Bipolar Disorder Therapy

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Bipolar disorder therapy can be extremely helpful in assisting both child and adult clients in predicting and managing their moods. This is in combination with mood stabilizers, antipsychotics or medications prescribed by psychiatrists.

I have written this page for you if you are considering starting therapy and are curious about what bipolar disorder treatment might look like.

Bipolar disorder therapy helps you to cope with the symptoms when they are present but also  helps you to deal with symptoms when they return. Ideally it will help you create a life that minimizes stress so that the likelihood that they will have an episode is minimized.

Th symptoms of bipolar disorder consist partially of a chemical imbalance, which causes a variety of impairments in your sense of self, beliefs about the world, ability to interact with others, and success in setting and reaching personal goals.

There are clusters of symptoms and different diagnostic categories to describe this illness, and it occurs on a spectrum. Some people have it in its most severe form, suffering from psychosis on a regular basis, or episodes of suicidal depression. Others have a less severe form that consists of what feels like an unpredictable fluctuation in mood states. Regardless of the specifiers or severity of the illness, any treatments must address the core issue of emotional dysregulation.

This article will discuss three major specific areas we cover in bipolar disorder therapy all of which deal with the core issue of emotional dysregulation.

1. Creating structure and routine

2. Monitoring your moods and experiences

3. Developing better communication patterns.

Medication, of course, is often the most important issue when considering bipolar disorder treatment, but this article primarily describes things that you can do once your medication has helped you with stability.

Emotional Dysregulation. The Core Symptom. 

If you have bipolar disorder you may feel unable to regulate your feelings, thoughts and behaviors. You are easily overwhelmed by stressful events, and the intensity of your emotional reactions, and fearful of that out of control feeling that may cause depression or mania.

This is emotional dysregulation ( ED). People with bipolar disorder are not the only people who struggle with this. This condition creates a tremendous amount of havoc. It’s terrible to feel so out of control. Fortunately, it’s not true that you have no control. Bipolar disorder just makes you feel that way, but you can learn strategies to help yourself.

Create Structure and Routine

One of the first steps in regulating emotional experience is to create a structure and routine. Unfortunately, this is incredibly difficult for you if you have bipolar disorder. You are likely creative and love living in the moment. A regimented day with structured activities, sleep schedules, social activities, and mealtimes is the last thing that feels comfortable to you. In therapy speak this strategy is called Interpersonal and Social Rhythm Therapy (IPSRT). It is one of the few therapies shown to be effective for bipolar disorder. We know that working on regulating your outside life can help tremendously with regulating your inside life. This helps with stress, and stress is certainly the most common trigger for mood episodes.

Habits, social interactions and stress management strategies have a tremendous impact on mood. Whether you suffer from bipolar disorder or not, creating an awareness of these issues, regulating them to the best of your ability, and then working on developing coping skills to handle the unexpected will all help you to feel happier. Journaling. 

If you have bipolar disorder, therapy can help, but you can try to do this on your own. Keep a sleep journal, and another journal in which you explore your routines and eating habits. There are apps for this now! This is the first step. The second step is keeping a mood journal.

The Mood Journal

Often the most useful technique for people suffering from this illness is keeping a mood journal. A mood journal develops an awareness moods, thoughts, perceptions and stress. This unfortunately, can be one of the hardest things to do. It can be time consuming and challenging to remember, but the payoff is worth it.

It’s amazing how many experiences we have that cause us to have emotional reactions, thoughts and behaviors that we are unaware of. Often, we have an experience of becoming stressed, angry, or uncomfortable and wonder why this is the case. Once we become aware and can reflect on what has happened, we can usually discover what it is that is triggering us.

For someone who has bipolar disorder, therapy always includes this strategy. This is a powerful technique which can help create a clear awareness of what is causing stress. Once this occurs, an action plan can be created to address it.

This journal can help you become aware that a phone call with your mother, an interaction with a boss, or too much sugar is the cause of your angry mood. Now, you are now able to solve that problem and decrease your stress. The mood journal creates the awareness of the triggers and stresses that may be destabilizing in the short term, giving you the ability to problem solve the little things that can eventually cause you to have an episode. They are all over the internet, and now, there are even iPhone applications that you can use!

Communication

Studies show that many people with anxiety and depression, as well as those with bipolar disorder, have distorted perceptions of reality. They see danger and anger in places where it isn’t; they read into other’s words and emotional expressions and come to false conclusions. If you have bipolar disorder, you need to know this about yourself. Your loved ones need to know this as well.

