What Kind of Therapy Helps Bipolar Disorder?

Summary: The most effective first-line treatment for bipolar disorder is medication with mood stabilizers, but for patients who need additional support, it’s important to understand that at least two types of cognitive behavioral therapy can help bipolar disorder.

Key Points:

• Medication and medication adherence form the core of successful treatment for bipolar disorders.
• Patients who engage in cognitive behavioral therapy (CBT) in addition to medication report improved treatment outcomes.
• Family support, education, functional remediation, and programs that help loved ones, family members, and friends understand bipolar disorder also improve outcomes for people with bipolar disorder.

Bipolar Disorder Basics

Here’s a succinct definition of bipolar disorder provided by the World Health Organization (WHO):

“Bipolar disorder is a mental health condition that affects a person’s mood, energy, activity and thought and is characterized by manic, hypomanic, and depressive episodes.”

Mental health experts identify three types of bipolar disorder: bipolar I, bipolar II, and cyclothymic disorder:

• Bipolar I (BD-I): main symptoms are manic episodes, depressive episodes, or mixed manic and depressive episodes.
• Bipolar II (BD-II): main symptoms are depressive episodes, hypomanic episodes, or mixed episodes. Hypomanic episodes in BD-II are less severe/intense forms of the manic episodes in BD-I.
• Cyclothymic disorder: main symptoms are persistent/repeated depressive and hypomanic episodes that are less severe/intense than the episodes in BD-I and BD-II.

For a detailed description of the different types of bipolar disorder, visit our bipolar disorder treatment page:

Bipolar Disorder Treatment at Crownview Psychiatric

For in-depth information on various aspects of bipolar disorders, explore the following articles on our blog:

What Does Psychosis Look Like in People With Bipolar Disorder?

How Can We Improve Bipolar Disorder Treatment?

In this article, we’ll discuss a recent review of the latest developments in bipolar disorder treatment, published in the article “Bipolar Disorders: An Update on Critical Aspects.” The review covers all aspects of bipolar disorder, but we’ll focus on what kind of therapy helps people with bipolar disorder, which includes various types of evidence-based psychosocial interventions.

Bipolar Disorder Treatment: What Works?

We mention this first, and we’ll repeat it here because it’s that important: adherence to a mood stabilizing medication such as lithium leads to the best long-term outcomes for people with bipolar disorder.

Bipolar used to be called manic depression, and the primary characteristics of the disorder are the mood swings, i.e. the cycling back and forth between mania and depression.

When people with bipolar disorder experience manic episodes, they feel full of energy, need less sleep than normal, feel a prolonged sense of euphoria/heightened perception, have fewer social inhibitions, and increased self-confidence. There’s a flipside to mania, though: confidence and energy may lead to risky behavior, an over-inflated sense of self, and irritation/anger towards others or themselves. Manic episodes typically last 1-2 weeks, but in some cases, may last only a couple of days, and in others, may persist for several weeks.

Depressive episodes in bipolar disorder are periods of a week or more characterized by symptoms associated with depression. These include low mood, feelings of hopelessness/helplessness, sadness, fatigue, problems concentrating, and withdrawal from friends, family, and favorite activities. While these episodes typically last around a week, they may persist for several weeks to a month or more.

Mood stabilizers help reduce the intensity of and contrast between the mood swings. Patients report feeling more even, steadier, and – as the name implies – more stable while on their medication, compared to when they’re not.

But once the mood swings stabilize, most people with bipolar disorder need additional support to improve cognitive function, improve basic daily function, improve quality of life, reduce suicidality, and manage manic and depressive symptoms attenuated by medication.

Therapy for Bipolar Disorder: What Kind of Therapy Helps?

Therapy helps people with bipolar disorder develop the practical, real world skills they need to manage their emotions, navigate relationships, and succeed in social, vocational, and academic situations. We’ll share relevant information from the review article we introduce above, as well as an earlier article on what kind of therapy helps bipolar disorder, called “Evidence-Based Psychotherapies for Bipolar Disorder.”

Effective Therapies for BD-I and BD-II: The Latest Evidence

Cognitive behavioral therapy (CBT):

During CBT, the primary goals include identifying and restructuring maladaptive thoughts, false beliefs, and managing maladaptive behaviors that are not only symptoms of bipolar disorder but also exacerbate the overall negative consequences of bipolar disorder. During CBT, a therapist leads the patient through a careful, stepwise process that helps them recognize and replace unhelpful automatic thoughts with helpful and logical thoughts, helps them replace cognitive distortions with ideas grounded in reality, and helps them develop behaviors and behavioral strategies that allow them to fully participate in all aspects of daily life.

Mindfulness-based cognitive behavioral therapy (MBCBT):

This approach combines techniques from mindfulness with the core concepts of CBT we describe above. Mindfulness teaches patients to develop a nonreactive awareness and acceptance of the world – and their personal circumstances – in the here and now, which helps them manage difficult emotions and situations without being overwhelmed by them. The mindfulness component of MBCBT helps patients tolerate distress, regulate emotion, and develop healthy resilience to challenging situations.

Family-focused therapy (FFT):

The idea behind family-focused therapy revolves around recognizing that when family members are not supportive, communication in the home is strained, and emotionality in the home is high, levels of stress increase for the individual with bipolar disorder, which exacerbates symptoms and has a negative effect on treatment outcomes. FFT addresses these issues by prioritizing three things: education about BD for family members, improving communication in the family and home, and focused problem solving related to issues associated with bipolar disorder.

Psychoeducation:

In bipolar disorder, psychoeducation helps everyone involved in the treatment process. Individuals with bipolar disorder benefit from learning the science behind what’s going on with them and the evidence base that supports the treatment they receive. Families and friends benefit from learning the real facts about what’s going on with their friend or loved one. They also benefit from learning basic communication and problem-solving skills that reduce conflict, promote harmony in the home, and improve treatment outcomes for the individual with bipolar disorder.

Functional remediation:

This approach focuses on two things: improving deficits in memory, attention, and executive function associated with bipolar disorder, and improving practical daily function. Daily function in this context refers to six areas, or domains of function: autonomy, vocation/occupation, cognition, interpersonal relationships, and leisure. During sessions, therapists engage patients with exercises that improve cognitive function, then assign therapy homework in the form of tasks that – in a logical, progressive manner – help patients restore function in all six domains. Improvement in cognition and improvement in daily self-efficacy improves overall treatment outcomes for people with bipolar disorder.

We’ll discuss these therapies further, below.

How This Information Helps People With Bipolar Disorder

There are two primary takeaways from this article for people with bipolar disorder and their friends/loved ones:

1. Understanding that medication is the foundation of successful treatment for bipolar/learning that adhering to a medication plan is essential for recovery.
2. Knowing the kind of therapy that helps with bipolar disorder involves two things:

• Developing skills to manage emotions, tolerate stress/distress, resolve cognitive distortions, and improve daily function.
• Learning as much as possible about bipolar disorder, both for the individual and for their family, friends, and loved ones.

When an individual stabilizes their mood swings, applies practical tools to manage their symptoms, and are surrounded by people who understand bipolar disorder and know how to help, their long-term prognosis improves dramatically. Medication starts the process, and therapy helps people with bipolar disorder build on their progress and move toward sustainable, lifelong recovery and successful management of symptoms.