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Bipolar Disorder

Individuals with bipolar disorder experience significant fluctuations in their mood including manic or hypomanic episodes (‘highs’) and depressive episodes (‘lows’). The term ‘bipolar’ refers to the way that mood can change between the two extremes. Different types of bipolar disorder are diagnosed depending upon which combination of mood states are experienced. Psychological approaches have been demonstrated to complement purely medical management of bipolar disorder (lam et al, 1999; Otto et al, 2009). Read more

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23 of 23 resources

Failure To Achieve

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/failure-to-achieve

Abandonment

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/abandonment

Therapy Blueprint (Universal)

A therapy blueprint is CBT tool which summarizes the work a therapist and patient have completed together. It represents the past (the problems, what ... https://www.psychologytools.com/resource/therapy-blueprint-universal

Entitlement

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/entitlement

Activity Menu

Helping clients to choose which activities to target during behavioral activation (BA) can be accomplished in a variety of ways: activity monitoring c ... https://www.psychologytools.com/resource/activity-menu

Enmeshment

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/enmeshment

Approval-/Admiration-Seeking

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/approval-admiration-seeking

Unhelpful Thinking Styles (Archived)

NOTE: Two improved versions of this resource are available here: Cognitive Distortions – Unhelpful Thinking Styles (Common) and Cognitive Disto ... https://www.psychologytools.com/resource/unhelpful-thinking-styles-archived

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Client Workbook

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition) comes in two volumes. This page is for the Client Workbook. ... https://www.psychologytools.com/resource/unified-protocol-for-transdiagnostic-treatment-of-emotional-disorders-second-edition-client-workbook

Behavioral Experiment

Behavioral experiments are planned experiential activities to test the validity of a belief. They are one of the most powerful techniques available to ... https://www.psychologytools.com/resource/behavioral-experiment

Emotional Inhibition

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/emotional-inhibition

Behavioral Experiment (Portrait Format)

Behavioral experiments allow individuals to test the validity of their beliefs and assumptions. They are a core experiential technique for therapeutic ... https://www.psychologytools.com/resource/behavioral-experiment-portrait-format

Dependence / Incompetence

Schema therapy posits that psychological difficulties stem from early maladaptive schemas (EMS) and clients’ characteristic responses to them, refer ... https://www.psychologytools.com/resource/dependence-incompetence

Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition): Therapist Guide

The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (Second Edition) comes in two volumes. This page is for the Therapist Guide. ... https://www.psychologytools.com/resource/unified-protocol-for-transdiagnostic-treatment-of-emotional-disorders-second-edition-therapist-guide

Evaluating Unhelpful Automatic Thoughts

The Evaluating Unhelpful Automatic Thoughts guide is written for clients who struggle with negative automatic thoughts. It provides a comprehensive in ... https://www.psychologytools.com/resource/evaluating-unhelpful-automatic-thoughts

Activity Diary (Hourly Time Intervals)

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/activity-diary-hourly-time-intervals

Activity Planning

Research suggests that an activity is more likely to be completed if it is planned and scheduled in advance. The Activity Planning worksheet can be us ... https://www.psychologytools.com/resource/activity-planning

Emotional Reasoning

The Emotional Reasoning information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effec ... https://www.psychologytools.com/resource/emotional-reasoning

Activity Diary (No Time Intervals)

Activity diaries can be used for activity monitoring during an assessment phase of therapy, symptom monitoring during therapy, correlating activity wi ... https://www.psychologytools.com/resource/activity-diary-no-time-intervals

Mental Filter

The Mental Filter information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effectively ... https://www.psychologytools.com/resource/mental-filter

Arbitrary Inference

Arbitrary inference is one of the earliest and broadest cognitive disotortions described in CBT. Beck defines it as "the process of forming an interpr ... https://www.psychologytools.com/resource/arbitrary-inference

Magnification And Minimization

The Magnification And Minimization information handout forms part of the cognitive distortions series, designed to help clients and therapists to work ... https://www.psychologytools.com/resource/magnification-and-minimization

Overgeneralization

The Overgeneralization information handout forms part of the cognitive distortions series, designed to help clients and therapists to work more effect ... https://www.psychologytools.com/resource/overgeneralization

Links to external resources

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

Assessment

  • Assessment Tools For Adult Bipolar Disorder | Miller, Johnson, Eisner | 2009
  • Mood Disorder Questionnaire (MDQ) | Hirschfield, Williams, Spitzer, Calabrese, Flynn, Keck, Lewis, McElroy, Post, Rapport, Russel, Sachs, Zajecka | 2000
    • Scale
    • Reference Hirschfeld, R. M., Williams, J. B., Spitzer, R. L., Calabrese, J. R., Flynn, L., Keck Jr, P. E., … & Russell, J. M. (2000). Development and validation of a screening instrument for bipolar spectrum disorder: the Mood Disorder Questionnaire.American Journal of Psychiatry,157(11), 1873-1875.
  • Diagnosing Bipolar Disorder | Vieta | 2014
  • Bipolar Recovery Questionnaire | Jones, Mulligan, Higginson, Dunn, Morrison | 2013
    • Scale
    • Reference Jones, S., Mulligan, L. D., Higginson, S., Dunn, G., & Morrison, A. P. (2013). The bipolar recovery questionnaire: psychometric properties of a quantitative measure of recovery experiences in bipolar disorder.Journal of affective disorders,147(1-3), 34-43.

