Managing Bipolar Disorder: Therapist Guide

The Managing Bipolar Disorder therapist guide provides step-by-step instructions and evidence-based strategies for supporting individuals experiencing bipolar disorder. A client workbook is downloadable separately.

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Chapter 1 – Introductory Information for Therapists

Chapter 2 – Overview of Treatment Structure and Strategies

Chapter 3 – Session 1: Introduction

Chapter 4 – Session 2: Mood Charting and Activity Scheduling

Chapter 5 – Session 3: Cognitive Restructuring—Part I

Chapter 6 – Session 4: Cognitive Restructuring—Part II

Chapter 7 – Session 5: Cognitive Restructuring—Part III

Chapter 8 – Session 6: Cognitive Restructuring—Part IV

Chapter 9 – Session 7: Core Beliefs

Chapter 10 – Session 8: Challenging Core Beliefs

Chapter 11 – Session 9: More Work With Core Beliefs

Chapter 12 – Session 10: Drafting a Treatment Contract

Chapter 13 – Session 11: Drafting a Treatment Contract

Chapter 14 – Session 12: Drafting a Treatment Contract

Chapter 15 – Session 13: Hypomanic Cognitive Errors

Chapter 16 – Introduction to the Problem-List Phase

Chapter 17 – Problem-Solving Module

Chapter 18 – Social Skills Training Module

Chapter 19 – Management of Comorbid Anxiety Disorders Module

Chapter 20 – Breathing and Relaxation Strategies Module

Chapter 21 – Anger Management Module

Chapter 22 – Managing Extreme Emotions Module

Chapter 23 – Well-Being Therapy and Relapse Prevention

Appendix

References

Front Matter

Overview

Bipolar disorder is a complex mental health condition affecting up to 5% of the population, characterized by recurring depressive and (hypo)manic episodes that often leave residual symptoms and impair daily functioning. Comorbid conditions such as anxiety and substance use disorders, along with elevated suicide risk, further complicate its course, making effective management essential. Managing Bipolar Disorder provides a structured yet flexible cognitive behavioral therapy (CBT) program tailored to address the unique challenges of bipolar disorder. Drawing on extensive clinical research, the program integrates psychoeducation, cognitive restructuring, behavioral activation, and relapse-prevention strategies. It promotes early detection of mood changes, lifestyle regulation, stress management, and skill-building to enhance coping and prevent relapse. This manual equips therapists with evidence-based strategies to deliver effective care, empowering patients to achieve greater stability and improved quality of life. By combining targeted interventions with ongoing medication, it offers a comprehensive approach to managing this challenging condition.

Why Use This Resource?

This program provides a step-by-step, structured approach for addressing bipolar disorder. It includes:

Detailed explanations of cognitive-behavioral principles tailored to bipolar disorder.
Evidence-based interventions for managing bipolar disorder.
Practical guidance for structuring sessions and implementing client exercises.
Strategies for overcoming common obstacles during treatment.

Key Benefits

Structured

Offers a clear, session-by-session outline for delivering effective therapy.

Educational

Helps clients understand the nature of their difficulties.

Effective

Supports therapists in implementing effective interventions for managing bipolar disorder.

Trusted

Part of the Treatments That Work™ series, developed by leading experts.

Who is this for?

Bipolar Disorder

Extreme mood swings that include episodes of emotional highs (mania or hypomania) and lows (depression).

Integrating it into your practice

Assessment

Explore how clients experience bipolar disorder.

Psychoeducation

Teach clients about bipolar disorder and what maintains it.

Skills

Implement effective cognitive-behavioral interventions to manage key symptoms.

Monitoring

Use structured worksheets to track progress and refine interventions.

Relapse Prevention

Equip clients with long-term strategies for maintaining their progress.

Theoretical Background & Therapist Guidance

Bipolar disorder is a complex and chronic mental health condition affecting 1% to 5% of the population, with an estimated 10 million individuals in the United States alone (Akiskal, 2007; Kessler et al., 1994). Typically emerging in the mid-teens, it is characterized by recurring mood episodes that include depressive and (hypo)manic phases. These episodes often leave residual symptoms and impair role functioning, even during periods of relative stability (Keck et al., 1998). Comorbid conditions, such as anxiety and substance use disorders, further complicate the course of the illness, leading to poorer outcomes, decreased treatment adherence, and higher hospitalization rates (Goldberg et al., 1999; Otto et al., 2006). Additionally, individuals with bipolar disorder face an elevated risk of suicide, with studies showing a nearly fourfold increase compared to other psychiatric populations (Brown et al., 2000).

This treatment manual, offers a structured yet flexible cognitive-behavioral approach designed to address these challenges. Drawing from clinical trials and extensive clinical experience, the program targets the core symptoms of bipolar depression while addressing factors that contribute to relapse. It builds upon established CBT strategies for unipolar depression (such as psychoeducation, cognitive restructuring, and behavioral activation) while introducing interventions tailored to the specific needs of individuals with bipolar disorder. These include training in problem-solving and interpersonal skills, strategies for stress management and lifestyle regulation, and protocols for early detection and intervention during prodromal symptoms of mood episodes (Miklowitz et al., 2007; Otto & Miklowitz, 2004).

