Using CBT with Bipolar Disorder

Cognitive Behavioral therapy is an evidence based practice for bipolar disorder as well as for unipolar depression. One way to access the skills of CBT is to go to therapy with a CBT practitioner. It is my belief, however, that the goal of a CBT therapist is to help one's clients understand and use CBT skills on their own. Those of us experiencing episodes of depression, whether mild or severe may benefit from the same kind of cognitive restructuring that folks with unipolar depression find helpful. In low moods we need to recognize pessimistic thinking and exaggerated self-criticism.

Clients with higher levels of mania are often helped to adjust their thinking to accept the need for medications and professional help. I am thinking that a more challenging area is for those of us experiencing milder mania. Hypomania can be very seductive, because it feels so damn good. The addictive voice of hypomania tells us to disregard feedback and criticism from others. Consequences of mild mania are less severe for the short term, but have the potential to affect our careers, our relationships with partners, parents, children and friends.

In my early recovery I was fortunate to get a strong dose of challenges to my "normal" way of thinking. When one is put in a position of getting a great deal of feedback from others, including peers and counselors, one may learn to consider alternative avenues of thought seriously. Also, treatment can provide the opportunity to identify priorities in life, such as a career, a committed relationship, parenting children and positive connections with family and friends. Mania, whether mild or severe tends to be self-focused, hedonistic and isolative, interfering with many of these priority values.

With mild mania, change may require time projection. It may be easier for those of us who have already experienced destructive consequences in our lives. For example, I can ask myself if I really want to lose ANOTHER job or relationship or if I like drifting from friendship to friendship without any permanence? I can notice old patterns of thinking and behavior that have cause me problems in the past. When others challenge me, I can listen and consider options and experiment with small changes that can lead to more and more significant changes.

Some examples. Racing thoughts have had a history of interfering with sleep. I have learned that progressive muscle relaxation and imagery can help me disperse these thoughts and relax my body to promote sleep. I have also learned to change what i am doing about every 30 minutes to try different approaches to the problem. Right now, I am writing this to divert the excess mental energy into a positive form. In a minute I will try lying in bed for a while. more examples will be coming.

Remember, You CAN change the way you think and feel!