Bipolar? How Psychotherapy Can Help

While medication remains the bedrock treatment for bipolar disorder, a few different types of psychotherapy have been modified especially for people with this condition. The therapies that have been tested include helping patients work on family coping and relationships; learn to understand and reorder their own distorted thinking; and develop strategies for managing mood swings.

The best therapy programs include these four common features.

• Providing a solid structure for each day


• Avoiding overstimulation and getting enough sleep


• Resolving any family conflicts that contribute to symptoms


• Learning to recognize the warning signs of manic and depressive episodes

Until quite recently talk therapy had a minor role to play in the treatment of bipolar disorder. Many patients describe hospitalizations combined with high doses of mood-flattening drugs, but little effort to understand the sometimes irrational thoughts of people with the disorder.

More from Health.com:

• 9 Ways to Manage Bipolar Disorder


• "My Life as a Bipolar Mom"


• Psych Drugs Can Pile on the Pounds





While she was in college, Laurel Lemke, now 54, of Lakewood, Wash., was hospitalized for the first time, for six weeks.

"During my first mania, I thought I had ESP, because my mind was putting connections between things in a way that made me think I had special abilities," she says. She doesn't know the diagnosis that was made because no one told her then. "At that time doctors didn't share their diagnoses with patients."

Targeted therapy speeds recovery
That's changing because of new evidence from a large, multicenter study on bipolar disorder. It found that psychotherapy that has been modified for people with bipolar can help substantially reduce the risk of a relapse.

In the study 84 bipolar patients were assigned to one of three different types of talk therapy, while 68 received collaborative care, in which they got a self-care workbook, an educational videotape about bipolar disorder, and three one-hour sessions focused on self-management tools. The group that received therapy had significantly higher recovery rates and shorter recovery times than those who received the video and workbook.

"Psychotherapy seems to be particularly good in protecting against the depressive part of bipolar disorder," says Michael Thase, M.D., professor of psychiatry at the University of Pennsylvania. "Therapy has measurable long term effects in patients with bipolar. It cuts down on relapses and improves work attendance."

Establish a pattern
John Markowitz, M.D., a research psychiatrist at the New York State Psychiatric Institute and clinical professor of psychiatry at Weill Medical College of Cornell University in New York City, agrees that in people with bipolar disorder, talk therapy really helps alleviate depression.

"People need to establish a rhythm to their days, a pattern they can fall into," says Dr. Markowitz. "They need to avoid overstimulation, and their days must be structured to allow them to get enough sleep. This is critical. Lack of sleep is the best-known trigger of mania."

If the daily routine gets jumbled, he says, it becomes increasingly difficult for people to take their medications as directed. But talk therapy doesn't take the place of drugs in bipolar disorder, the way it can in depression.

Comments

[Gerry Wong]

05:41 PM on 04/18/2011

My Mother learned and used this ineffective coping mechanism to deal with emotions that she believed were unacceptable from both a religious and social perspective. She was very fearful of the depressive component of this behavior disorder because she was judged a mental patient by my father and her family and treated with drugs and electro shock therapy. She told me that whenever she felt the her depressive reaction to her distress developing, she would go into a manic state in order to stave off the depressive component. Unfortunately, she was so fearful of being labeled as crazy or, as a sinner that she was never able to accept herself as a worthwhile human being. Nor was she able to allow herself to become aware of her emotions and learn how to use them to make choices in her life that would reinforce and elevate her self-esteem and self-confidence. Instead, she took mood elevators, lithium and finally haldol. She then committed suicide in order to escape her pain.

I hope that professionals and society stop calling manic depression a mental illness because I believe that it gives people a mistaken impression about the origins of the thought and behavior patterns that reflect their beliefs about themselves and the world they live in. I further believe that when people use the term "mental illness" they also give themselves permission to believe that drugs will cure them and when they don't, which they don't, the sense of dispair becomes overwhelming.

[Beth Alexander]

05:14 PM on 03/30/2011

"Lack of sleep is the best-known trigger of mania"

Never heard that one before but from personal experience it is OH SO true. I also think having a stricter routine that allows for more structure can be beneficial for reducing the severity of mood swings. Good article. People shouldn't go home and throw out their medications by any means but dealing with environmental triggers such as personal demons, family issues, past trauma etc., in my opinion is also extremely important for someone living with bipolar.

