CBT can help individuals with bipolar disorder manage their moods.

What is Bipolar Disorder?

Bipolar disorder (BD) is a mood disorder characterized by recurring periods of depressed mood alternating with periods of elevated mood, known as mania or hypomania. BD affects roughly 2% of adults worldwide. Bipolar disorder is a serious mental health concern and is typically managed with a combination of medication and psychotherapy. CBT can be an effective therapeutic intervention for bipolar disorder and can help individuals suffering from BD manage their moods, learn coping skills, and make lifestyle changes that can help prevent and shorten the duration of episodes. 

How Does CBT Help? 

CBT can help people with bipolar disorder manage depressive episodes using many of the same techniques that are used in CBT for depression. Some techniques focus on helping clients become more engaged in activities that they find pleasurable or meaningful, including those that they may have given up since becoming depressed. Other techniques involve helping clients evaluate and respond to automatic thoughts that can perpetuate their depressed mood—thoughts like, “Things are never going to get better,” or “There’s something wrong with me.” In addition, CBT teaches clients coping skills that can help them manage stress, solve problems, and manage interpersonal conflicts that may arise as a result of their diagnosis. 

CBT also prepares clients in advance to manage mania. Therapists and clients predict the urges clients may have to take risky actions when they are in a manic episode. They do problem-solving, for example, figuring out how clients can maintain their usual daily routine and activity level even in the face of greatly increased energy and strong desires to pursue thrilling activities. Therapists also elicit and help clients respond to predicted unhelpful thoughts that are likely to drive actions which result in negative outcomes and adverse consequences for themselves and their families. 

Many clients with bipolar disorder benefit from taking psychiatric medication to help manage their moods. CBT therapists can help clients solve practical problems that interfere with taking prescribed medications and respond to unhelpful thoughts about taking medication. If a client is having difficulty taking medications as prescribed, the therapist will first want to find out what is getting in the way. If the client is simply not used to taking medication regularly, setting a reminder on their phone, or pairing the medication with an activity they do daily, like brushing their teeth, can be helpful. If the client is having thoughts like, “I don’t need to take medication,” the therapist may help the client evaluate the pros and cons of taking medication and weigh them against the pros and cons of not taking medication. If the client is unhappy with the side effects, or doesn’t feel as if the medication is helping them, the therapist can help facilitate open and honest conversations between the client and their medication provider about possible changes to the regimen. 

CBT therapists provide their clients and families with psychoeducation— education about bipolar disorder and its symptoms, and information about what to expect during treatment. During this process, they may help clients accept their diagnosis and respond to unhelpful thoughts they may have about bipolar disorder. Some clients may worry about the stigma attached to mental health diagnoses, and therapists can help clients understand that mental health conditions are common and nothing to be ashamed of, and convey realistic hope that the client will feel better by taking their medications and participating in therapy.  

Therapists may also help clients identify warning signs for depression and mania. Often, clients experience certain patterns of thoughts, sensations, or behaviors either prior to, or in the early stages of a depressive or manic episode. Catching episodes early can help shorten the duration of episodes. The therapist may also work with the client to develop strategies that promote healthy lifestyle habits that can prevent the onset of episodes—strategies like getting adequate sleep and exercise, and avoiding the use of substances. Engaging in regular, predictable, healthy activities can be very helpful to individuals with bipolar disorder. Most importantly, a modern and strengths-based approach to CBT treatment will take into account an individual’s values and aspirations, and help them set and achieve meaningful goals, while overcoming the challenges associated with bipolar disorder.