Creating routine and structure, figuring out your triggers, understandings your stressors and the impact on your mood are all incredibly helpful techniques. These strategies help to raise your awareness, enable you to take action to regulate your moods and to stabilize your illness. However, you do not live in a vacuum, and you must share what you have learned with the people you love.

Understanding and communicating about your internal experience, perceptions, and reactions help you to build healthy relationships with others. This is true whether you have or do not have bipolar disorder. This is a process that takes an endless amount of work, but if you want to keep the people in your life you love you must do it! You also must do this with people you need to interact with(such as your boss) even if you don’t love them.

It can be hard to trust others enough to share with them your emotional experience, but it is the only way to have healthy and functional relationships. There are many strategies you can find on the internet about communication, and you can use them. It’s also important to share what you have learned about yourself in your journals. This information is helpful for your boss, teachers, friends, family, and significant others.

Therapy for bipolar disorder consists of understanding how stress impacts your mood states, and how through self-monitoring, understanding the impact of your thoughts on your feelings and behaviors, and reducing your stress, the you can minimize the impact of your mental illness. Additionally, a therapist will provider support around implementing the techniques and getting through your daily struggles, as well as monitoring your medication.

Bipolar disorder therapy first starts with relationship building, self-monitoring, and psychoeducation. Understanding the illness and symptoms of each mood state is a key focus of treatment.  This looks different for each person.

In my office I like to involve everyone in a client’s life who wants to participate. For example, a child's parents and siblings, or an adult’s spouse. Often those closer to you are better able to read the signs of a mood state than  you are, and they can help support you during these times.  

Many of my clients do not agree to or feel comfortable involving their families. That is okay too.

Sometimes it is helpful to note that changes that appear behavioral are often mood state related. Significant others can be taught that when they are feeling angry or frustrated with the person they love; it is often because the bipolar person is going through an unstable mood state. 

For example, if your loved one or partner cannot get out of bed, cannot go grocery shopping and cries all day long- they are not lazy, they are not weak, they are in a depressed mood state!

If your child is angry and oppositional during a certain period each evening, it suggests not that they are badly behaved, (if they are diagnosed with bipolar disorder), but perhaps they are struggling with an unstable mood state. 

Reaching the goal of understanding symptoms can be done with journaling and mood charts. I often will outline the symptoms on paper and continuously refer to them.  Bipolar Disorder does not go away. Even when stable on meds, it is likely that someone with bipolar will continuously struggle with mood episodes and will need to get proficient at recognizing them.

Other Benefits of Therapy

Bipolar disorder therapy can help you to challenge your negative or unrealistic thoughts and manage your symptoms.

Challenging unrealistic thoughts is a key function of therapy. If your are  not stable, we can start to use the language of your  symptoms to assist you with monitoring the effect of your  medicine.

If the you are stable, we can help you to recognize what may be triggers for their moods and avoid those triggers. This will be important in different phases in treatment to prevent or manage future episodes.

Here is an actual example of mood symptoms written down by one of my clients:

How do I know when I am experiencing depression?

I don’t want to get out of bed in the morning

I don’t want to cook

I feel hopeless and overwhelmed; I can’t deal with small tasks

I start to worry about my marriage and husband leaving me

I start to think I am a loser and I will never be able to accomplish anything

I eat a lot more

What might be a trigger for my symptoms?

Work stress

Not sleeping

Credit card bills being ignored

Family trouble

 

This client was able to learn that when she is thinking “I am a loser and can’t accomplish anything” she was likely depressed. Bipolar disorder therapy helped her to learn how to recognize and challenge this thought. This is not a real thought; this is a depressed thought. She learned that when she does not feel depressed, she doesn’t have this thought. Cognitive therapy taught her the skills to recognize and challenge thoughts that are distorted. 

Challenging thoughts includes coming up with examples of how she is not a loser, and all the things she has accomplished. 

Therapy can teach you and your family coping skills

Therapy for can help you to learn how  certain situations will trigger your mood states and how to cope with  stress that triggers your mood states. When family members are involved the benefits of these strategies are magnified because your family can learn how to support you rather than hinder you.  

Long Term Management

If you suffer from bipolar disorder, therapy remains an important way to assist the you in managing your illness, your relationships, and your behaviors. These are only a few examples of how cognitive therapy for bipolar can be helpful! There are many ways this approach can be combined with others to effectively treat bipolar you.

Caution

Cognitive therapy for bipolar disorder is not helpful for children and teens that are not stable. In my practice I will tell parents we cannot expect your child to make progress or benefit from therapy until they are stable on their meds. Depending on the severity of the adults cycling and illness they may also need to be stabilized on their meds first prior to benefiting from bipolar disorder therapy using cognitive techniques.

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