Introduction

Bipolar disorder affects 0.8-1.6% of the population (e.g., Kessler et al., 1994, 1997), and is equally distributed between men and women. The mean onset is in late adolescence and early adulthood, causing lasting psychosocial difficulties, partly due to the impact of the age of onset and the crucial impact on individual development (Ramana & Bebbington, 1995), but also as a result of the high likelihood of repeated episodes within a few years in 80-90% of the bipolar population (Goodwin & Jamieson, 1990). One of the tragic manifestations of the complexity and the lasting impairments often caused by the traumatic impact of early and multiple episodes is the high suicide rate in bipolar disorder; the mean rate is 15-20% (e.g., Iometsa, 1993; Simpson & Jamieson, 1999). This places the issue of suicidal risk at the centre of the therapeutic intervention.

One of the first challenges facing the CBT therapist in bipolar disorder is the strong heterogeneity of this disorder group and its various phenomenological manifestations. In comparison with other mood disorders, the emotional, cognitive, and behavioural problems associated with bipolar disorder range from long periods of depression to varying degrees of euphoria, irritability, agitation, and psychotic symptomatology. Most individuals suffering from bipolar disorder experience cyclical symptoms and multiple episodes of both depression and mania over their lifetime, causing significant disruptions in their lives as well as lasting psychological and psychosocial difficulties.

Mood Disorders: A Handbook of Science and Practice. Edited by M. Power. © 2004 John Wiley & Sons, Ltd. ISBN 0-470-84390-X.

A second challenge for the treatment of bipolar disorder is the high proportion of comorbidity. Clinically significant are the high prevalence rates of substance abuse, up to 61% (Brady & Lydiard, 1992); a large proportion of the 21% of individuals suffering from a bipolar disorder also suffer from an anxiety disorder (Himmelhoch, 1999), and 50% display difficulties associated with personality disorders (Peselow et al., 1995). These high rates of comorbidity create clinical complexity not only in the assessment of current difficulties and realistic treatment goals, but also in terms of the CBT of core symptoms and psychosocial impairments, as these difficulties are often masked by heightened depressive or manic symptoms.

CBT has been shown to be a highly effective short-term psychotherapeutic intervention for a wide range of disorder groups, especially recent developments in CBT for treatment-resistant schizophrenia and severe and enduring depressive disorder, and the increasing positive evidence base has opened the prospect of the development of psychological interventions for bipolar disorders. To date, there have been several efficacy studies and some experimental trials reporting on the effectiveness of adapted CBT in bipolar disorder (see Chapter 12). Overall, these preliminary findings are promising and support the feasibility and clinical effectiveness of CBT for individuals suffering from bipolar disorder.

The relatively late development of psychological therapies for bipolar disorder might be due to the historical predominance of a biological paradigm in this disorder group; research investigating genetic and biological factors has been dominant, and there seemed to be a common misconception that most patients with bipolar disorder make a full interepisode recovery. Secondly, earlier psychotherapeutic approaches to bipolar disorder came with the warning that patients suffering from bipolar disorder were poor candidates for psychotherapy, as they lacked sufficient introspection, showed a high degree of dependency, and formed poor therapeutic relationships.

Bipolar Disorder Uncovered

Bipolar Disorder Uncovered

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