In-Depth: Living with Bipolar Disorder
To effectively treat bipolar disorder, a treatment team—typically, a therapist and a psychiatrist or other medical doctor—is important. This way, professionals from different perspectives are sharing the best information possible and providing “feedback about the nature and intensity of the symptoms in response to medications and side effects,” said Brondolo. She adds that this brings tremendous relief to the practitioners, patient and loved ones, because “you feel like decisions are being made collaboratively.”
Research has shown that cognitive-behavioral therapy (CBT) and interpersonal and social rhythm therapy (IPSRT) are effective in treating bipolar disorder.
CBT features five key components, according to Basco, the UTA psychologist. It:
- Educates patients and loved ones about symptoms and managing the disorder.
- Helps to create an early warning system to detect symptoms before they escalate.
- Teaches strategies for controlling negative emotions and thinking and destructive behavior patterns.
- Helps individuals stick with treatment and take medication consistently.
- Focuses on managing stress and solving life problems.
As part of the CBT approach, Reilly-Harrington helps her patients create a treatment contract, which consists of three parts:
- Selecting the support system. Patients select several people they believe will be supportive and helpful throughout treatment. These individuals are then taught about bipolar disorder.
- Preventing depression. Patients along with their supportive others learn how to recognize the warning signs of depression, anticipate an episode and manage it. Reilly-Harrington talks with her patients about how their sleep, mood and behavior change when an episode is about to occur. Then, her patients list specific ways their support team can help when symptoms surface. Because suicidal thinking is common during depressive episodes, Reilly-Harrington asks her patients how they can be honest with their support system and get help.
- Preventing mania. Mania tends to sneak up on patients, going from sociable and chatty to a full-blown euphoric episode. Similar to above, patients and their support system learn to anticipate and manage episodes. Reilly-Harrington also has her patients use a “two-person feedback” system, where they verify ideas with two people.
IPSRT is a manualized treatment with three components:
- Interpersonal psychotherapy, originally developed to treat unipolar depression, focuses “on the links among mood symptoms and interpersonal relationships and life events, helping to understand reciprocal relationships among these factors,” said Dr. Swartz. “Unstable mood can disturb relationships and life endeavors, while relationship problems can lead to mood instability,” she said.
- Social rhythm focuses on developing and maintaining regular routines. Research has shown that “disturbances in circadian biology are associated with bipolar disorder,” but “there are social cues that can help entrain one’s underlying biological rhythms,” Dr. Swartz said. Such social cues include keeping a consistent schedule of sleeping, eating and other daily activities. “The social rhythm component of IPSRT helps individuals learn to develop more regular routines in order to, presumably, regulate the underlying biologic systems,” Dr. Swartz said.
- Education concentrates on helping patients become experts on bipolar disorder.
Conquering Common Challenges in Psychotherapy
Various obstacles can impede therapy, but all of them can be overcome. Common ones include:
- Dismissing the diagnosis. The biggest challenge for patients is accepting their diagnosis. “If you disagree about the diagnosis, get more information,” Basco said. She suggests thinking about what kind of evidence you need to be convinced. Educate yourself about the disorder and talk to patients and professionals.
- Resisting the lure of mania. Many patients don’t want to give up their euphoric episodes—which can feel pleasurable and intoxicating—and can resist or discontinue treatment. To work through this, Basco has patients contemplate how mania affects them, listing the pros and cons. In her experience, “they decide it isn’t worth it in the long run.”
- Having the time. Making the time to attend weekly sessions can be challenging, said Reilly-Harrington. Though there is much variability in the length of necessary sessions, Reilly-Harrington suggests attending at least 12 sessions.
- Continuing treatment. Once patients start feeling better and symptoms subside, they tend to want to discontinue therapy (and medication), and some even believe they’ve been misdiagnosed, Reilly-Harrington said. However, bipolar disorder is episodic and chronic, requiring continuous treatment. When patients stop treatment and deny the disorder, “that is when we see people start to relapse,” she said.
- Separating life from symptoms. It can be very difficult to distinguish between typical life events and bipolar symptoms. For instance, one of Brondolo’s patients would get very anxious when taking her daughter to sports practice 25 minutes away from home. She was embarrassed that such a seemingly simple task was so alarming to her. When Brondolo asked her patient to explain the directions to the practice, the patient was stumped, even though she relied on GPS. It turned out that, because the GPS was instructing her to take numerous turns, she could never retain the directions. It wasn’t that she was experiencing anxiety; instead, the disorder was depleting her information processing. “You may not realize how much bipolar disorder affects your ability to manage the details in your life,” Brondolo said.
- Understanding it’s a process. Brondolo likens bipolar treatment to a rehabilitation model. After you’ve been in a car accident, returning to your regular functioning is a step-by-step process that takes time. The same is true for bipolar, which requires mastering many skills.
Tartakovsky, M. (2016). In-Depth: Living with Bipolar Disorder. Psych Central. Retrieved on October 23, 2017, from https://psychcentral.com/lib/living-with-bipolar-disorder/