Therapy for Bipolar Disorder

As bipolar is characterised by fluctuations in the high and low moods it can be difficult to diagnose. While the individual is experiencing a low phase it is more apparent that they are suffering from a mental health issue. However,  when this is followed by a period of mania, the individual may appear to be functioning in a regular manner and living a fulfilled and successful life.

It is really important that the individual learns how to recognise and understand their symptoms. This will allow them to communicate with their loved ones and therapist should they need to return for therapy sessions. In time they may become able to guide themselves out of their depressive and manic episodes. That is the goal of psychotherapy for bipolar disorder: control of the symptoms. A therapist will provide self-help advice, self-management advice, and teach them to deal with the practical aspects of a long-term condition.

It is thought that using a combination of different treatments is the best way to control bipolar disorder. It is also recommended that those close to the person suffering also learn about the condition to help them to understand and spot the symptoms while maintaining a positive relationship.

Cognitive Behavioural Therapy for Bipolar Disorder

Psychotherapy is a healthy way to deal with problems. Through Cognitive Behavioural Therapy (CBT), the approach involves four key stages:

  • Outline the problem (such as mood, work, or relationship stress)
  • Examine the thoughts, behaviours, and emotions associated with this problem
  • Identify the negative, non-representative behaviours and emotions associated with this problem (such as insomnia, overspending, depression, or unhappiness)
  • Change your reaction to the problem and, as a result, the thoughts and feelings that are associated with it

CBT assists individuals suffering from bipolar because it can help them to:

  • Manage the symptoms of bipolar disorder.
    • prevent behaviours that can result in a relapse into those symptoms.
    • learn effective coping techniques that help control the emotions and stress associated with the disorder.
  • Try alternative or additional treatments when others are ineffective particularly when medication is not an option.

You can find out about the other kinds of therapy we can use to treat bipolar disorder on our Psychoanalytic Psychotherapy, Systemic Psychotherapy, and Existential Psychotherapy pages.

The role of therapy

There is a range of talking treatments which can play an important and active role in helping sufferers to manage their condition. Used in concert with medication these are seen as the best methods of recovery and staying well following a diagnosis of bipolar disorder. Psychoanalytic psychotherapy addresses the deeper structure of personality and allows to learn emotional containment experientially, over time. This has the effect of allowing greater personality changes.

In addition, suffers can also benefit from enhanced relapse prevention therapy aimed at helping you learn effective coping strategies. Finally, family therapy can be considered as a method of working with the whole family to tackle behavioural traits, teach an understanding of the condition, and enable the learning of coping strategies.

Talking treatments should always be undertaken through properly qualified and registered professionals, who in turn, can help bipolar disorder sufferers deal with emotional issues directly related to or affected by their illness. As well as this therapists can assist sufferers to learn to live with their condition, develop strategies for coping with triggers, episodes, and symptoms through a range of methods, including mindfulness. Finally, a therapist can act as an impartial sounding board to help bipolar sufferers to plan and set goals, as well as preparing a crisis plan in the event that they start to feel very distressed again.

What has helped your bipolar disorder?

We always encourage the sharing of your own personal experiences with bipolar disorder – In many cases talking or writing about your story, your experiences and successes can help others find the strength and courage to face up to this debilitating and painful condition. Please leave your comments, tips, and observations below.

Causal Factors

Bipolar disorder is relatively rare with around 1% of the population suffering from this condition. However, a formal diagnosis of bipolar disorder should be seen as a positive step on the road to understanding, treatment, and management of this distressing illness. After diagnosis, it is completely understandable to ask the question, “Why me?”

The exact causes of bipolar disorder in people are widely credited to three broad areas: geneticsbrain chemistry, and environmental factors, such as current or previous life experiences. In none of these ways is the development of bipolar disorder the sufferer’s ‘fault’ or due to any kind of ‘weakness’.

Genes and brain chemistry

Current thinking is that a predisposition toward developing Bipolar disorder is inherited through the parent’s genes with a history of this bipolar disorder in one or both family lines, leading toward a higher risk of this condition emerging in a child’s later life.

Abnormal brain chemistry is present in both the manic and depressive states in this disorder with an imbalance of the usual neurotransmitters, such as noradrenaline, serotonin, and dopamine being present. It is in this element that medication can actively assist in treatment by normalising these levels and subsequently “smoothing out” the emotional and behavioural mood swings. However, medication is seen as only one half of an effective bipolar treatment regime – the other is professional psychotherapy.

Environmental and social factors

Whilst medication is dedicated toward altering the biochemical causes of bipolar disorder, it is talking treatments, such as psychotherapy, which address the environmental and social factors contributing to the sufferer’s depressive and manic episodes. These take the form of previous life experiences (often from childhood) and current events which may ‘trigger’ the start of an episode.

Childhood traumas are often a significant factor in the development of bipolar disorder – According to medical studies 30% to 66% of sufferers report abusive or traumatic experiences whilst growing up. This then can have a huge impact on an individual’s likelihood of developing bipolar disorder.

Childhood trauma as a contributing factor

According to some experts, the emotional distress of childhood trauma, abuse, or neglect can be a huge factor in developing and maintaining bipolar disorder. These events have a tremendous impact on an individual’s psychological make-up, thereby greatly affecting how they learn to regulate emotions, deal with stressful situations, and live their everyday life.

Examples of childhood trauma that sufferers might have experienced include physical, emotional, or sexual abuse. Studies indicate that this subset of people was more likely to experience a range of elements, including earlier onset of bipolar disorder, greater risk of suicidal behaviour, and a greater tendency toward substance abuse. A less traumatic (but no less damaging) reason can be attributed to a caregiver leaving a baby to cry without making their emotions more tolerable through physical contacts, such as rocking and holding a distressed child. This is enough to produce biological dysregulation in a child’s growing brain.

