Bipolar Disorder - References

Psychotherapy and Lifestyle Changes

Psychotherapy is an important addition to medication. There are many approaches. Trained mental health professionals can:

• Educate patients about bipolar disorder and its treatments
• Teach patients to recognize and manage early warning symptoms of imminent manic or depressive episodes
• Help them comply with drug regimens
• Monitor the patient's on-going status

In addition, psychotherapy can help patients:

• Adjust to the reality of the illness and understand the negative consequences of mania -- particularly important for patients who consider their mania to be positive, creative, and exhilarating
• Cope with feelings of guilt and remorse that occur after manic episodes
• Deal with feelings of imperfection and despair

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Cognitive-Behavioral Therapy

Therapists trained in cognitive-behavioral therapy (CBT) may be particularly helpful for many patients. CBT is a structured, conscious method that aims to help a patient recognize negative thoughts and behavioral patterns and to change them. CBT is known to be helpful for other mood disorders, including depression and anxiety, and some studies suggest that it benefits patients with bipolar disorder as well.

Typical goals of CBT for patients with bipolar disorder patients include:

• Recognize manic episodes before they become full-blown and change behaviors during an episode
• Cope with depression by developing behaviors and thoughts that may help offset the negative mood

Family Therapy

It is important that partners, family members, or both be involved in therapy. Therapy can help them learn how to accept and cope with the condition.

Support for the Patient. Recommendations for supporting the patient include:

• Create a treatment contract as a first step. In this contract, the patient and family agree to specific steps for maintaining emotional stability, including compliance with treatment. If such measures fail, all parties agree on further actions to be taken during an acute episode, including hospitalization.
• Be supportive. Unlike relatives of patients with alcoholism who may be encouraged to get tough, relatives of patients with bipolar disorder must be strongly supportive because of the high risk for suicide with this disorder. Simply listening attentively and being empathic can help. Bipolar disorder results from an imbalance of chemicals in the brain and not from anyone's fault.
• Get the patient to comply with treatment, even if it means threatening a hospitalization if the patient fails to comply.
• For emergencies, have ready a hotline number or the telephone number of the patient’s psychiatrist.