Information Handouts

Presentations

  • Cognitive behavioral therapy for bipolar disorder | Culver | 2009
  • Diagnostic challenges: bipolar disorders and other mood disorders | Wang | 2008
  • Recovery focused CBT for bipolar disorder | Steven Jones youtube
  • Cognitive behavioural treatment of bipolar disorder | Michael Otto

Self-Help Programmes

Treatment Guide

  • Understanding bipolar disorder: why some people experience extreme mood states and what can help | British Psychological Society (BPS) Division of Clinical Psychology (DCP) | 2010
  • Bipolar disorder: assessment and management: clinical guideline | National Institute for Health and Care Excellence (NICE) | 2014

Worksheets

Recommended Reading

  • Mansell, W. (2007). An integrative formulation‐based cognitive treatment of bipolar disorders: Application and illustration.Journal of clinical psychology,63(5), 447-461.
  • Juruena, M. F. P. (2012). Cognitive-behavioral therapy for the bipolar disorder patients. InStandard and Innovative Strategies in Cognitive Behavior Therapy. InTech.

What Is Bipolar Disorder?

Signs and Symptoms of Bipolar Disorder

Diagnoses of bipolar and related disorders are made based on the presence of episodes of hypomania, mania, or depression. Summary diagnostic criteria are given below.

  • To meet criteria for Bipolar I disorder an individual must have experienced at least one lifetime manic episode.
  • To meet criteria for Bipolar II disorder an individual must have experienced at least one hypomanic episode and one depressive episode; and must never have experienced a manic episode.
  • To meet criteria for cyclothymic disorder the individual must have experienced numerous sub-threshold episodes of hypomanic and depressive symptoms that do not meet full criteria for a hypomanic, manic, or depressive episode; have never met full criteria for a manic, hypomanic, or depressive episode; and experience cyclothymic periods most of the time.

A manic episode is characterized by the experience of at least four of the following symptoms for a period of at least a week, and to a degree severe enough to cause a marked impairment in the individual’s functioning:

  • a period of elevated, expansive, or irritable mood that is abnormal for the individual
  • increased goal-directed activity or energy
  • increased self-esteem or grandiosity
  • decreased need for sleep
  • increased talkativeness, or pressure to keep talking
  • flight of ideas or the subjective experience that thoughts are racing
  • difficulty concentrating or distractibility
  • excessive reckless behavior
  • increased activity or physical restlessness
  • loss of social inhibitions resulting in inappropriate behavior
  • marked sexual energy/​indiscretions

A hypomanic episode is characterized by the experience of at least five of the following symptoms for at least four consecutive days, and to a degree where there is an unequivocal change in functioning:

  • a period of elevated, expansive, or irritable mood that is abnormal for the individual
  • persistently increased activity or energy
  • increased talkativeness or pressure to keep talking
  • difficulty concentrating or distractibility
  • decreased need for sleep
  • excessive reckless behavior
  • increase in activity or psychomotor agitation
  • inflated self-esteem or grandiosity
  • flight of ideas or the subjective experience that thoughts are racing
  • increased sociability or over-familiarity
  • increased sexual energy

A depressive episode is characterized by the experience of at least five of the following symptoms for at least two weeks:

  • depressed mood most of the day, nearly every day
  • diminished interest in previously pleasurable activities
  • fatigue or loss of energy
  • sleep disturbance
  • feelings of worthlessness, self-reproach, or excessive guilt
  • diminished ability to think or concentrate
  • recurrent thoughts of death or suicide, or suicidal behavior
  • changes in appetite, with corresponding weight change
  • psychomotor agitation or retardation
  • loss of confidence and self-esteem

Evidence-Based Psychological Approaches for Working with Bipolar Disorder

Bipolar disorder is best seen as a multifaceted condition with broad biological, social, and psychological components. Medical management is crucially important, but psychological interventions can also play a helpful role: particularly in the long-term management and prevention of relapse, building resilience, and improving quality of life. A 2014 review concluded that “The evidence demonstrates that bipolar disorder-specific psychotherapies, when added to medication for the treatment of bipolar disorder, consistently show advantages over medication alone on measures of symptom burden and risk of relapse … those who receive bipolar disorder-specific psychotherapy fare better than those who do not”(Swartz & Swanson, 2014). Interventions that have been researched include:

  • psychoeducation
  • cognitive behavioral therapy for bipolar disorder
  • interpersonal and social rhythm therapy (IPSRT)
  • family-focused therapy
  • mindfulness-based interventions

Resources for Working with Bipolar Disorder

Psychology Tools resources available for working therapeutically with bipolar disorder may include:

  • psychological models of bipolar disorder
  • information handouts for bipolar disorder
  • exercises for bipolar disorder
  • CBT worksheets for bipolar disorder
  • self-help programs for bipolar disorder

References

  • Lam, D. H., Jones, S. H., Hayward, P., & Bright, J. A. (1999). Cognitive therapy for bipolar disorder: A therapist’s guide to concepts, methods, and practice. Malden, MA: Wiley.
  • Otto, M. W., Reilly-Harrington, N. A., Kogan, J. N., Henin, A., Knauz, R. O., & Sachs, G. S. (2009). Managing bipolar disorder: A cognitive-behavioral approach—therapist guide. New York: Oxford University Press.
  • Swartz, H. A., & Swanson, J. (2014). Psychotherapy for bipolar disorder in adults: A review of the evidence. Focus, 12(3), 251–266.