than traditional approaches, focusing not only on thoughts but also on acceptance and mindfulness.

Use of apps and technology to provide psychoeducation, monitor mood, and support medication adherence.

Compassion-Focused Therapy approach. Focuses on self-compassion in relation to bipolar disorder.

Acceptance and Commitment Therapy helpful in bipolar and psychosis. Aims to increase acceptance of thoughts and feelings rather than fighting them.

The National Institute for Health and Care Excellence (NICE) advises adults with bipolar depression to consider psychological interventions specifically designed for bipolar disorder. These include high-intensity therapies like Cognitive Behavioral Therapy (CBT), Interpersonal Therapy (IPT), or Behavioral Couples Therapy.

CBT for Bipolar Disorder (CBT-BD) aims to:

1. Set collaborative goals with the client.
2. Relieve current symptoms.
3. Help manage mood fluctuations.
4. Restore social and work functioning.
5. Prevent future episodes.

CBT-BD assumes mood swings stem from personal interpretations of internal changes. For example, high energy can be interpreted as success or breakdown, while low energy can be seen as relaxing or failing, leading to internal struggle for control.

Stressful life events, like losing a job, job interviews, exams, or relationship problems, can trigger bipolar episodes. These triggers lead to internal struggle and pressure.

Mood shifts are influenced by personal appraisals of changes in energy levels or internal state. High appraisal = mania; Low appraisal = depression. This affects thoughts, feelings, and behaviour.

Many individuals find medication ineffective or unacceptable. Often, therapy is not readily available despite desire. Timing can be a challenge, as people might not seek help while hypomanic.

It's a structured plan that helps individuals with bipolar identify early, middle, and late symptoms of an episode. The plan includes coping strategies to reduce the risk of recurrence.

Psychoeducation helps patients understand bipolar by:

1. Emphasizing routine.
2. Monitoring symptoms.
3. Maintaining good sleep hygiene.
4. Encouraging a regular lifestyle.

Miklowitz's meta-analysis revealed that CBT + psychoeducation is the most effective intervention for bipolar. CBT helps stabilize depressive symptoms, and cognitive restructuring and routine management work well for both mania and depression. Group and family psychoeducation can prevent recurrence.

Individual's response to CBT-BD depends on many factors, including their specific therapy approach, sample characteristics, and their personal views of the disorder. People with positive views of mania may benefit less from CBT.

The 'ABC' concept in bipolar disorder treatment refers to 'Appraisals, Behaviors, and Consequences'. It highlights how our interpretations (appraisals) of our internal states drive our behavior, which in turn influences our mood (consequences).

Ascent behaviors are responses to mood changes that can worsen the situation. They involve increased activity, risk-taking, and a sense of heightened energy (like 'hyping yourself up').

Descent behaviors involve withdrawing from activities, suppressing feelings, and feeling sluggish or hopeless, often in response to mood changes.

Appraisals, or how we interpret our thoughts and feelings, significantly impact our mood. For example, thinking 'I'm agitated and about to have a breakdown' can worsen anxiety and lead to behavioral changes.

The ICM suggests that how we appraise our internal state plays a crucial role in bipolar disorder: Our thoughts about our inner experiences can contribute to symptoms and even contribute to diagnosis.

These approaches move beyond traditional CBT, focusing on acceptance, mindfulness, and values-based living. They help individuals manage challenging emotions and learn to live a fulfilling life despite bipolar disorder.

This approach emphasizes personal recovery goals, helping individuals with bipolar disorder find meaning in their diagnosis and develop personalized coping strategies.

This approach aims to address distressing images and mood instability by rescripting negative imagery, practicing positive visualization, and engaging in tasks that compete with negative thoughts.

It's a large-scale study that investigated the effectiveness of psychotherapy for bipolar disorder. It found that therapy could significantly delay the time until a manic episode.

OXMAPP is an effective imagery-based therapy program. It helps clients identify distressing images, rescript them, and practice positive imagery techniques.