However, childhood traumas are not limited to deliberate abuse. Instances such as the death of a close family member or loved one – particularly one or both parents – have been shown to be an important contributing factor in the chances of someone developing the bipolar disorder later in life. In addition, traumatic events occasioning extreme emotional reactions (such as being in a devastating road traffic accident, terrorist attack, or hostage situation, for example) also have the potential to impact how well a person can regulate their own emotions – especially if there is no support following this event.

Finally, there is evidence that some people who suffer from bipolar disorder may not have had a chance to experience and learn emotional regulation in their early life – a process that is automatic in most people.
As can be seen from the above examples, it is not unreasonable that children experiencing one or more of these traumatic events in their life could be thought to be at a higher risk of developing bipolar disorder.

Triggering events in the present

Often with bipolar disorder, there is an event in the present or very recent past which can be identified as the ‘trigger’ for an episode. However, triggers can also be so subtle that it seems that the emotions start switching without a particular reason. However, where a trigger can be identified these often revolve around stressful circumstances or life events. As with environmental and historical issues, these can include the breakup of a relationship, marital problems, the death of a loved one, an instance of abuse, or being the subject of an attack (sexual or not). Such events are recognised as traumatic for anyone regardless of their mental health or predisposition to bipolar disorder – hence suffers should not feel that they are ‘weak’ or that somehow they are responsible for the onset of an episode – a feeling which is all too prevalent in the depressive side of this condition.

Other triggering events can include what might be considered as ‘normal’ stressful situations that everyone can anticipate during their life: these include money worries, work issues, or relationship troubles. Even something as mundane as sleep disturbance (such as when nursing a young baby) or even just not getting enough sleep can, over time, lead to greater difficulties with regulating emotions in a normal manner.

Substance misuse as a trigger

The use of both alcohol and drugs (recreational and prescribed) can cause hypomania or depressive mood states in vulnerable individuals. Certain prescribed medicines can do this as a result of taking them or as a withdrawal symptom when they are stopped. In all cases, it is very important that when being prescribed new drugs or medicines that the health professional concerned is aware of the person having bipolar disorder – even if that person has been symptom-free for some time or has the condition under control.

Needless to say, taking street drugs or any other form of substance misuse can be very triggering to vulnerable individuals. Indeed, there is some evidence that illegal drugs can contribute to a person actually developing bipolar disorder- Cannabis has been identified as being especially likely to bring on or exacerbate a bipolar episode.

Early experiences as an influence on bipolar vulnerability

Having identified the various factors which can make someone susceptible to suffering from or experiencing bipolar disorder we can see where the twin approaches of medication and talking therapies can start to help. Whilst medication can assist with the issue of biochemical imbalances in the brain, psychotherapy can be used as a method of rewiring the brain and learning experientially that emotion can be contained. In this manner, the therapist acts as both a role model and support. The therapist also enables the sufferer to find meaning in their condition, rather than just feeling that they shouldn’t have it. In addition, they provide help in dealing with current and previous emotional issues, as well as helping sufferers to come to terms with traumatic events in their past. In addition, talking treatments can offer alternative ways of thinking or interpreting events that are far more positive and realistic than the negative and unrealistic patterns that sufferers typically adopt.

As outlined above, one of the primary reasons thought to lead to bipolar disorder is where a person’s early experiences as a child have been of a negative and/or traumatic nature. Incidents of child abuse (physical, mental, sexual, or emotional) can have a deep and profound impact on a child’s development. Such problems are likely to manifest either immediately or in later life during periods of high stress or anxiety, giving rise to unhelpful coping strategies and/or a distorted view of the world as a hopeless, bleak, or over threatening place.

Such early experiences influence the way a person’s personality is structured – often resulting in persistent bipolar mood swings. Research would seem to indicate that those individuals suffering from bipolar disorder lack the normal innate emotional regulation which others learn very early in life. It is believed that a traumatic event in a sufferer’s early life fails to provide safe, regular containing experiences with one or more caregivers. In addition, these traumas also result in sufferers having less impulse control and cognitive functioning – all of which significantly reduce the individual’s ability to deal with stressful situations in later life.

Bipolar can also be categorised as a mood disorder: bipolar as a mood disorder.

Living with Bipolar: Periods of depression

You may initially be diagnosed with clinical depression before it becomes apparent that you also experience manic episodes, leading you to then be diagnosed with bipolar disorder. You can experience future manic episode months or even years after a period of depression. While they are in the depression or hypomanic state, individuals often suffer from a badly distorted worldview covering a broad spectrum of unhelpful thinking styles and behaviours.

Symptoms to look for

You can find out more about the symptoms of depression on our depression page. This provides advice on what to look out for when you or another person is suffering from a depressive episode. During depressive stages this is when the individual will appear to need support most, however it is important to continue this support when they experience mania.

Living with Bipolar: Periods of mania

During a manic phase, the individual may have higher energy levels, lots of ideas, and ambitious plans. They are likely to feel happy generally. Some people with bipolar disorder find their manic phases to be a positive experience, but occasionally some experience more negative symptoms. In some cases, the ‘manic’ side of this mental disorder can extend into delusional beliefs and even psychosis (where they see or hear things that aren’t there or become paranoid). 

Symptoms to look for:

  • Increased or over-spending on items they cannot afford or wouldn’t usually want.
  • Insomnia.
  • Reduced appetite.
  • Although generally happier they may be irritable.
  • Talking quickly.
  • Increased levels of creativity.

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