How to Treat Bipolar Disorder with Cognitive Behavioral Therapy

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:

• anxiety
• attention deficit hyperactivity disorder (ADHD)
• autism
• bipolar disorder
• depression
• eating disorders
• insomnia
• obsessive-compulsive disorder (OCD)
• personality disorders
• post-traumatic stress disorder (PTSD)

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.

Research from 2017 shows that CBT can help people with bipolar disorder in many ways, including:

• 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.

If you’re experiencing symptoms of bipolar disorder and think you might need help managing them, reaching out to a therapist or psychiatrist could be beneficial. You can also try online services.