One of the most challenging psychiatric illnesses is bipolar disorder—also known as manic-depressive illness. This is a form of a depressive disorder that also includes periods when the individual is “manic” rather than depressed. Mania includes symptoms such as lack of need for sleep, inflated self-esteem, excessive irritability or hostility, inability to sit still, racing thoughts, easily distracted, and inappropriate or highly risky behavior (such as driving very fast, spending too much money, odd business schemes, excessive and risky sexual behavior, etc.). The individual can have long periods of normality—periods with no significant depression or mania. Often periods of mania may be less severe (called “hypomania”) and may go undetected because the individual may just feel especially good and believe that there is nothing wrong. The problem with manic episodes is that they often lead to damaging behavior (e.g., spending too much money, hostility, sexual acting-out) and generally are followed by periods of depression.
Approximately 1 % of the population has bipolar disorder. A number of famous people have suffered from this, including Mozart, Beethoven, Virginia Woolf, T.S. Eliot, Emily Dickinson, Victor Hugo, and many others. Bipolar disorder is a life-long illness—similar to diabetes— and requires continuous treatment with medication. Untreated, manic-depressive illness can be devastating-often leading to suicide (15%-20%). Many individuals go years without being diagnosed properly. Unfortunately, if the patient is bipolar and receives only anti-depressant medication, this will increase the chances of cycling into a manic phase and then back to a depressive phase.
The essential component of treatment is the use of medication. This includes the well-known mood-stabilizer– lithium, anti-convulsants (such as depacote), and anti-psychotic medication. In addition, the psychiatrist can add certain medications, such as anti-depressants or anti-psychotics, depending on the mood that the patient is in. Research in the United Kingdom and the USA now shows that various forms of psychotherapy can help the patient (who is also taking medication). These therapies include cognitive-behavioral therapy, family therapy and interpersonal therapy.
Dr. Leahy has recently co-authored Bipolar Disorder: A Cognitive Therapy Approach (Guilford Publications). Individuals with bipolar disorder can benefit from therapy that helps them understand their illness, deal with feelings of hopelessness and guilt, help resolve family conflicts that arise, gain better control over impulses and moods, and assist in decision-making. Although bipolar disorder is a difficult problem, there are useful treatments that can help the individual maintain a more normal life. To read more about the nature of Bipolar Disorder, you can read the chapter by Sheri Johnson in Psychological Treatment of Bipolar Disorder available here.
How does therapy work for people with bipolar disorder? There are several important components to cognitive behavioral treatment. Patients and their families can cope better if they learn more about the nature of bipolar disorder. No one “chooses” to have bipolar disorder—so educating families about the genetic basis of this problem can be very helpful. Also, family members can learn how to respond to the patient’s mood fluctuations—such as sadness, irritability, exuberance, and hopelessness—without being critical or controlling. We can provide reading material and information on this for patients and their families. In addition, it is helpful to “catch” yourself before a mood episode gets too far. For example, increases in mania are often not noticed by the patient—because he or she either feels exceptionally good or blames other people. Learning how to catch your manic or depressed moods early —and to consult with your psychiatrist about medication adjustment and utilize your self-help skills—can dramatically reduce the negative impact of your mood period. Moreover, the therapist can help the bipolar patient learn how to handle the depressed mood by applying cognitive and behavioral techniques to help reduce self-criticism, hopelessness, withdrawal, lethargy, and lack of interest in activities. We recognize how hard the depressed episode can be, so combining therapy with medication can give the patient the added skills and support they need. Mania–characterized by grandiosity, irriabability, risk-taking, excessive spending and sexual behavior—- can have longer term negative consequences. The therapist and patient can identify the early signs of mania, contract for self-control and risk-reduction, and practice plans to reduce “acting out”. To learn more about what clinicians should know about bipolar disorder and its treatment see this article by Dr. Robert Leahy
Our group empoys an integrated clinical approach to bipolar illness. Thus, we recognize the importance of medication, modifying thinking, changing behavior, enhancing effective communication, reducing family stress, management of sleep patterns and activity levels, and reducing risk. Since many patients with bipolar disorder also misuse drugs and alcohol, we address these risks directly in treatment.
Although many people have thought that bipolar disorder is a “biological” illness, the leading authorities in the field now recognize how valuable effective psychotherapy can be (along with medication). Indeed, in the United Kingdom the National Health Service requires that bipolar patients have access to cognitive behavioral therapy as part of their treatment regimen. Our group here in New York is directed by Dr. Robert Leahy, who has co-authored two books on bipolar disorder and who is currently editing a special issue of the Journal of Clinical Psychology on bipolar disorder.
Blog Posts on Bipolar Disorder:
Sample Chapters from Guilford Press:
- Bipolar Disorder, Second Edition: A Family-Focused Treatment Approach by David J. Miklowitz
- The Bipolar Teen: What You Can Do to Help Your Child and Your Family by David J. Miklowitz and Elizabeth L. George
- The Bipolar Workbook: Tools for Controlling Your Mood Swings by Monica Ramirez Basco
- Cognitive-Behavioral Therapy for Bipolar Disorder, Second Edition by Monica Ramirez Basco and A. John Rush
- Integrated Group Therapy for Bipolar Disorder and Substance Abuse by By Roger D. Weiss and Hilary Smith Connery
- Psychological Treatment of Bipolar Disorder Edited by Sheri L. Johnson and Robert L. Leahy
- Psychotherapy for Children with Bipolar and Depressive Disorders by Mary A. Fristad, Jill S. Goldberg Arnold, and Jarrod M. Leffler
- Raising a Moody Child by Mary Fristad and Jill Arnold Goldberg
- Treating Bipolar Disorder: A Clinician’s Guide to Interpersonal and Social Rhythm Therapy by Ellen Frank
- What Works for Bipolar Kids: Help and Hope for Parents by Mani Pavuluri
- When Someone You Love Is Bipolar: Help and Support for You and Your Partner by Cynthia G. Last
* Note: These excerpts are posted with permission of Guilford Publications, Inc. and are subject to copyright law and restricted from further use. No part of this excerpt may be reproduced, stored in a retrieval system or transmitted in any form or by any means (electronic, photocopying, recording or otherwise) without prior written permission of the publisher. To obtain permission please contact Guilford Publications, Inc. at the address below or e-mail: firstname.lastname@example.org This book may be ordered directly from Guilford Publishing at http://www.Guilford.com