Psychotherapy for Bipolar Disorder. A comprehensive approach
The treatment for bipolar disorder, once primarily managed with medication, evolved to a more complex, comprehensive approach involving a combination of medication and psychotherapeutic and psychosocial interventions.
However, even today the psychopharmacology remains the main pillar of the treatment. Without medication, stabilizing manic or depressive moods proved to be impossible. Even during stable periods, relapses are highly probable. Psychotherapy can complement the treatment for bipolar disorder, imparting skills to cope better with the condition.
Medication therapy for BD
Medication strategies vary based on the disease phase. Acute manic phases typically require the use of neuroleptics (antipsychotics) such as Risperidone, Quetiapine, or Olanzapine. For depressive phases, antidepressants like Selective Serotonin-Noradrenaline Reuptake Inhibitors (SSNRIs) or Selective Serotonin Reuptake Inhibitors (SSRIs) are commonly prescribed. Unlike unipolar depression, these are often combined with antipsychotics or mood stabilizers.
The aim of long-term treatment for bipolar disorder is the mood stabilization preventing shifts into mania or depression. Prevention of relapses is a key aspect of treatment. Mood stabilizers like Lithium or antiepileptic drugs such as Valproic Acid, Lamotrigine, or Carbamazepine are used. Lithium has been found to be the most effective medication for preventing relapses. However, the lithium therapy requires regular controls of lithium plasma level, kidney parameters, thyroid gland hormones and ECG.
Psychotherapy approaches in treatment for bipolar disorder
Multiple psychotherapeutic and psychosocial treatment approaches have proven effective. These include family-oriented therapy, cognitive-behavioral therapy, interpersonal and social rhythm therapy, and group psychoeducation. These approaches facilitate quicker recovery from depressive or manic phases, and between the phases reduce the likelihood of experiencing another episode.
Psychotherapy for bipolar disorder. The relapse prevention
One critical therapeutic objective is relapse prevention. This entails educating patients and their families. All involved parties need to understand the nature of the illness. There is an emphasis on ensuring patients consistently take their prescribed medications. Patients also learn improved stress management, early identification of episode warning signs, and the application of suitable coping strategies.
In the case of depressive episodes, psychotherapy closely resembles the treatment for unipolar depression. The goal is to establish a structured daily routine, motivate increased activity and enjoyable activities, and encourage the social interactions. An important distinction in bipolar disorder is the therapist’s constant vigilance for potential shifts into hypomania or mania.
During acute manic or mixed episodes or severe depressive phases, psychotherapy is scarcely feasible. In these instances, medication is the most effective treatment method. Such phases require often patient’s hospitalization.
While a hypomanic episode also necessitates appropriate medication, hospitalization is usually unnecessary. In such cases, continuing psychotherapy contributes to stabilizing the patient.
Couple and family therapy for bipolar disorder
This therapy is particularly valuable because bipolar disorder often triggers conflicts within families or partnerships. These conflicts can trigger mood swings in patients, raising the likelihood of slipping into mania or depression. Couple and family therapy can prove highly beneficial in managing bipolar disorder and significantly reduce the risk of relapse. Key aspects of this approach include educating families about the disorder and its causes (psychoeducation), assisting in resolving everyday problems (problem-solving training), improving communication skills, and providing guidance for the patient and his family. Over time, the patient and his family gain a better understanding of each other’s viewpoints, potentially leading to mutually satisfactory solutions.
For example, family members may often notice the patient’s changing moods and become concerned while the patient may not perceive their state as problematic. When family members attempt to intervene, suggesting, “You’re behaving differently; you should see a doctor,” the patient may feel patronized. Conversely, family members also bear the burden of the patient’s condition.
Cognitive-Behavioral Therapy (CBT) in treatment for bipolar disorder
This therapy has also proven effective in managing bipolar disorder. Therapists and patients collaboratively identify contributing factors to the disorder and specific risk factors for manic and depressive episodes. Therapists work with patients to underscore the importance of consistent medication adherence and encourage balanced daily routines.
In cognitive-behavioral therapy, patients also acquire general psychological skills, such as better expressing their emotions and needs, managing conflicts, and dealing openly with the illness. The therapy also focuses on identifying individual warning signs that may indicate the onset of mania, hypomania, or depression. For example, patients learn to differentiate between ordinary mood fluctuations in response to specific situations, such as irritation from criticism, joy from passing an exam, and emotional states that may serve as early indicators of mania or depression. Additionally, the therapy aims to help patients identify and address thought patterns that may precipitate manic or depressive episodes, such thoughts like “I can do anything” or “My unique abilities are not properly recognized.”
Patients are often encouraging to maintain mood diaries to retrospectively identify mood fluctuations and their triggers. In cases of worsening symptoms, patients and therapists collaborate to establish a crisis plan outlining appropriate responses to early warning signs. These plans typically include multiple steps, such as finding tranquility through relaxation exercises and early bedtime for mild symptoms. For more severe symptoms, patients may be advised to visit the psychiatrist. In cases of pronounced symptoms, patients may be instructed to contact an emergency clinic.
Interpersonal and social rhythm therapy for bipolar disorder
This approach operates on the premise that irregular sleep-wake cycles primarily trigger manic and depressive mood swings. Thus, therapy focuses on establishing regular sleep-wake patterns and relatively consistent daily routines. Simultaneously, patients receive support in resolving individual and interpersonal problems.
Other approaches
Psychoeducational and socio-therapeutic approaches have also proven beneficial for managing bipolar disorder. Patients receive information about the origins of their condition and learn better coping strategies. Additionally, self-help groups can be valuable, enabling patients to share difficulties with others and obtain helpful insights into managing their condition.