Cognitive Behavioral Therapy in Treatment of Bipolar Disorder

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Treating Bipolar Disorder with Cognitive Behavioral Therapy

Cognitive behavioral therapy (CBT) is a type of psychotherapy that can be used to help manage bipolar disorder.

Psychotherapy may involve a one-on-one interaction with a therapist. It may also involve group sessions that include the therapist and other people with similar issues.

Although there are many approaches, they all involve helping people manage their thoughts, perceptions, and behavior. Psychotherapy is also a resource for finding healthy ways to deal with problems.

Usually, the core treatment for bipolar disorder is a combination of medication and psychotherapy. CBT is one of the more common types of psychotherapy.

CBT is used to treat bipolar disorder by:

• addressing depressive symptoms that occur as part of periods or episodes of depression
• addressing feelings of guilt or other negative thoughts and beliefs about manic episodes
• addressing feelings of losing friends or relationships

This can reduce overall distress and decrease manic or depressive episodes. It can also create awareness of one’s mood, emotions, physical sensations, and common indicators of a manic episode.

This awareness can help you plan accordingly for manic episodes by:

• setting an appointment with a psychiatrist
• engaging in behaviors that facilitate relief, such as proper sleep and self-care
• making practical plans to mitigate risk associated with bipolar disorder, such as giving money and credit cards to a trusted friend if you have a history of spending behaviors

CBT can be used in a number of ways, including:

• managing symptoms of mental health conditions
• preventing behaviors that can result in those symptoms
• learning effective coping techniques to help control emotions and stress
• acting as an alternative treatment until a good regimen of medications is discovered

The primary goal of CBT is to teach you ways to approach thoughts differently so when they do come, you don’t have to buy into them or let yourself believe your negative thoughts.

CBT works to identify thoughts that contribute to your emotional distress and influence you to behave in negative ways.

For instance, believing others are judging you contributes to social anxiety and could lead you to avoid others, thus losing opportunities to form social relationships and develop beneficial sources of social support.

Once you learn to identify these thoughts, you can learn to challenge them by generating alternative explanations and seeking evidence for them. These approaches then lead to more realistic or balanced thoughts, less emotional distress, and behaviors that are more appropriate to your context.

Looking at thoughts more objectively can relieve the experience of difficult negative emotions because thoughts and emotions are shown to be linked and to impact each other.

The therapy is generally short-term and directly focused on eliminating or managing specific problems. It involves contributions from you and the therapist.

During a CBT session, you and the therapist will work together to:

1.

Determine the problem

This can be mental health condition symptoms, work or relationship stress, or anything else that’s bothering you.

2. Examine the thoughts, behaviors, and emotions associated with these problems

Once the problems are identified, you will work with the therapist to begin looking at how you’re reacting to the thoughts around these problems in order to affect your emotions and actions.

3. Spot negative or inaccurate thoughts, behaviors, and emotions

There are a number of ways you can perceive or deal with something that worsens a problem. This can include thinking negatively about yourself or focusing on the negative aspects of a situation or occurrence.

4. Change your reaction

During a session, you and the therapist work together to replace these with more objective, realistic, or balanced thoughts. This can include attempting to view a situation more objectively, which can generate positive thinking or at least strengthen your coping skills in challenging situations.

Cognitive behavioral therapy can be effective for nearly everyone in various situations.

Psychotherapy can be accessed in many settings, including hospitals and private practices. CBT is one of the more common types of therapy. Many employers offer psychotherapy through their employee assistance programs.

There are no direct physical side effects to psychotherapy.

However, if you decide to try CBT, you must be prepared to talk openly with a therapist or even a group of people. Some people may find this uncomfortable.

CBT is a popular treatment that can be applied to a wide range of issues, including the management of bipolar disorder.

Treatment with CBT focuses on identifying problems and your reactions to them. It then helps you replace these reactions with more objective, balanced thoughts. This can create self-awareness and strengthened coping skills.

CBT therapy for bipolar disorder (bipolar affective disorder)

• Bipolar affective disorder (BAR) is
• Symptoms and causes
• Intense symptoms
• Course of treatment
• Cognitive behavioral therapy in bipolar affective disorder

Bipolar affective disorder (BAR) is

Bipolar affective disorder (BAD) is a mental disorder characterized by a fairly frequent change of various affective states. From the name BAD we can see that it is a mood disorder. As a rule, it can be either a depressive state or a manic state. Such a state of a person is extremely dangerous, since the patient is not able to maintain control over his behavior and does not perceive criticism of what is happening at the proper level. A manic state can lead to rash spending of money, distribution of property. The patient and his environment differently perceive the individual phases. Close people perceive mania as a greater evil, compared with a depressive episode, while for a patient, mania is a very pleasant period.

