Cognitive Behavioral Therapy for Bipolar Disorder

bipolar.stanford.edu

Cognitive Behavioral Therapy for Bipolar Disorder

Cognitive Behavioral Therapy

for Bipolar Disorder

Jenifer L. Culver, Ph.D.

Clinical Assistant Professor

Bipolar Disorders Clinic

Stanford University School of Medicine


Overview

� Overview of CBT (cognitive behavioral therapy)

� Does CBT work?

� Getting started


Why is psychotherapy important?

� Relapse is common even with optimal

medication treatment

� There is something else you can do!

� Psychotherapy can improve illness course

� Knowledge about therapy helps in choosing a

therapist


What is Cognitive Behavioral Therapy?

Feelings

Thoughts

SITUATION

Behaviors


The Role of Thoughts

� Thoughts / interpretations influence feelings

Situation Interpretation

A few people are

yawning while I‛m

speaking

My talk is boring!

I‛m a bad speaker!

Some people are

tired.

Emotional Response

Embarrassed,

disappointed,

angry at self

Minimal response?

Inspired/interested

in engaging crowd


The Role of Thoughts

� Thoughts / interpretations influence feelings

Situation Interpretation

Boss emails me

to set up an

appointment

I‛m getting laid off!

I‛m being assigned a

new project.

My boss wants a

routine update on

current projects

Emotional Response

Worried,

devastated, angry

Overwhelmed?

Excited / hopeful?

Calm? Stressed?

Motivated


The Role of Thoughts

� Thoughts / interpretations influence feelings

� Distorted / biased thoughts lead to problematic

emotions, moods, and behaviors

� All or nothing thinking

� Mind reading

� Personalizing

� Catastrophizing

� Disqualifying the positive


“I’m getting laid off!”

“Here comes the

depression. I won’t be

able to get a job if I’m

depressed.”

Feelings

Worried, devastated, angry

ANGRY

Depressed Hopeless

What is CBT?

Thoughts

Boss schedules

meeting

Behaviors

Complain to others

about company

Sleep all weekend


Common CBT Strategies

� Responses to unhealthy

Thoughts

Cognitive Restructuring: Reevaluating

negative thinking patterns

� Strategies to promote effective problem

solving

� Mindfulness techniques to help clients gain

some distance from negative thinking


Common CBT Strategies

� Responses to unhealthy

Behaviors

� Clients taught to re­enter situations they’ve

been avoiding

� Activities that provide pleasure / mastery are

planned

� Training in new skills (communication,

assertiveness, social interactions)


Common CBT Strategies

� Responses to painful

� Clients learn how to accept or tolerate painful

emotions and are sometimes taught how to

change those emotions in the moment

� Relaxation exercises

Feelings

� Strategies to manage extreme emotional

reactions are taught


Goals of CBT for Bipolar Disorder

Psychoeducation

Recognize Early

Warning Signs

Improve

Functioning

Medication

Understanding

& Adherence

Prevent

Relapse

Mood

Charting


What happens in therapy sessions?

� Structured, with an agenda

� Homework is key component

� Assessment and tracking are common

and guide treatment

� Mood monitoring / symptoms

� Thought records

� Activity logs

� Tracking of behaviors for change


% of Patients With Events

Does CBT work for bipolar disorder?

60

50

40

30

20

10

0

Depression

(P ( P


Limitations of CBT

� Can be hard to find a good CBT therapist

� CBT requires effort and work outside of

sessions

� CBT will not work for everyone


Getting Started: CBT Self­ Self ­Help Help


Conclusions

� Medication alone is often not enough

� Adding CBT can:

� facilitate recovery from episodes

� decrease or delay relapse

� improve overall functioning

� You are an active participant in treatment

� You can get started today

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