CBT for bipolar disorder can help you change the distorted thinking patterns that arise during mood episodes.
Bipolar disorder is a chronic mental health condition that involves extreme shifts in mood and energy levels.
The disorder requires a long-term treatment plan that usually includes mood-stabilizing medications, anticonvulsants, or antipsychotics. For many people, therapy can help alongside medications.
Cognitive behavioral therapy (CBT) for bipolar disorder is based on the idea that your feelings, thoughts, and behaviors are all connected, and that unhelpful thinking patterns (which often occur during mood episodes) can affect your behavior.
CBT aims to help you identify and change these unhelpful thought patterns.
CBT is a type of psychotherapy that helps you identify and change distorted or unhelpful thinking.
The idea with CBT for bipolar disorder is that when unhelpful or “negative” thought patterns are replaced with more useful ones, you can change your behavior and feel more in control of your life.
CBT is goal-oriented and typically focuses on current problems in your life rather than working through your childhood or past experiences. During sessions, your therapist helps you move forward with new, healthier coping skills.
CBT has been extensively researched and shown to improve symptoms of various psychiatric conditions, including the following:
Bipolar disorder is a chronic mental health disorder affecting more than 2% of adults globally. It’s characterized by severe shifts in energy and mood, and ways of thinking that can make daily functioning difficult.
CBT for bipolar disorder is based on the idea that changes in mood and thinking during depressive and manic episodes can influence behavior.
- improving depressive symptoms
- reducing mania severity
- decreasing relapse rate
- improving psychosocial functioning
Researchers stated that improvements in depression and mania were more significant when CBT treatment was 90 minutes or longer per session.
In one trial of CBT for bipolar disorder, researchers compared 6 sessions of CBT with treatment as usual. At 6 months, CBT was associated with:
- fewer hospitalizations
- lower rates of stopping lithium against medical advice
- fewer episodes due to inconsistent lithium use
In general, CBT uses the following approaches to treat bipolar disorder:
- education about bipolar disorder
- changing negative thought patterns
- future episode intervention
CBT is most helpful during the later stage of treatment, the maintenance phase.
Also, the most beneficial treatment for bipolar disorder is the right medication and supportive therapy with family support.
Education about bipolar disorder
Education is a vital component of CBT for bipolar disorder. During CBT for bipolar disorder, the client learns about the biological, psychological, and social factors that contribute to the condition.
CBT also teaches circadian rhythms and how a lack of sleep can affect mood cycling. Clients also learn the importance of sticking with their treatment plan.
Clients may also learn about the symptoms of bipolar disorder and how to look out for and keep track of symptoms.
During a depressive episode, symptoms may look like the following:
- sadness or feeling low
- loss of interest in previously enjoyed activities
- feelings of hopelessness or worthlessness
- changes in sleep or appetite
During a manic phase, symptoms may look like the following:
- extreme feelings of happiness
- having grand ideas and plans
- feeling self-important
- talking very quickly
- high levels of energy
- easily agitated or irritated
- making risky decisions that are out of character
Changing unhelpful thought patterns
Unhelpful thoughts often take hold during depression. In CBT, the therapist helps the client reframe difficult or distorted thinking patterns, which helps reduce harmful impulses and actions.
Clients learn to pay close attention to their self-talk to determine whether their beliefs and actions are helping or harming them. When they notice they’re engaging in faulty thinking, CBT helps them replace it with more realistic or positive thoughts.
Want to try it yourself? We have a guide here.
Future episode intervention
CBT teaches clients to identify the early warning signs of depressive and manic symptoms. This can help reduce the severity of future mood episodes.
With CBT, you will learn:
- conflict management skills
- stress reduction techniques
- the importance of getting enough sleep to help reduce the risk of severe manic or depressive episodes
Family therapy can also help family members learn these techniques as well.
CBT for bipolar disorder involves several strategies to change faulty thinking patterns, including:
- Mood tracking. This may involve keeping a daily journal in which you rate your mood from 0 (depressed) to 10 (feelings of mania). This activity helps you become aware of your mood fluctuations and triggers.
- Self-talk monitoring. Your internal thought processes influence your mood and behaviors. By carefully monitoring what you think about yourself, you can improve your mood and perception of yourself.
- Cognitive restructuring. This technique builds on self-talk monitoring. Cognitive restructuring allows you to reframe your unhelpful thought patterns as positive ones.
- Examine behaviors. In CBT, you may pinpoint your negative behavioral patterns and identify what triggers them.
- Problem-solving. You may also learn how to identify problems and reach possible solutions. Once you choose a solution and carry it out, you and your therapist will evaluate how well it went.
When bipolar disorder is managed with a comprehensive treatment plan, such as with medication and CBT, there’s often a higher rate of success.
CBT for bipolar disorder can be taken individually or in a group. It may also include other strategies, such as mindfulness-based cognitive strategy (MBCT) or integrated group therapy (IGT) for substance misuse with bipolar disorder.
It will likely cover topics and strategies such as stress reduction, triggers, and the link between sleep and major mood shifts.
If you or someone you love has bipolar disorder, and you believe CBT can help, consider talking with a therapist.