Overall, the cognitive behavioural approach to the treatment of bipolar disorder aims to enhance non-pharmacological coping skills, to enhance elements of self-efficacy and responsibility in the treatment of the condition, to support individuals in recognising and managing psychosocial stressors and the impact of past episodes, to introduce specific strategies to deal with cognitive and behavioural difficulties, and to modify underlying schemata and core assumptions.
CBT for bipolar disorder relies on the basic characteristics of a CBT model. In that the cognitive behavioural model is most effective when the individuals are full collaborative partners in the treatment process. The therapist educates individuals about the diathesis-stress model of bipolar disorder, socialises them into the cognitive model of mood changes, and appraises them of the rationale for particular interventions. An assessment of the individual's core beliefs and underlying schemata is essential in the case formulation of individual vulnerabilities that form an integral part of the treatment plan.
CBT for bipolar disorder is naturally phase specific. The specific focus of the intervention varies depending on the individual formulation of treatment goals and the phase of the disorder in which the patient presents. For example, if a patient presents in an acute phase of a bipolar episode, the cognitive behavioural strategies will be aimed at crisis intervention, the treatment of acute symptoms, an assessment of risk and the factors that are maintaining the episode, and the establishment of a good therapeutic alliance. If a patient presents in the recovery phase following a recent episode or in a phase of stabilisation between episodes, CBT would aim to be insight oriented; to explore the meaning and context of symptoms, interpersonal functioning, preventative cognitive strategies, and self-management skills; to reduce the psychosocial impact of the disorder; and to build resilience regarding ongoing stressors.
The following section will outline the four main components of cognitive behavioural psychotherapy for bipolar disorder: psychoeducation; early warning signs and coping with prodromal symptoms; cognitive behavioural strategies for dealing with manic, hypomanic, or depressive symptoms; and finally the targeting of associated difficulties in psychosocial functioning, especially interpersonal difficulties.
Crucial for the adaptation of a cognitive behavioural intervention to any psychiatric disorder is the individual case formulation. This should be developed in collaboration with the patient, and it should be based on a developmental and cognitive model of the specific phenomenology of the bipolar disorder. The cognitive formulation is the starting point for the therapeutic intervention; it can be used as an alternative explanation of the patient's difficulties and will help to engage the patient into a cognitive way of understanding and working with the presenting problems.
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