[Peta51]

05:11 PM on 03/24/2011

I agree that Psychotherapy can and does help. We need to go to the roots of matters, not just skim the surface. Be wholistic. Talking over issues and problems can be therapeutic, esp. in a non-judgmental setting. @Peta_de_Aztlan

[ZENNEPHI]

04:04 PM on 03/24/2011

I'm a dual-diagnoised Bi-pol/Drug & substance history client.
I'm also a graduate of the {Karl Jungian orchestraited} Mandeer Academy. Better known in
circles of physco-therapy as "Dynamic-Meditation". This involves an exhaustive catharsis of
self-talk "gibberish" in a language, other then your "mother-tounge".
Witnessing what you utter for one-full hour-one hour dance-and 30 minutes of witnessing again.
It may be held condusive with a partner. More paticulair setting so that you listen to what is
envibed in your sub-councious terrain, while you are ascertivley speaking in tounges.
"Self-talk" is a bio-feed mechanism, that translates what is suppressed into the "migraines" of
one's mind set, and as a result, clearing the "scatterbrain-webs" that we all carry.
Nueroliptics {Rx} may compliment Dynamics, as in this day and age humanity amass; has one
or two capsules on our tounge at any given time, for any paticulair purpose.
With a little help from above, we all may just go through a transference from medication to
meditation.

For studious review:
"Pulling Your Own Strings"
[Wayne Dyer MD]
Double-Day Publishing

[Blodo]

12:42 AM on 03/24/2011

As a partner of someone with bpd I agree. The worst thing that happened was when my partner went to a psychiatrist and he prescribed an anti-depressant. That's fine when a bpd person is in a down phase, but when that switched suddenly to a manic phase, it was like insanity on steroids.

Lithium works as a mood modulator for the bad periods. Apart from that, the recommendations about sleep, routine, stability are right on. I would also add: good nutrition, avoid caffeine and excessive sugar, get enough exercise and have a good social network.

Best of luck to anyone suffering from this. And to anyone who is a caregiver...this advice applies to you as well, plus...don't by shy about asking for help from friends, family, health professionals if you need it. You don't need to, and shouldn't, try to carry all the weight on your shoulders.

Peace.

[Malembe]

10:09 PM on 03/23/2011

My bipolar symptoms went away five years ago after I started taking the supplement that truehope.com in Canada makes for that. I don't know for sure that the supplement was what did it, but I do know for sure that I have had no more depression or mania during that time. I also know from their research that it doesn't work for everyone.

[Vivian Alicia Evans]

03:31 AM on 03/29/2011

That is a snake oil.

[JOHNSPEAKS]

09:15 PM on 03/23/2011

Think twice before -You- get involved with the mental health industry because of inhuman experimentation with antipsychotic drugs that have horrendous side effects? Psychotherapy is nothing more than brain washing mentally ill human beings into believing they are being helped with a never ending -Ponzi Scheme- of pain and suffering and false hope of recovery? For every mental health client with serious mental illness that is supposedly helped I will show -You- another hundred human beings that are suffering inhuman experimentation with antipsychotic drugs etc.? The use of experimental medical procedures such as -Deep Brain Stimulation- and or -Electroshock Therapy- and or -Lobotomy- etc. proves that mental health professionals are nothing more than ........? You can't claim to be helping people with mental illness and then think it is OK to experiment on human beings and call it science? Since I worked for years at one of the top mental health rehabilitation facilities (FH) in nothern new jersey and documented thousands of clients who suffered from these experiments? I became an expert at trying to stop this inhuman experimentation and pain and suffering and false hope and then -Suicide- to end their suffering? Psychotherapy is nothing more than brain washing in the vast majority of cases?

[stopthe]

10:58 PM on 03/23/2011

What is with all the ???????????????

[JOHNSPEAKS]

09:43 AM on 03/24/2011

-?- It is meant as a joke sort of, the opinons I am expressing are questionable?

