What Keeps Bipolar Disorder Going?

The What Keeps Bipolar Disorder Going? handout presents key factors that maintain bipolar disorder.

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Professional version

Offers theory, guidance, and prompts for mental health professionals. Downloads are in Fillable PDF format where appropriate.

Client version

Includes client-friendly guidance. Downloads are in Fillable PDF format where appropriate.

Overview

The What Keeps It Going? series is a set of one-page diagrams explaining how common mental health conditions are maintained. Friendly and concise, they provide an easy way for clients to understand at a glance why their disorders persist, and how they might be interrupted.

What Keeps Bipolar Disorder Going? is designed to help clients experiencing bipolar disorder understand more about their condition.

Why use this resource?

Understanding what keeps bipolar disorder going is crucial for effective intervention. By identifying these factors, therapists can develop idiosyncratic models of clients' experiences and focus their interventions.

Highlights and explains key factors that maintain bipolar disorder.
Provides a visual model that to facilitate discussion and inform case conceptualization.
Helps clients better understand the difficulties they are experiencing.

Key benefits

Insightful

Provides insights into what perpetuates bipolar disorder.

Informative

Serves as a roadmap for therapeutic discussions and formulations.

Educational

Helps clients comprehend their difficulties and the ways to address them.

Engaging

Simplifies complex ideas and explanations, enhancing understanding and communication.

Who is this for?

Bipolar Type I

In bipolar I, people have manic episodes and can be very unwell. Those with bipolar type I usually – but not always – experience episodes of depression as well.

Bipolar Type II

In bipolar II, people have hypomanic episodes which can be like full mania but do not go on for as long. Those with bipolar type II tend to have more severe and longer episodes of depression than those with bipolar disorder type I.

Integrating it into your practice

Introduce

Explain to the client that many mental health difficulties persist due to cycles that maintain them.

Discuss

Use the handout to discuss what might be keeping clients' difficulties going.

Identify

Pinpoint and personalize maintaining factors that are relevant to the client.

Strategize

Explore how these maintaining cycles can be interrupted.

Theoretical background and therapist guidance

Bipolar disorder is a mental health condition where an individual experiences ‘lows’ (episodes of depression) and ‘highs’ (episodes of hypomania or mania). These are episodes that are different from the daily emotional ups and downs that most people experience. For people with untreated bipolar, these episodes can last for weeks and cause problems with their work, relationships, and daily functioning.

Symptoms of bipolar disorder include:

Episodes of depression (tiredness, self-criticism, hopelessness, less enjoyment, and loss of interest in activities).
Episodes of hypomania or mania (e.g., increased energy or activity, reduced sleep, impulsivity, and big ideas).
Mood episodes that go on for several days or weeks at a time.
Mood changes that have a negative impact (e.g., difficulties working or studying).
Long periods of time (months or even years) without a major mood episode.

The What Keeps Bipolar Disorder Going? information handout describes some of the key factors which are believed to act to maintain bipolar disorder. It illustrates the maintaining factors in a vicious flower format, in which each ‘petal’ represents a separate maintenance cycle. These factors include positive bias (Schönfelder et al. 2017), sleep disruption (Steinan et al. 2016), unhelpful beliefs (Woods et al. 2023), and behaviors which rebound (De Prisco et al. 2022). Helping clients to formulate a model of their experiences is an essential part of CBT for bipolar disorder. Therapists can use this handout as a focus for discussion, or as a template from which to formulate an idiosyncratic model of a client’s experiences.

What's inside

Introduction and overview of bipolar disorder.
Guidance for introducing the resource to clients.
Template for developing personalized maintenance cycles.
Key references for learning more about bipolar disorder.

Get access to this resource

FAQs

It helps clients and therapists understand why bipolar symptoms persist and offers a framework for collaborative formulation and intervention.

Introduce it as a framework for gaining a deeper understanding of their difficulties and the reasons why they persist.

Use it as a starting point to explore unique factors that are specific to the client's experience, and tailor the diagram accordingly.

How this resource improves clinical outcomes

This resource enhances treatment by:

Giving clients insight into the processes maintaining their difficulties.
Support collaborative formulation and treatment planning.
Present key information in a structured, understandable format.

Therapists benefit from:

A clear framework that helps explain why problems persist.
A visual tool to enhance communication and understanding.
An adaptable resource that can be tailored to clients' unique experiences.

References and further reading