How Talk Therapy Can Improve Bipolar
If you (or a loved one) are among the estimated seven million people in the United States living with bipolar disorder, then you know just how life-changing treatment can be for the rollercoaster ride this condition can take you on. While medication is the first and most effective line of treatment to help steady your state of mind (and keep it there), studies show, psychotherapy (whether in a group format or individual sessions), when used in addition to medication, can have many advantages over simply taking meds alone.
What Bipolar Is and How It’s Treated
Bipolar is a major mood disorder marked by extreme mood swings known as mania and depression. Mania can feel like the highest of highs, almost like a sense of euphoria. The depression side of things can bring about overwhelming sadness, low energy and no motivation to complete daily tasks, feelings of hopelessness and worthlessness, and an increased need to sleep. Studies show psychotherapy, as an adjunct treatment to medication, helps patients with bipolar disorder improve their compliance, awareness, and coping skills for life events, all of which result in a better response to medication.
Talk Therapy Helps You Learn to Cope
Talk therapy can't always prevent new manic or depressive episodes, but “it can remove some of the risks,” says Chicago-based Aimee Daramus, Psy.D., clinical psychologist and author of Understanding Bipolar Disorder. How? By helping you lower stress levels, get more pleasure and relaxation out of life, have some supportive relationships, find healthier ways to channel urges during mania or hypomania, and reduce depressive thinking, Dr. Daramus says. Start with your M.D. for a referral to a mental-health professional who can help put you on the right track toward a steady state of being.
It Can Prevent Mood Swings
Talk therapy can also help you identify mood triggers and develop strategies to prevent episodes, says psychiatrist Lindsay Israel, M.D., chief medical officer of Success TMS in Palm Beach Gardens, FL. “With the combination of medication and talk therapy, there are longer time periods between episodes, and the mood symptoms can be less severe as compared to medication treatment only,” Dr. Israel says. Research shows psychotherapy speeds up recovery from depressive episodes and can help prevent new mood swings. It also improves functioning and quality of life. There are several talk therapy styles that can be beneficial.
Cognitive Behavioral Therapy (CBT) is a type of therapy that teaches you how to approach negative, intrusive, or outlandish thoughts in a different way, so that when they pop up, you won’t have to accept or believe them. By recording thoughts, keeping mood diaries, and scheduling activities, patients learn to control automatic negative thoughts, eliminate distorted thinking, and interrupt cycles of mania and depression. “If a patient starts to notice a dark intrusive thought, they can recognize it, change it to be more positive and realistic, and in turn, steer away from a negative or maladaptive behavior,” Dr. Israel says.
How CBT Works
Research shows CBT has a positive impact on patients with bipolar disorder by reducing depression levels, improving the severity of mania, decreasing relapse rates, and increasing psychosocial functioning. People with bipolar often have distorted cognitions which can lead to negative mood states; researchers believe CBT helps people deal with those distorted cognitions, also called hyperpositive thinking, particularly during manic states. “It can help with depressive and suicidal thoughts while managing the energy and impulsiveness of hypomania in a healthy way,” Dr. Daramus says.
Dialectical Behavior Therapy
Researchers believe those with bipolar disorder have a compromised ability to regulate their emotions. Dialectical Behavior Therapy (DBT) specifically targets this emotion dysregulation and helps to improve emotion control and mood symptoms in patients with bipolar disorder. “DBT can help people tolerate and reduce strong emotions, and find them distractions from stressors,” Dr. Daramus says. Therapists help patients seek out replacement behaviors “when they’re feeling impulsive, angry, or hyposexual, so they can manage stress levels to help prevent future episodes,” she says.
How DBT Works
Studies show DBT treatment that teaches mindfulness, emotion regulation, and distress tolerance skills helps reduce depression—and reductions in emotion dysregulation improves overall well-being. What’s more, teaching patients with bipolar the skills they need to regulate their emotions more effectively may contribute to an improved sense of mastery and control over their environment. “DBT can help manage symptoms during depression and hypomania, as well as manage strong emotions,” Dr. Daramus says.
Family-Focused Therapy (FFT) involves treating the patient and any family members or loved ones and focuses on education and understanding bipolar disorder. It covers things like how best to detect early warning signs of an episode, problem-solving skills training, and communication strategies to address family conflicts these episodes can trigger, Dr. Israel says. “Family therapy can be very beneficial when bipolar disorder is causing a lot of conflict. Supportive therapy helps people stay strong during the long journey to stability,” Dr. Daramus says.
How FFT Works
Studies show that in patients from families with high levels of bipolar disorder, those who received FFT had approximately half the number of depressive episodes and spent half as much time depressed as those receiving medication alone. “Patients often don’t reach out for help because they feel they are a burden on their families,” Dr. Israel says. “FFT can help the family have a better understanding of this condition and hold the patient accountable for their behaviors—within reason. They can also come up with a plan for when the patient is decompensating,” she says.
Interpersonal and Social Rhythm Therapy
Interpersonal and social rhythm therapy involves coaching a patient on how to monitor and regulate their daily routines, such as eating habits, sleep patterns, exercise, or stress, which can help prevent either depressive or manic episodes, Dr. Israel says. “It empowers the patient to have better insight into their own warning signs so that help can be reached sooner rather than later,” she says. The right combination of medication and a talk therapy technique that works for you can help you maintain a balanced emotional state of being and live a happy life that’s not dictated by your moods.
Talk Therapy & Bipolar: Focus. (2014.) “Psychotherapy for Bipolar Disorder in Adults: A Review of the Evidence.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4536930/
CBT & Bipolar: PLoS One. (2017.) “Efficacy of cognitive-behavioral therapy in patients with bipolar disorder: A meta-analysis of randomized controlled trials.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5417606/
DBT & Bipolar: Behavior Therapy. (2017.) “Dialectical Behavior Therapy Group Skills Training for Bipolar Disorder.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6145450/
Family Therapy & Bipolar: The Journal of Clinical Psychiatry. (2008). “Family Treatment for Bipolar Disorder: Family Impairment by Treatment Interactions.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2862220/
Bipolar Statistics: National Alliance on Mental Illness. (2021.) “Mental Health by the Numbers.” https://www.nami.org/mhstats