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Cognitive-Behavior Therapy for Bipolar Disorder

Cognitive-Behavior Therapy for Bipolar Disorder. Monica Basco, Ph.D. Clinical Psychologist University of Texas at Arlington Department of Psychology. Why Therapy for Bipolar Disorder?. Patients do not understand their illness Adherence is poor Breakthroughs are common

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Cognitive-Behavior Therapy for Bipolar Disorder

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  1. Cognitive-Behavior Therapy for Bipolar Disorder Monica Basco, Ph.D. Clinical Psychologist University of Texas at Arlington Department of Psychology

  2. Why Therapy for Bipolar Disorder? • Patients do not understand their illness • Adherence is poor • Breakthroughs are common • Psychosocial sequelae • Stress

  3. Depression& Mania Changes in Cognition & Emotion Insomnia, stress, & other symptoms Targets for Therapy Changes in Behavior Psychosocial Problems Decreased Psychosocial Functioning

  4. Primary Goal of CBT is Relapse Prevention

  5. Methods for Preventing Relapse • Educate patients and family members • Develop an early warning system • Improve adherence • Control subsyndromal symptoms • Reduce stress, solve problems

  6. What about denial?

  7. Facilitating Adjustment • Help patient explore alternative explanations for symptoms • Challenge negative automatic thoughts • Examine advantages and disadvantages of each action • Explore the meaning of having Bipolar Disorder • Use the Cognitive Triad

  8. Develop an Early Warning System

  9. Symptom Summary Worksheet

  10. Symptoms of Depression

  11. Symptoms of Mania

  12. Lifestyle Management • Importance of consistency with medication • Good sleep hygiene • Avoidance of alcohol and drugs of abuse • Consistent daily schedule or routine

  13. Sleep Enhancement • Reduce stimulation early in the evening • Reduce caffeine intake • Deal with worries before bedtime • Make an action plan for tomorrow • Relaxation exercises

  14. Symptom Management

  15. THINGS TO AVOID Overstimulation Arguments Confrontations with others Sleep loss Overextending oneself Taking Chances

  16. Address Cognitive Distortions • Catch it! – Identify common thinking errors • Control it! – Keep it from affecting actions • Correct it! – Use logical analysis methods

  17. Improve Cognitive Processing • Slow it! - Reduce stimulation, relax • Focus it! - One thing at a time • Structure it! - Use formal problem solving, examine choices

  18. CBT for Improving Treatment Adherence

  19. CBT Model of Adherence Everyone is capable of adherence if the treatment is: • Acceptable • Understandable • Manageable

  20. Many things can interfere with adherence.

  21. If the obstacles to adherence can be identified, they can be removed with CBT methods.

  22. STEP 1: Conditions for Adherence • Does the patient agree that he or she has bipolar disorder? • Is the idea of medication treatment acceptable? Any hesitations? • Does the patient understand that treatment is continuous? • Is the patient organized enough to take medications regularly? Can anyone help?

  23. Step 2: Identify Obstacles • What could keep you from taking your medication everyday? • What kinds of things in the past might have kept you from taking medication regularly? • Everyone has trouble sticking with treatment. Has it ever been a problem for you?

  24. Common Obstacles • Medication – Side effects, dosing schedules in conflict with patient’s lifestyle • Competing advice – from family, friends, PDR, internet, other MDs • Poor therapeutic alliance - trust • Practical issues – forgetfulness, money • Personal adjustment – denial, negative attitudes about medication, anger

  25. Step 3: Troubleshooting • Can the regimen be adjusted to address potential obstacles? • What can be done to avoid the most common obstacles? • Is a reminder system needed? • Do negative cognitions need to be addressed? • If the patient runs into problems, what should he or she do? • How can you help?

  26. References • Basco, M.R. & Rush, A.J. (2005). Cognitive-Behavioral Therapy for Bipolar Disorder. 2nd Edition. New York: Guilford Press. • Basco, M.R. (2006). The Bipolar Workbook: Tools for Controlling your Mood Swings. New York: Guilford Publications

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