Can CBT therapy be helpful with bipolar disorder?

Traditionally conditions like schizophrenia and bipolar disorder, were seen as forms of severe mental illness, which could not be helped by psychological therapy.

Whilst these conditions usually require medications to help the person balance, in recent years there have been many advances in the use of CBT with life long conditions such as bipolar disorder.

In bipolar disorder, the person can have periods of mania. These can involve symptoms such as frenzied activity and energy, difficulties focussing, restlessness, sleep difficulties, grandiose ideas and dis-inhibited behaviours. These can cause significant impairment to the persons social, occupational and general functioning.

In depressive phases, the person can have severe withdrawal and all the features of major depressive disorder. These depressive symptoms can sometimes remain in the background when other symptoms have settled.

There are different categorisation of bipolar, called bipolar I and II and many different sub-types. There can also be cyclothymic disorder involving symptoms which cycle but are not sufficient to meet full mania, hypomanic or depressive criteria.

In bipolar disorder, the focus of CBT is on helping reduce and minimise the impact of relapses for the person.

This can mean helping the person recognise subtle features of relapse before they occur or helping to overt relapse. For example by addressing the impact of loss of sleep, as a trigger to relapse.

The Psychologist may often work closely with the client and with the person's Psychiatrist to help with pattern monitoring, in order to recognise and avert relapses.

Treatment can focus on improving medication adherence and understanding, by addressing client beliefs which promote medication non - compliance.

It is not uncommon for some people with bipolar disorder to be severely disadvantages in work contexts, though some people can learn to control manic phases to their advantage for creativity and energy. 

In this context, therapy can sometimes help the person with life goals, satisfaction and pacing their available energy.

Treatment may also help the person reduce stress and help them to effectively solve problems in their life and relationships, some of which may arise from their bipolar condition.

There is some evidence that the therapeutic alliance accounts for a third of the treatment benefit in the outcome studies that have been done (Basco).

There is much research still needed in this area, but there are more options for therapy than there were in the past.