The program promotes psychoeducation to help patients and families understand the nature of bipolar disorder, including the critical role of medication adherence, the impact of stress, and the importance of maintaining regular sleep and activity patterns. This structured approach is designed to be used alongside ongoing pharmacotherapy, which remains the cornerstone of bipolar disorder treatment. Medications such as lithium, divalproex, and lamotrigine, as well as newer atypical antipsychotics like aripiprazole and quetiapine, are integral to stabilizing mood episodes and supporting long-term management (Sachs et al., 2007).

This manual provides therapists with a detailed roadmap for delivering evidence-based care that is both effective and adaptable to individual patient needs. By combining pharmacotherapy with targeted psychosocial interventions, Managing Bipolar Disorder offers a comprehensive framework for improving outcomes and quality of life for individuals living with this challenging condition. Through its emphasis on skill acquisition, relapse prevention, and collaborative care, the program equips clinicians to address the multifaceted nature of bipolar disorder effectively.

The program includes two books:

Managing Bipolar Disorder: Therapist Guide
Managing Bipolar Disorder: Workbook

Authored by leading psychologists including David Barlow, Michelle Craske and Edna Foa, Treatments That Work™ is a series of manuals and workbooks based on the principles of cognitive behavioral therapy (CBT). Each pair of books (Therapist/Clinician Guide and Workbook) – contains step-by-step procedures for delivering evidence-based psychological interventions and will help you to provide the best possible care for your clients.

What's inside

A structured, session-by-session treatment manual.
Therapist checklists and progress monitoring tools.
Detailed guidance for implementing cognitive-behavioral interventions for bipolar disorder.
Case examples and troubleshooting tips for common challenges.

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FAQs

No, this resource is designed for therapists. Clients may benefit from the companion Client Workbook, which provides exercises for independent practice.

The full program is designed to be completed over multiple sessions, but can be tailored to individual client needs.

The guide includes structured assessments and self-monitoring tools to evaluate symptom changes over time.

Encourage gradual implementation and support clients in identifying and addressing the barriers they encounter.

How This Resource Improves Clinical Outcomes

By integrating this resource into therapy, therapists are able to:

Deliver a structured, comprehensive treatment specifically developed for bipolar disorder.
Implement effective, evidence-based interventions.
Help clients maintain long-term gains through relapse prevention strategies.
Tailor treatment to meet diverse client needs.

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References And Further Reading

Akiskal, H. S. (2007). The emergence of the bipolar spectrum: Validation along clinical-epidemiologic and familial-genetic lines. Psychopharmacology Bulletin, 40, 99–115.
Brown, G. K., Beck, A. T., Steer, R. A., & Grisham, J. R. (2000). Risk factors for suicide in psychiatric outpatients: A 20-year prospective study. Journal of Consulting and Clinical Psychology, 68, 371–377.
Cochran, S. D. (1984). Preventing medical noncompliance in the outpatient treatment of bipolar affective disorders. Journal of Consulting and Clinical Psychology, 52, 873–878.
Goldberg, J., Garno, J., Leon, A., Kocsis, J., & Portera, L. (1999). A history of substance abuse complicates remission from acute mania in bipolar disorder. Journal of Clinical Psychiatry, 60, 733–740.
Keck, P. E. Jr., McElroy, S. L., Strakowski, S. M., West, S. A., Sax, K. W., Hawkins, J. M., et al. (1998). Twelve-month outcome of patients with bipolar disorder following hospitalization for a manic or mixed episode. American Journal of Psychiatry, 155, 646–652.
Lam, D. H., Watkins, E. R., Hayward, P., Bright, J., Wright, K., Kerr, N., et al. (2003). A randomized controlled study of cognitive therapy of relapse prevention for bipolar affective disorder: Outcome of the first year. Archives of General Psychiatry, 60, 145–152.
Miklowitz, D. J., & Goldstein, M. J. (1997). Bipolar disorder: A family-focused treatment approach. New York: Guilford Press.
Miklowitz, D. J., & Otto, M. W. (2006). New psychosocial interventions for bipolar disorder: A review of the literature and introduction of the systematic treatment enhancement program. Journal of Cognitive Psychotherapy, 20, 215–230.
Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Wisniewski, S. R., Kogan, J. N., et al. (2007). Psychosocial treatments for bipolar depression: A 1-year randomized trial from the systematic treatment enhancement program. Archives of General Psychiatry, 64, 419–426.
Otto, M. W., & Miklowitz, D. J. (2004). The role and impact of psychotherapy in the management of bipolar disorder. CNS Spectrums, 9(11 Suppl 12), 27–32.
Perry, A., Tarrier, N., Morriss, R., McCarthy, E., & Limb, K. (1999). Randomised controlled trial of efficacy of teaching patients with bipolar disorder to identify early symptoms of relapse and obtain treatment. British Medical Journal, 16, 149–153.
Sachs, G. S., Nierenberg, A. A., Calabrese, J. R., Marangell, L. B., Wisniewski, S. R., Gyulai, L., et al. (2007). Effectiveness of adjunctive antidepressant treatment for bipolar depression. New England Journal of Medicine, 356, 1711–1722.
Scott, J., Garland, A., & Moorhead, S. (2001). A pilot study of cognitive therapy in bipolar disorders. Psychological Medicine, 31, 459–467.

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