Bipolar psychotherapy is not freud, not couches, not talk/talk/talk. There are specific skills to learn. Learning them may help you as much as pills.Social cognitive views of learning sorreee, so far no one’s shown that you can do without pills entirely using these skills. However, you may be able to get by with fewer medications or lower doses (talking with you provider of course).Social cognitive views of learning

Until the early 2000’s, treatment for bipolarity was all about pills. Then five therapies were shown to improve outcomes compared to pills alone.Social cognitive views of learning you’ll find details below on these old therapies below. The common ingredients are important parts of bipolar treatment. Unfortunately, many parts of bipolar psychotherapy are hard to do on your own.Social cognitive views of learning common ingredients in bipolar psychotherapy

• monitor mood and energy. If you can spot changes early you can turn them around before they turn into big and/or long episodes.Social cognitive views of learning how? Tighten up your sleep control (lot’s to learn there) and learn a whole bag-of-tricks for slowing yourself down when accelerating; or keeping going when getting depressed.Social cognitive views of learning until you’re good at this, some external monitors may help you (friends, mood charting, your therapist).

Because this website is mostly about bipolar II and other non-manic versions of bipolar disorder, I’ll link here one workbook that’s specific for these versions and has many of these common ingredients of therapy.Social cognitive views of learning as with any workbook, you’ll only get as much out of it as you put into it. Most people do best with these things if they use them with a therapist (which works even if the therapist is not well-versed in these techniques; just go through the workbook together.Social cognitive views of learning the key is to do the exercises in the book, not just read the book). Okay, have a look at the bipolar II workbook. But return to my website here for continued updated bipolar education (free; and I have no $ connection to this workbook either).Social cognitive views of learning

In april 2007 a major research program published their results testing three out of these five versus a 3-session education program. When any of these three were added to mood stabilizer treatment for patients with bipolar disorder experiencing significant depression, patients recovered more quickly and more were likely to stay well.Social cognitive views of learning miklowitz

In this study, a psychologist “with little previous clinical experience” met with patients up to 12 times (average 9) while the rest of the clinical team proceeded as usual.Social cognitive views of learning she discussed with the patient her/his personal experience of bipolar disorder and the signs preceding manic and depressive episodes in the past.Social cognitive views of learning they planned and rehearsed a plan for action should those symptoms appear again. The plan was written on a laminated card, carried by the patient.Social cognitive views of learning the therapist helped the patient keep a weekly diary, increasing to daily notes if symptoms were appearing. She informed the rest of the treatment team (a psychiatrist and mental health worker and primary care physician) of the plan.Social cognitive views of learning that was it, nothing any fancier than that, although it looks like she is a very smart person from the style of the write-up, of which she is the primary author.Social cognitive views of learning

Here are the striking results for prevention of manic episodes (prevention of depression was much less dramatic). The lines show the total number of patients having some sort of manic recurrence (so, as time goes on, the number grows and grows).Social cognitive views of learning if we watched long enough, and everyone had a relapse of some sort, the line would eventually flatten way up to the right at 1.0, meaning 100% of the patients had finally relapsed.Social cognitive views of learning as you can see, in the control group that didn’t get to meet with the psychologist, 50% of the group (the 0.5 line from left to right) had relapsed in some way in about a year).Social cognitive views of learning

By comparison, in the group who met with the psychologist, in one year only about 20% relapsed. We have to wonder if just anybody could get these results, besides ms.Social cognitive views of learning perry, but still, it’s pretty impressive. I’m planning on adding some of her tricks, like the card thing, to my approach, based on this result — for patients who have clearly identifiable “episodes” and pre-episode warning signs.Social cognitive views of learning psychoeducation

This research team (including dr. Vieta, who provided much of the material for this entire essay) added 21 sessions of education about bipolar disorder, in groups of 8-12 patients each, to routine treatment in their clinic.Social cognitive views of learning A control group received 21 sessions of “nonstructured” meetings with the same two therapists, but in these groups, they tried not to teach about bipolar disorder (think about it: this was a very rigorous test of the theory that education itself is the active ingredient in the different outcomes shown below).Social cognitive views of learning

