Cognitive Behavioral Therapy (CBT) for Bipolar Disorder

What Is Cognitive Behavioral Therapy?

Cognitive behavioral therapy (CBT) is a therapeutic style that has been practiced for more than 60 years. CBT is a short-term, goal-oriented therapy where the client and their therapist work together to identify and resolve issues with thoughts, feelings, and behaviors.^1,2

CBT focuses on:¹

• The present
• The person’s conscious experience of the world
• Their ability to solve problems
• Their sense of control over their well-being

CBT establishes effective ways for a person to change their environment to create happiness. If a person cannot change the environment, CBT will find ways to change how people think of a situation so that their perspectives and feelings will change.

How Does CBT for Bipolar Disorder Work?

Bipolar disorder is determined as one condition, but based on each person and their mix of bipolar symptoms, it can present in very different ways. The best CBT treatments are tailored to the exact needs of the individual, so no matter the individual needs, CBT can address the condition in specific and effective ways.^1,2,5

Here are six reasons why CBT is an invaluable tool for bipolar treatment:

1. Universal Techniques

CBT provides the client with a fundamental understanding of the connection between thoughts, feelings, and behaviors. Once the client and therapist review this information, the client can apply the skills to numerous situations. Identifying, tracking, and modifying negative self-talk can be used in countless situations, so what the person learns today can be applied to whatever conditions present tomorrow.

2. Increased Sense of Self-Control

Unpredictable mood changes are what distinguish bipolar disorder from depression or anxiety. Someone could be in a depressive episode one day and begin moving towards mania the next. CBT helps give people a sense of control over their symptoms. They may not have the power to eliminate all effects of the condition, but they can offer direction for what to do and when to do it.

3. Improve Medication Compliance

Other therapies may make bold and unsubstantiated claims that someone using that treatment will not need medication to manage bipolar disorder. CBT is much more realistic. During intense mood episodes, medication compliance may worsen. Cognitive behavior therapy works better with consistent medication, so the therapist will plan practical interventions to increase a person’s ability to maintain medication compliance in their treatment.

4. Increased Success at Work & School

Using the skills learned in CBT, a person can improve their mental health at work or school, improving their ability to interact with others and complete daily tasks. If symptoms flare too much, CBT teaches people the communication skills needed to assertively express their concerns and needs with their employers or address stress at school. This way, the damage can be limited, and the person can resume their position once symptoms stabilize.

5. Mending Interpersonal Relationships

Not only can the communication skills, self-monitoring, and behavior modifications of CBT help at work and school, they can also help at home and reduce interpersonal conflicts. The person can learn when it’s best to enjoy the relationship instead of focusing on what needs to be improved, work to communicate clearly, and adjust their behaviors based on the other person’s needs.

6. Avoiding Hospitalization

Hospitalizations are an unfortunately common occurrence for people with bipolar disorder, either from the lows of depression or the highs of mania. CBT sessions and their relapse prevention can help by intervening before symptoms escalate to needing emergency treatment. If the client can use self-monitoring and communication with the treatment team, they can better use techniques or medications to reduce or reverse symptoms. By staying out of inpatient psychiatric hospitalization, the recovery from symptoms will not disrupt the rest of their life.

How Does Cognitive Behavioral Therapy for Bipolar Disorder Fit Into Treatment?

CBT for bipolar disorder aims to stabilize a person’s moods, energy, and thought patterns when symptoms are high. In addition, when a person’s symptoms are mild, it aims to help the person understand how their thoughts and behaviors are helping to produce this outcome. CBT also encourages people to track their bipolar symptoms to recognize changes before they become too problematic.³

In many situations, CBT is not a standalone treatment for bipolar disorder. Often, it is just part of a well-rounded treatment plan that could include:

• Psychiatric medication management
• Physical health management
• Case management
• Financial, nutritional, and employment services

CBT Techniques for Bipolar Disorder

During a CBT session, a therapist will help you to develop essential skills to target the core aspects of bipolar disorder.