It should be noted that in a depressed state, a person lacks any motivation, a person can stay in bed for days. In addition, the patient cannot perform simple processes, both at work and in caring for himself and loved ones.

However, the depressive and manic symptoms of bipolar affective disorder can only be controlled if you turn to specialists in a timely manner.

Symptoms and causes

In the course of numerous studies, experts have come to the conclusion that there is no clear cause for the occurrence of this disorder. Usually, bipolar disorder occurs as a result of the influence of some specific factors.

Causes that may result in bipolar affective disorder:

• Genetic feature
• Biological type factors
• Imbalance of the chemical composition in the cerebral cortex
• Hormonal imbalance

Manic during bipolar disorder the following symptoms are observed:

• little need for sleep, sometimes only a few hours;
• feeling of constant euphoria, increased excitement, the person considers himself the master of the whole world;
• the patient is dominated by the belief that he is too important and his self-esteem is too high;
• severe irritability;
• accelerated speech and a fairly large number of phrases;
• presence of eccentric statements, too frequent changes of thoughts;
• excessive sociability, which may be accompanied by aggression;
• propensity for risky behavior, promiscuity in sexual intercourse, addiction to alcoholic beverages, participation in dangerous situations;
• neglect of money and their excessive spending;
• quick, reckless and careless decision-making.

Intense symptoms

Depending on the intensity of symptoms, there are:

• Hypomania (mild)
• Mania (severe) symptoms (most severe)

this type of disorder is as follows:

• state of despondency, despair, sadness, gloomy thoughts, hopelessness;
• with exacerbation of the condition, suicidal tendencies are noted;
• sleep disturbance, insomnia;
• frequent anxiety, for no apparent reason;
• feeling of guilt for everything that happens;
• increased or no appetite;
• positive or negative change in weight;
• complaints of lethargy, weakness, fatigue;
• impaired concentration;
• there is increased irritability to sounds, smells, bodily sensations, light sources;
• lack of positive emotions from situations that were previously accompanied by satisfaction.

Course of treatment

When prescribing a course of treatment and maintenance therapy for bipolar affective disorder, the following is used:

• Drug treatment. Depending on the severity of the patient’s condition and the type of course, the specialist individually prescribes the dosage of each necessary medication. Many patients require supportive and prophylactic treatment to prevent relapse;
• Psychotherapy. This method is aimed at changing the behavioral state and thinking of the patient. CBT is considered the most common method of psychotherapy;
• Electroconvulsive therapy is used in severe depressive states, if medical treatment has not brought positive results. Also suitable for mixed episodes and severe mania during pregnancy.

Cognitive Behavioral Therapy for Bipolar Affective Disorder

Psychotherapy provides that it is carried out as an adjunct to pharmacotherapy. CBT focuses on the depressive episode and the prevention of phases, as well as helping with hypomania. In addition to working with symptoms, she focuses on the life problems of the patient and his family.

A big role is given to psychoeducation, explaining the essence of bipolar disorder to the patient and his relatives, for maximum cooperation in overcoming the disease. One of the main goals of CBT is to prevent relapse.

The task of the therapist is to teach the patient self-control and self-regulation so that he can independently identify the initial stage of the disease, identify the early symptoms of mania and depression, plan his life, cope with social situations confidently, express his emotions and solve problems.

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Modern trends in psychology

Author Masha Pushkina, psychoeducator Views 156 Published 08.12.2018 Updated 09.03.2023 9 0149

Contents

Many people have heard that the most effective treatment for bipolar disorder is cognitive-behavioral psychotherapy (CBT). But this is not the only option available. Meet Dialectical Behavior Therapy, Acceptance and Responsibility Therapy, Interpersonal Therapy, and Social Rhythm Therapy.

There is no universal formula for choosing the type of psychotherapy. The style, the approach, the expectations – it’s all so unique, how unique is the person who seeks treatment.

Research has shown that psychosocial interventions, including talk therapy, support groups, and problem-solving strategies, can significantly improve the condition of people with bipolar disorder. These types of care also reduce the risk of relapses and improve the ability to function normally in remission. Those who regularly attend psychological sessions report that their therapists provide support, understanding and empathy that family members or friends may not always be able to offer.

