The terms “cognitive behavioral therapy” are used diversely to capture a number of therapy based either on cognitive therapy, behavior therapy or on a combination of both. The use of cognitive-behavioral therapy for bipolar disorder was started in the late 1990s. This paper addresses the issues related to the use of cognitive-behavioral therapy for people with bipolar disorder.
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The Content of the Therapy for Bipolar Disorder
Cognitive-behavioral therapy for bipolar disorder has unique features that distinguish the treatment of depression from that of bipolar disorder by the same therapy. Given that people with bipolar disorder are likely to experience relapse, the therapy involves additional delivery of medication to stabilize the mood swings.
Emphasis on psychoeducation regarding the nature of the disorder makes the patient to understand his/her biological susceptibility to episodes of mania and depression. According to the group of researchers (3), since stressors spark off these episodes, the patient therefore, learns to identify and control then in order to reduce the frequency of occurrence of the clinical episodes.
Cognitive-behavioral therapy helps the patient to understand how his/her distorted positive and negative thinking may trigger the stressors into action. For instance, a patient with distorted positive thinking occurring within a manic episode may easily think that s/he has power and value that can do marvelous things.
Such skewed thinking can lead a patient to make decisions, say of extravagant expenditure, with devastating negative repercussions to the family. Moreover, the therapy enables patients with bipolar disorder to manage their regular daily activities/routines.
According to Alloy, Nusslock, and Boland (1), when left without the therapy, such individuals often experience disrupted routines and poor sleep that increase the risk of developing mania.
In cognitive-behavioral therapy, the prevention of relapse is a key aspect of treatment for patients with bipolar disorder. Usually, individuals are between manic episodes or depression when they seek for treatment.
The occurrences of manic episodes often leave the patient with terrible negative consequences and therefore, it is important for the patient and the practitioner to work together and identify the warning symptoms in order to develop a coping strategy. Early diagnosis is important because it helps engage individuals who experience manic signs in cognitive-behavioral therapy, especially if they are suicidal or early in their condition.
The reason being, they are highly likely to be in denial of their situation and refuse to be treated. As researchers (1) remark, people with long history of bipolar disorder, on the other hand, may have developed co-occurring disorders (for example, substance abuse) and a degree of neuropsychological impairment that need to be considered and treated concurrently.
According to a report published by Bond and Anderson (2), the effects of cognitive-behavioral, therapy for patients of bipolar disorders were found to be positive for those who had been on treatment for over six months. In this study, participants were given between twelve to twenty sessions of cognitive-behavioral therapy and the results compared to the traditional method of treatment.
The participants who were placed under cognitive-behavioral therapy reported fewer episodes of either depression or mania, and a fewer instances of hospital admissions. Moreover, in six months after undergoing the treatment, patients for cognitive-behavioral therapy reported higher social interactions and fewer cases of depression (2).
It should also be mentioned that cognitive-behavioral therapy is effective on patients who have experienced episodes of mania or depression not more than six times. Moreover, it has been observed that treating patients with bipolar disorders using components of cognitive-behavioral therapy such as relapse prevention and psychoeducation are crucial in reducing the frequency of relapse (1). Cognitive-behavioral treatment is so far the best way to medically address the problem of bipolar disorder.
Prediction of a Better Response to Cognitive-Behavioral Therapy for Bipolar Disorder
As mentioned earlier, people with a history of less than six episodes of depression or mania and those with fewer co-occurring disorders reported positive feedback for cognitive-behavioral therapy treatment. Furthermore, individuals who gave a realistic sense of themselves, recognizing their limitations did benefit from cognitive-behavioral therapy (1). However, those who reported unrealistic sense of themselves such as high intelligence, high levels of energy, and creativity never benefited from cognitive-behavioral therapy.
Accordingly, therefore, it is observed that the severity of an illness can be used to predict a person’s response to medication. Some people with bipolar disorder are passionate about manic episodes since they feel more creative and productive during these incidents. When exaggerated, these beliefs are often challenged during cognitive-behavioral therapy treatment, mostly when trying to avoid damages of depressive episodes (1).
Due to the devastation that bipolar disorder causes in families with affected members, it is important to screen for manic episodes and interview family members in order to identify and treat bipolar disorder. Therefore, family members will be at a better position to identify early warning symptoms of either manic or depressive episode and prevent it. They can also ensure that the affected member sticks to his/her treatment schedule.
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Cognitive-behavioral therapy combines aspects of cognitive therapy with behavioral therapy in offering treatment for bipolar disorders. The content of cognitive-behavioral therapy provides for medical intervention for the reason that people who suffer from bipolar disorder experience relapse. The content also has psychoeducational provision that enables patients to identify and cope with signs of manic and depressive episodes.
It has been noted that cognitive-behavioral therapy is effective on individuals who have had fewer than six episodes of manic or depressive disorders. Families should also be involved in cognitive-behavioral therapy given the devastation wrought by bipolar disorder. By identifying the early signs of manic episodes in the affected member, they will be able to prevent the disorder or seek medical attention in time.
- Alloy LB, Nusslock R, Boland EM. The development and course of bipolar spectrum disorders: an integrated reward and circadian rhythm dysregulation model. Annual Review of Clinical Psychology. 2015;11:213-250.
- Bond K, Anderson IM. Psychoeducation for relapse prevention in bipolar disorder: a systematic review of efficacy in randomized controlled trials. Bipolar Disorders: An International Journal of Psychiatry and Neurosciences. 2015;17(4):349-362.
- Chiang KJ, Tsai JC, Liu D, et al. Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: a meta-analysis of randomized controlled trials. PLoS One. 2017;12(5):e0176849.