[hugatree]

05:29 PM on 03/23/2011

After years of drugs with horrible side effects, I had three years of psychotherapy and intense behavorial work that taught me to how to manage my disorder. I have been several years without drugs and am finally living a stable and fruitful life. A strict schedule, diet, exercise, stress avoidance, and coping mechanisms have made me "normal" again.

[Blodo]

12:33 AM on 03/24/2011

Glad to hear it. Take care of yourself.

[Joseph Burgo PhD]

05:06 PM on 03/23/2011

This has certainly been my experience with bipolar clients in my own practice; once the clients have stabilized to some degree, it's also important to address underlying feelings of hopelessness about how psychologically damaged they feel, how impossible it seems to do anything realistic to improve, and the way they take flight into perfect, magical solutions as a result.

Joseph Burgo PhD
http://www.afterpsychotherapy.com/bipolar-disorder

[ianmcc]

01:05 AM on 03/24/2011

I to am a therapist and I have found what has worked with a majority of my own bipolar clients is to give them a sense of empowerment and control by doing a monthly graphing of their mood swings.

[ianmcc]

04:17 PM on 03/23/2011

I have what is called Reverse Seasonal Affective Disorder, SAD is considered an offshoot of Bipolar Disorder. My disorder however affects me in the springtime (as opposed to the majority of SAD sufferers in the winter, hence the reverse label) and I can get very depressed from the increased intensity of light and changing weather, and also get just a little manic for 1-2 weeks in August. The rest of the year I am fine. I have had this pretty much my entire life and did NOT experience it for nearly 4 yrs when I lived in a non-seasonal climate in CA a decade ago.

As opposed to using anti-depressants in the springtime, I concentrate on taking care of my mental health through meditation, staying in locations with central air and avoiding staying outside in bright light during the spring months. These things help me immensely and allow me to not resort to taking medication. But of course I would always recommend for one to be diagnosed by a professional before opting out of meds.

[lightbulb10]

09:19 PM on 03/23/2011

That's so interesting.

Did you ever have generalized anxiety symptoms?

[ianmcc]

01:04 AM on 03/24/2011

Yes, but not I believe due to my R-SAD. As a child I was the victim of domestic abuse and my mother attempted to kill me 4X, 3 with a butcher knife & one attempt to light me on fire, my older brother 2X first with a bat and then an attempt to get our parents pistol, and my father 1X by choking. This understandably made me anxious via the sense of walking on egg-shells around my family. As an adult I spent years anxious to attain my B.S. & M.A. while dealing with serious health issues (had heart surgery two days before my 30th b-day) and the stress of being low-income, while also dealing with the stress & anxiety of coming out as a gay man back when I was 22.

However ironically it was learning to deal with these other issues that trained me to take care of my mental health and much better equiped me to deal with my R-SAD, which I finally realized I suffer from back when I was 28.

[justmy2sense]

02:54 PM on 03/23/2011

DBT, Dialectical Behavioral Therapy, which was developed to help those with "Borderline Personality Disorder," but has been found to help those with bipolar, esp. those who frequently relapse or can't break the cycle of suicidal thoughts. It provides a set of skills to counter the negative thinking. My daughter was in such a cycle about 3 years ago and got into an outpatient program at the Institute of Living in Hartford CT, with much success, where as other programs had made little progress. http://en.wikipedia.org/wiki/Dialectical_behavior_therapy

[manelady]

12:40 PM on 03/23/2011

Sounds a lot like Charlie Sheen is in the manic stages these days. How sad.

[Godiva]

01:30 PM on 03/23/2011

After watching his interview I thought the exact same thing. He is a classic case.

[stopthe]

11:05 PM on 03/23/2011

I thought that Sheen had bipolar disorder from the first rant. He even seemed to have the breathing cadence  and wide eyes of someone in a mania. Unfortunately I only recognize this from experience.

[Vivian Alicia Evans]

03:33 AM on 03/29/2011

me too.

[nolabear]

10:57 AM on 03/23/2011

Good and sound advice. As a mental health professional I have helped people cope with not only the bipolar sx, but the life problems and the grief and shame that often accompany the disorder, as well as helping people to develop the insight that helps them stay on the medication when the seduction of a manic high can initially be so compelling.

Thanks for the article.