Cognitive behavioral therapy is one of the well-known forms of psychotherapy. Short-term and focused, CBT aims to help people develop skills and behavioral strategies by switching from negative ways of thinking and acting to new, positive ones. But CBT is only one type of helping therapy. There are other approaches as well. Some of them are built on the principles of CBT, while others include mindfulness techniques tailored to specific individual needs.

“Therapy is like soup for me,” shares his experience Zachary A. Borinek, a psychologist, Ph.D. from Texas (USA), who uses an integrative approach in his practice. “Depending on how much of each ingredient you use, the flavor and aroma change.”

Regardless of direction, successful therapy is based on a respectful and trusting relationship with the therapist. Here is a brief overview of effective, but not so widely known directions.

Dialectical Behavior Therapy (DBT)

Introduced in the 1980s by psychologists at the University of Washington, credited to Marsha Lainen, Dialectical Behavior Therapy is a modified form of CBT. Initially, DPT was created for the treatment of borderline personality disorder (BPD) and only then was used to treat affective and behavioral disorders.

A study published in 2013 found that a 12-week course of DPT reduced depressive symptoms and led to fewer hospitalizations in people with bipolar disorder . A follow-up study on DBT and emotional regulation in bipolar disorder in 2017 confirmed these results: the authors noted that “DBT is an effective adjunct to medical therapy for patients with bipolar disorder.”

The therapeutic approach of DBT is to teach acceptance and promote change. “Dialectical means the simultaneous coexistence of two opposites,” says Cindy Koch, a psychotherapist, founder and director of the Koch Center in New Jersey, specializing in DBT. DBT helps people learn and master the four skills that are essential for a fulfilling life: mindful attention, the ability to experience suffering, the ability to regulate emotions, and healthy communication skills. The fifth skill needed by teens and parents is called “walking in the middle” or “choosing the middle path” and is aimed at helping both groups understand the contradictions and evaluate the prospects for their actions.

The mindfulness component of attention – awareness of thoughts, feelings, and here-and-now behavior – is the cornerstone of DBT. It is a skill based on acceptance. Learning to live with suffering is learning how to deal with difficult situations without impulsively reacting and making the situation worse. It is also considered an acceptance-based skill. Emotion regulation and interpersonal effectiveness are skills focused on changing communication for the better.

Koch says that it is necessary to first “teach people to identify their emotions more clearly so that they can sort them out and recognize what is happening more quickly. After that, they can use the skills they have learned to cope with their emotions instead of counting from 0 to 100 and end up in a manic phase.” Interpersonal effectiveness skills help you clarify what people want from others and how to behave in a way that does not destroy relationships or compromise yourself.

“I am grateful for DBT for saving my life and ultimately for specific tools for managing bipolar 2 disorder.” — Bill, 55. Bill went through DBT three times a year in addition to individual sessions with a therapist and found that he could use these tools with ease. He began DBT therapy after moving from Virginia to New York with his parents. Bill was on the verge of a divorce, left his legal career and was hospitalized once or twice a year for almost ten years. “I started with mindfulness practice, which sounds like a cliché these days, but it really taught me how to ground myself,” he says. “It’s more than just being attentive. It means acutely perceiving everything around you, being in the present moment and accepting it. I even enjoy washing dishes by hand as a mindful mindfulness practice. Soaping and rinsing is relaxing.”

Bill became a mental health activist with the National Mental Illness Alliance USA. He dedicated his energies to being a good father to his teenage son, and has maintained a relationship full of love and understanding for the past five years. About DBT, Bill says: “I don’t know what I would do without this therapy.”

Acceptance and Responsibility Therapy (ACT)

Brian Blatt was bored with his usual therapy, so when his therapist suggested trying Acceptance and Responsibility Therapy to finally get over the breakup and deal with the symptoms of bipolar disorder, he decided to try this new one. view.

Instead of suppressing difficult emotions, “you have to be ready to feel everything, including emotional pain, anxiety, guilt, self-hatred and everything else that was with me at that time” , says a 33-year-old man from New York.

Feeling, however, does not mean drowning in these feelings. The next step is to consider emotions and thoughts “as separate from yourself as you can separate images from words,” explains Brian.

