Different Types of Therapy for Bipolar Disorder
Bipolar disorder (BD) is a condition that is strongly affected by stress. Episodes of mania and depression can be triggered by significant life events, severe family conflicts, turbulent relationships and situations that disrupt sleep/wake rhythms. This is why it’s problematic when treatment is presented as mostly pharmacological. Those with BD function better when they receive medication management from a psychiatrist andregular (weekly or biweekly) psychotherapy sessions.
Therapy can help a person cope with the stress from these external factors, manage their symptoms and improve their relationships. Here are several different forms of therapy that have been found to be effective for BD.
Family-focused therapy (FFT) includes both the person with BD and their parents, spouse, or other family members. FFT typically lasts about 12 sessions (depending on the family’s needs) given by a single therapist. Early sessions focus on education about the condition: its symptoms and how they cycle over time, its causes, how to recognize the early warning signs of new episodes, and what to do as a family to prevent the episodes from getting worse. Later sessions focus on communication and problem solving skills, especially to address family conflicts. In many randomized trials conducted by my labs at University of Colorado and UCLA, we have found that people with BD who get FFT and medication after an episode have less severe mood symptoms and better functioning over 1-2 year periods than those who get medications and briefer treatments or case management.
Interpersonal and Social Rhythm Therapy
IPSRT is an individual therapy in which the person with BD keeps daily records of their bed times, wake times, and activities, and the effects of changes in these routines on their moods. The clinician coaches the person on how to regulate their daily routines and sleep-wake cycles as a way to stabilize moods. The person and his/her therapist identify one or more interpersonal problem areas (e.g., conflicts with coworkers; difficulty sustaining friendships) and discuss potential solutions to prevent similar problems from emerging in the future.
Cognitive Behavioral Therapy
Cognitive behavioral therapy (CBT) is an individual therapy focused on the relationship between a person's thoughts, feelings and behaviors. CBT teaches people to:
Identify negative assumptions and thinking patterns, and challenge themselves to rehearse more adaptive ways of thinking.
Monitor their activity levels to make sure they are engaged with rewarding aspects of their environment when depressed, and are not overly stretched when manic.
Dialectical Behavior Therapy
Dialectical behavior therapy is a skill-based approach that includes both individual and group therapy. It teaches mindfulness and acceptance skills, such as the ability to experience moment-to-moment thoughts, emotions and their accompanying physical sensations from an observer’s stance, without negative judgment. It also teaches distress tolerance, emotion regulation and interpersonal effectiveness.
People with BD get together (often accompanied by family members) and are led by a group facilitator (either a psychologist or a trained peer mental health counselor). Some groups are highly structured and follow an educational and skill-training agenda. Others are oriented toward telling one’s story and getting support and suggestions from people who have gone through similar situations. These groups, including those provided by NAMI and the Depression and Bipolar Support Alliance, are quite beneficial to people because they reduce feelings of isolation that often come with mental illness.
Over time, the specific type of therapy may not be as important as the continuity of having a therapist or a group that knows you well and makes you feel comfortable enough to disclose important issues. Along with medications, support from mental health professionals who understand your journey are key to an effective treatment plan and recovery.
David J. Miklowitz is the author of The Bipolar Disorder Survival Guide, 3rdEdition (www.guilford.com/p/miklowitz2), which has just been published by Guilford Press. Check out his website and information about the UCLA Child and Adolescent Mood Disorders program (www.semel.ucla.edu/champ).
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