This article describes the types of psychotherapy that appear to be most useful for people with bipolar disorders, and mentions which kinds of patients are most likely to benefit from each. As mentioned previously in this chapter, many good therapists use techniques and concepts from several of these disciplines.
Insurance companies love cognitive therapy (also called cognitive-behavioral therapy), because it sometimes produces relief from troubling symptoms within a defined, limited period of time. Patients like that too, especially those who are strongly motivated to help themselves.
The cognitive therapist begins by helping the patient identify which negative behavior patterns he would like to work on. Together, they identify what kinds of thoughts and feelings precipitate these behaviors.
Next, the therapist helps the patient figure out strategies for replacing thoughts that have negative consequences with new thoughts that have positive consequences. In other words, the cognitive therapist helps you “think yourself well.”
Cognitive therapy works best for handling specific “thought errors” and behaviors. For example, if a teenager with bipolar disorder tends to catastrophize when depressed, seeing only the negative side of everything and then becoming further depressed as a result, cognitive therapy can help him find strategies for breaking this negative thought spiral. These strategies might include the use of affirmations, consulting with the therapist or another trusted adult to double-check negative thoughts, or mentally substituting positive thoughts for the negative ones.
Does it work? Not always, but more often than one might think. Cognitive therapy has helped many people identify and combat errors in thinking, and has even proved useful for stopping thoughts that can lead to troubling behaviors, including self-injurious behavior. It has a good track record for helping people with compulsive behaviors, those in recovery from substance abuse or dependency, and patients suffering from anxiety, panic, and other out-of-proportion reactions to daily events. Evidence is mounting that cognitive therapy produces actual physical effects, such as changes in the production and absorption of neurotransmitters.
In the hands of a professional who has strong rapport with young children, cognitive therapy can be a powerful tool, even for preschoolers. Not every therapist has the ability to work well with this age group, however. It has been well-tested for use with adolescents and teens.
Cognitive-behavioral therapy has also shown effectiveness for educating bipolar patients about monitoring their mood cycles and symptoms, and for encouraging treatment compliance.