Kenneth Fang, a psychiatrist, physiotherapist and assistant professor at the University of Toronto in Canada, is the founder of the local Association for Contextual Behavioral Sciences, which supports ACT. Dr. Fang came to practice AST after realizing how much the CBT techniques he taught were limiting his abilities. “CBT will help rebuild negative thoughts, but those thoughts still exist,” he says. “I know I’m not as terrible as I thought, but I’m still terrible,” Fang explains. “I was looking for an opportunity to provide acceptance, to help someone be aware of their thoughts without drowning in them and not falling into their trap. ”

ANT encourages psychological resilience, which, through mindful attention, allows people to accept their inner sensory experiences as well as develop a more compassionate attitude toward unwanted thoughts or feelings.

With ACT, the therapist is “motivated to help clients accept emotions as transient because they can be very intense and all-consuming,” says Michelle Locke, a clinical psychologist in Toronto. The obligatory (or responsible) part begins with clarifying personal values ​​and changing your behavior in the direction of these values.

“Performed action leads to a feeling of satisfaction with one’s life,” says Dr. Fang. “You begin to act in accordance with what you believe, and not under the influence of simultaneous thoughts and feelings.” In a way, ACT is about accepting that you feel bad but still do something. Despite this.

“You are building a life of meaning and value,” says Christine Sloss, PhD in Psychology. “Focus on acting on what you believe in and don’t let emotions or mental issues become a barrier to what really matters to you. ”

Brian Blatt now uses ACT quite frequently: “It changed my thought process,” he says. “I have found it easier to deal with impulsive and obsessive thoughts, and have also reduced stress, depression, and anxiety… I am bringing myself back to the here and now rather than the past or the future, and this improves my overall mental health.”

Interpersonal and Social Rhythm Therapy (IPSRT)

People live in a 24-hour cycle driven by circadian rhythms. Cycles are regulated by the internal biological clock that tells our body when to sleep, wake up and be active.

Helen Frank, PhD, psychologist at the University of Pittsburgh in the USA, is an internationally recognized expert in the field of affective disorders. She developed interpersonal and social rhythm therapy for the treatment of bipolar disorder. This approach focuses on the relationship difficulties and circadian rhythm disturbances that are common among people with bipolar disorder.

Thinking through the regime and a certain daily routine leads to improved mood and more stable relationships, and also helps to recognize the signs of an upcoming manic or depressive episode.

Although IPRT is not widely accepted as a separate discipline, its basic principles have become tools in the treatment of bipolar disorder. “Even among my colleagues, this is not the most famous type of therapy, but it is so successful that I fell in love with it,” says Gabriella Farkas, MD, New York City psychiatrist. “A lot of people intuitively feel how important regularity is to them, and this tool helps them achieve it.”

Typically, at the beginning of treatment, patients keep a diary for several days, recording important information about their lifestyle, including the time they get up and go to bed, the time of meals and other activities, and how they felt during during the day.

The therapist obtains this information during therapy sessions and assists, where necessary, in making desired actions practical and manageable to help cope with future changes in routine, such as vacations or job changes.

“Illness dictates the need to lead a healthy lifestyle, and it is small steps that can make a big difference,” says Farkas.

Other Therapy Options

Psychodynamic therapy assumes that by improving self-awareness and understanding of unconscious emotions and motives, people can more clearly trace the relationship between past events and current behavior.

Family Emotionally Focused Therapy recognizes that the patient’s relationship with the family is important to the treatment of illness and works to develop a support system for effective problem management.

Art Therapy uses creative forms of self-expression – painting, drawing, dancing, poetry – that help in the expression of emotions and healing.

Narrative Therapy helps you to rethink your past and present and thus distance you from negative events and open up new opportunities for moving forward.

It is worth asking your psychologist what kind of therapy he is trained in, however, many psychologists practice combining different types of therapy.

“There is no structure to my meetings with a therapist,” says Kimberly of Ontario, who has bipolar II and has been seeing her doctor for a decade. “I can just show up for a session and give free rein to any thought or feeling without worrying about what technique I need to know to figure it out.” Kimberly is 37 and appreciates her therapist’s insight and empathy despite the fact that their meetings are usually short, ranging from five (quick check) to twenty minutes (full session). “Whatever approach my therapist uses, it works because I’m still struggling.”

Recommendations for everyone

Regardless of which therapy works best for a particular person, some strategies are useful for everyone.

1. Think about how to deal with the situation before it happens.

During DBT training, Bill Perun learned how to prepare for situations when he is vulnerable. He also realized that being vulnerable was exactly the emotion he avoided in every possible way.