How Can Cognitive Behavioral Therapy (CBT) Help People Living With Bipolar Disorder?

Bipolar disorder has — or more accurately said, bipolar disorders have, since there are multiple distinct subtypes — a bit of a reputation as a mental illness that's exclusively managed with medication. Even, the American Psychological Association reports, among doctors and other healthcare professionals. 

What kinds of talk therapy are used to manage bipolar disorder?

Though no one treatment approach will be right for every person with bipolar disorder, three approaches to psychotherapy are highlighted as most evidence-based, and therefore most recommended. These therapeutic approaches include: 

• Interpersonal and social rhythm therapy, in which people with bipolar disorder work on creating biological and social routines that work for them and improving their relationships with the important people in their lives. Together, these steps can have a great impact on stabilizing a person's mood.
• Family-focused therapy isn't just for the patient, but also for their relatives and partners. Together, families learn about bipolar disorder and its management, and how to communicate about the illness in a way that fosters productive and healthy interpersonal relationships. 

How does cognitive behavioral therapy work?

Cognitive behavioral therapy is usually a short-term kind of therapy that is well-suited for people who prefer analytic and practical approaches. The basic foundations of cognitive behavioral therapy lie in the ideas that:

• Somewhere along the way, people end up with unhelpful, wrong, or even harmful thought and behavioral patterns. These can create loops we get stuck in without even realizing it, leading to or worsening mental health problems. 
• Learning to understand which of your thoughts and behaviors are really not good for you can help you change your life for the better. 
• Better coping skills can have a significant impact on the symptoms of a mental disorder you have been diagnosed with, and on your quality of life. These coping skills can include anything from meditation techniques to stress reduction strategies, as well as learning to rid yourself of the tendency to ascribe motives to other people's actions that might be entirely wrong. 
• Good CBT therapists will essentially make themselves redundant as they teach you to manage your own problems by applying the principles of cognitive behavioral therapy yourself. This means the therapy will include a fair amount of homework — as CBT becomes part of your life, you need to practice it in action. 

Can cognitive behavioral therapy help people with bipolar disorder? How?

Medications form the backbone of the management of bipolar disorder. Lithium, in particular, is well-known to be successful — but in the grand scheme of things, it doesn't work that well. Only about 60 percent of patients taking lithium respond to it well, in terms of symptom reduction, and even for those who do well with lithium, the medication is much better at preventing manic relapses than preventing depressive episodes. Half of bipolar patients will still have depressive episodes on lithium. 

This is why talk therapy is a very important aspect of successful management of bipolar disorder. Cognitive behavioral therapy has been well-studied for this purpose, and research has found that:

• People living with bipolar disorder who attend CBT sessions are more likely to stick to their prescribed medication or medications. 
• If you have bipolar disorder and participate in cognitive behavioral therapy, your odds of a mood episode severe enough to require hospitalization goes down. In general, CBT reduces both the severity and frequency of mood episosdes — mania, hypomania, and depression.
• Cognitive behavioral therapy has a positive impact on the quality of life of people with bipolar disorder — and that would include things like subjectively feeling happier, safer, and more stable. 

Cognitive behavioral therapy can be delivered one-on-one with a therapist, or in group sessions. The impact of group CBT on people with bipolar disorder has been less studied that the benefits of individual sessions, but some studies have found group therapy to be beneficial. 

It's important to note that CBT includes, in this context, psychoeducation. That concretely means, here, learning more about the nature of bipolar disorder, warning signs of depressive, hypomanic, or manic relapses, and lifestyle changes that have been shown to help people manage their bipolar disorder. Relatives are often included in this educational portion of the therapy, or else patients are encouraged to share their knowledge openly. 

What should you do if you're interested in cognitive behavioral therapy?

The specifics of how to get referred for CBT if you have bipolar disorder, what is covered by insurance, and so on, will vary from country to country — so we won't cover those. We'd advise you, however, to look for a qualified therapist who is deeply experienced in helping people with bipolar disorder, and who specializes in that. 

The benefits of cognitive behavioral therapy outlast the duration of the sessions themselves — so the fact that bipolar disorder is a chronic disorder that often features relapses does not mean you have to necessarily commit to weekly sessions for many years. You'd usually start with a course of CBT during which you meet weekly. After that, the sessions can reduce in frequency so that you just check in with your therapist for "maintenance" sessions. When you do recognize warning signs of relapse, it can then be helpful to again have a period of more regular sessions.