These skills can include:^1,2,4,5

• Understanding the cognitive triad: Nothing in CBT works without the client understanding the connection between their thoughts, feelings, and behaviors about themselves, the world, and the future. When an emotion is undesirable, changing thoughts and behaviors will improve symptoms.
• Self-monitoring: CBT relies on the client’s self-report of their symptoms to gather information. With better information, a person can receive better treatment. CBT will teach the client to notice and track their symptoms over time.
• Identifying negative self-talk and automatic thoughts: Thoughts are at the center of CBT. The client will document and report their thinking patterns to the therapist to understand which ideas are leading to unwanted symptoms.
• Cognitive restructuring: CBT shows clients how to adjust their unwanted self-talk and thinking with cognitive restructuring. By noticing and correcting these thoughts, clients can develop positive feelings.
• Behavior modification: In bipolar disorder, the client could go from too much motivation, energy, and drive to too little, depending on their mood episode. CBT teaches people to adjust their behaviors based on bipolar symptoms to maintain balance and stability.
• Communication skills: In CBT, people need to know what they are experiencing, and it’s equally important to enable them to communicate themselves to others. By learning communication skills in CBT, the person can express their needs and wants to friends, family, employers, and mental health professionals.
• Relapse prevention planning: Due to the nature of bipolar disorder, when one mood episode ends, it is only a matter of time before the next one begins. Relapse prevention planning explores ways to best manage a shift into a manic or depressive episode by establishing a list of warning signs and a procedure to follow.

With a person using all of these skills simultaneously, bipolar symptoms and mood cycles can be managed and minimized to allow for better functioning in daily life.

How Effective Is CBT in Treating Bipolar Disorder?

As proven by multiple studies over the years, CBT is highly effective in treating bipolar disorder. Due to many variables and individual differences, it is impossible to say that CBT is “more effective” than other options.

However, one research study showed that CBT was able to accomplish a lot in the treatment of bipolar disorder, including:⁶

• Decreased relapse rate
• Improved depressive symptoms
• Improved manic symptoms
• Improved overall psychosocial functioning

People may achieve similar effects from other, more specific psychotherapy options like dialectical behavioral therapy (DBT), Acceptance and commitment therapy, and assertive community treatment.

Are There Any Drawbacks to Using CBT for Bipolar Disorder?

In general, there are no universal drawbacks to using CBT for bipolar disorder. CBT is a well-researched treatment approach with a long track record of efficacy.

Even still, some people may experience unique drawbacks of CBT for their bipolar disorder, which may include:

• Expecting the CBT to reduce all their symptoms. CBT is effective, but many people will require medications to aid their treatment.
• Not having the capacity to accurately reflect on self-talk
• Lacking the physical ability or control to change their behaviors
• Having a therapist who is not effective at teach skills

How to Maximize the Results of CBT for Bipolar Disorder

There is a lot a person can do outside of a session to boost the success of CBT effectively. Small lifestyle changes are linked to numerous improved mental health outcomes.

Some great ways to maximize your CBT treatment can include:⁷

• Stick to the treatment plan and follow the therapist’s instructions
• Work with a medication prescriber (like an online psychiatrist service) and always take medications as directed
• Focus on mental health through physical health by exercising, eating well, and getting enough rest
• Avoid negative coping skills like alcohol, other drugs, compulsive shopping, or risky sex
• Get plenty of social support from loved ones and support groups
• Work to find purpose, meaning, and direction in life

Being open and honest with a therapist is always essential. People should always let their therapist know if there is a block or concern stopping treatment from being successful.

Deciding If CBT Is Right For Your Bipolar Disorder Treatment

Deciding what kind of therapy a person needs is not easy, but it always starts with seeking the best therapists. Good therapists will acknowledge the symptoms and presenting problems and outline a proposed treatment plan.

Therapists will discuss their theoretical orientation and note if they can effectively address these symptoms. Because of this, you never have to decide the best treatment for you. Your therapist will guide the way.

Finding a Cognitive Behavioral Therapist

Finding a therapist does not have to be a challenging task, especially when you use an online therapist directory. CBT is the most popular and widely-used therapeutic approach, so many local therapists will specialize in the practice. However, make sure you find someone who specializes in treating bipolar disorder.

The state’s license signifies that the therapist has enough experience and education to treat numerous mental health conditions.

How Much Does CBT for Bipolar Disorder Cost?

CBT treatments will vary widely, with many sessions costing anywhere from $50 to $200. Though this sounds like a lot, mental health insurance coverage is available for CBT for bipolar disorder.

CBT usually lasts between 12 to 20 sessions, but this duration could be much longer based on the person’s specific needs and severity of symptoms.¹

Final Thoughts

Bipolar disorder can feel like an intimidating and overwhelming condition. Though the disorder is complex, cognitive behavioral therapy, paired with medication management, is a great way to address the challenges head-on. Today is a great day to start your recovery.