CBT for bipolar disorder

Domain II · Behavioural & cognitive · Lam, Jones, Hayward · 1999

What it is

CBT for bipolar disorder is a structured, collaborative, educational therapy given alongside mood-stabilising medication, not in place of it. It rests on a stress-diathesis model: there is a biological vulnerability to mood episodes, and stressors, disrupted sleep and routine, non-adherence, and…

Format

• Format. Individual outpatient therapy is the main form tested (Lam; Scott). Group and brief versions exist (see below). The therapy is usually started when the client is euthymic or only mildly symptomatic, not during acute mania. Each session follows the usual CT structure: agenda, review of mood…
• Session counts by version

Questions to explore with your client

• What drew you to it, and what are you hoping it will change?
• Does it involve any substance, plant preparation, remedy or supplement? Has your doctor or prescriber been told, especially about any medication you take?
• Does it involve intense or unusual breathing? Have you been told about the medical conditions for which that is not advised?
• Does it involve fasting, a special diet or 'detox'? Have you discussed this with your doctor?
• Is it a group, retreat or community? How do they respond if someone wants to leave or raises a concern?
• Who runs it, and what training or registration do they hold?
• What actually happens in a session or meeting, and how often?
• What does it cost, and is there pressure to commit to more?
• How do you feel afterwards, in the hours and days that follow?
• Does it fit with, or clash with, the work we do here?

What practitioners of it watch for

• Self-harm urges; assess risk. It is working when urges pass without harmful action.
• Risk to others. Follow local safeguarding procedures. It is working when time-outs are used and incidents fall.
• Anxiety that is part of a mixed or depressive prodrome. It is working when avoidance falls and mood stays stable.
• Stress management turning into another striving project. It is working when stress peaks pass without changes in sleep or mood.
• Relaxation used in place of acting on a clear prodrome. It is working when the client uses it without prompting and arousal drops.

When to involve someone else

• New or worsening physical symptoms, or advice to stop or change prescribed medication: involve the client's doctor or prescriber.
• Signs of coercion, isolation from family and friends, escalating costs or secrecy: discuss openly and consider safeguarding.
• A crisis or thoughts of suicide: follow your crisis protocol. In the US, call or text 988; in the UK and Ireland, Samaritans on 116 123.

Drawn automatically from the guide's own sections. Stay curious: neither endorse nor dismiss what the client values, and check anything that matters against the full guide and its sources. Not medical advice.