This technique was introduced in 1996 by drs. Basco and rush (ph.D. And M.D. Respectively) in their book cognitive therapy for bipolar disorder.Social cognitive views of learning for psychologists seeking training in this method — or patients and families seeking the most thorough treatment possible and willing to teach their therapists while both patient and therapist learn by working through the a training manual — another more recent book describes the technique used by the authors of the largest research study of this method: cognitive therapy for bipolar disorder: A therapist’s guide to concepts, methods and practice, by dominic lam and colleagues.Social cognitive views of learning

They too have shown a strikingly lower relapse rate in patients who had 14 sessions of this therapy added to their regular treatment. Note that this is not quite as rigorous a test as the psychoeducation method above, since the control group here is getting no additional treatment, whereas colom and colleagues conducted an identical group for the controls, without the education.Social cognitive views of learning thus there is a chance that the improvement we’re seeing here is simply due to 14 sessions with skilled, caring therapists, and not necessarily due to the treatment described in their book.Social cognitive views of learning however, in any case, the results are still impressive:

There is even a free, online CBT for depression that is worth looking at if you can’t find a good, live CBT therapist, or can’t afford one.Social cognitive views of learning this is a great program but you’ll have to be very disciplined about working all the way through it to get the benefit. If you do, research shows you’ll likely get as much benefit as if you’d seen a live therapist (wow.Social cognitive views of learning true). Wagner interpersonal and social rhythm therapy (IPSRT)

The data supporting this method are not as strong for the other methods described in this essay.Social cognitive views of learning we will skip quickly on to another method which incorporates this approach. Professionals may recognize the following graph from the 1999 publication by frank et al, which primarily shows that if you start with one method, be it IPSRT or regular clinical management with interpersonal therapy (ICM), you’re better off if you stick with it:

social cognitive views of learning

However, this therapy also includes the family in a major way, which is not a feature of any of the above approaches. In addition to involving family members in all the steps just listed, it also focuses on communication within the family, teaches communication skills, and prepares the entire family for relapse episodes so that all members (not just the patient) have a plan for what to do when symptoms start to reappear.Social cognitive views of learning

As before, this shows the total number of patients staying well. Over a year, many relapse, but the treatment group (red line) does so more slowly.Social cognitive views of learning unlike previous methods, this one shows the same pattern but for depressive relapse, which has been more difficult to address in most of the studies shown here (the psychoeducation method is an exception, also showing as much or more benefit in preventing depressive relapse).Social cognitive views of learning

Like almost all the others, this therapy also focuses on the importance of “adherence” — staying on medications — and showed a specific benefit there (it’s a little unnerving to note that the control patients, shown below in yellow, were not taking medications as directed half the time, and that even when improved by treatment, shown in red, that was still a problem 25% of the time):

social cognitive views of learning

I hope, my readers, if you’re still with me here, that you’re already seeing the main point: all these treatment have common ingredients. As a final demonstration of that point, here are results dr.Miklowitz and his team obtained when they combined FFT with IPSRT.Social cognitive views of learning IFIT is the combined therapy, in red; the comparison group received treatment as usual plus 2 family education sessions and crisis management (CM):

social cognitive views of learning

To answer this properly, with the same kind of emphasis on evidence, will take additional research. Since these studies cost a lot and take years of work, I doubt we’ll see “head-to-head” comparisons (we don’t have that for many medications, either).Social cognitive views of learning for now it looks simpler to conclude that they all have some merit and that elements of each, at minimum the simpler ones, should be part of a treatment package that most patients with bipolar disorder receive.Social cognitive views of learning

#2. PsychoEducation — the manual is now available in english: the psychoeducation manual for bipolar disorder. This is a remarkable text. It details each of the 20 sessions from a group leader’s point of view, including tips on opening the session, specific tools used in each session, things to watch out for in that particular session — and all with a very amusing sense of humor.Social cognitive views of learning

Perhaps you can recruit some local therapist — one that your insurance might pay for; and one that may be easier to find than a psychiatrist who knows and is willing/able to use all this stuff — to work through the book with you. (this may be a pie-in-the-sky idea, I should warn you.Social cognitive views of learning I learned some methods this way, but I’m not sure it’s typical of what other therapists do).