Combining Medication Treatment and Cognitive-Behavior Therapy for Bipolar Disorder

Abstract

Bipolar disorder (BPD) is a severe, recurrent psychiatric illness characterized by a chronic course of vacillating episodes of major depression and mania that impair functioning across many psychosocial domains (DSM–IV; DSM–IV-TR). Within each type of episode, changes occur in mood, cognitive processing, and regulation of vegetative functioning. Typical mood shifts include sadness (in depression) or euphoria (in mania). Either state can produce irritability, anxiety, and anger. In addition, both the process and the content of cognitive functioning are altered. Typical changes in process include decreased speed of thought in depression and increased speed of thought in mania. Content changes include negativity in depression and in mixed states, and grandiosity or paranoia in manic states. According to the cognitive-behavioral model of BPD (Basco & Rush, 2005), these changes in mood and cognition are accompanied by behavioral changes, typically increases in activity in mania and decreases in activity in depression. These behavioral changes, in turn, generally have a negative impact on the individual’s psychosocial functioning, such as slowed work productivity, neglect of household or family responsibilities, and reduced involvement in social activities, bring negative consequences to patients as well as those in their primary support groups. In mania, risk taking, disorganized behavior, sleep loss, and reduced medication adherence quickly exacerbate symptoms, reduce quality of functioning, and create significant psychosocial problems. BPD is sensitive to stress (Goodwin & Jamison, 1990). As symptoms alter functioning, new stressors are created as a consequence. Added stress exacerbates symptoms, and functioning may decline further.

Psychosocial Interventions: Empirically-Derived Treatments for Bipolar Disorder

“…CBT includes elements in common with other psychosocial interventions such as, to increase patients' understanding of the treatment and management of bipolar disorder (i.e., identify triggers to episodes, mood monitoring), medication adherence, and lifestyle regularity [2]. PE differs from CBT in that it views bipolar disorder as *Address correspondence to this author at the Massachusetts General Hospital, Bipolar Clinic and Research Program, 50 Staniford St., Suite 580, Boston, MA 02114, USA; Tel: 617-643-4804; Fax: 617-7266768; E-mail: lsylvia2@partners.org a predominantly biological disturbance and therefore, is more heavily focused on patients' knowledge of medication compliance.…”

Getting to wellness: The potential of the athletic model of marginal gains for the treatment of bipolar disorder

“…CBT also includes elements similar to other psychosocial interventions such as increasing patients' understanding of the treatment and management of bipolar disorder (i.e. identify triggers to episodes, mood monitoring), medication adherence and lifestyle regularity (Basco et al, 2007).…”

Cognitive Behavioral Therapy in Bipolar Disorder

“…Çünkü kişinin bozukluğuna dair içgörüsü arttıkça, hipomanik/manik veya depresif belirtilerini tetikleyebilecek olaylara dair farkındalık ve başa çıkma becerisi geliştirdikçe, yinelemelerin önlenmesi-nin yanı sıra, kişinin yaşam kalitesi de artmaktadır. [66,67] BDT'nin geniş teknik çeşitliliği, bipolar bozukluğun değişken, karmaşık ve heterojen doğası için zengin alternatif müdahaleler sunma potansiyeline sahip görünmektedir. BDT'de, bir yandan hastanın ve ailesinin bu bozukluğun kronik tekrarlayıcı yapısı ve ilaç tedavisinin bu mücadeledeki önemi hakkında bilgi edinmeleri sağlanırken, öte yandan prodromal ve kalıntı belirtilerin tanınması, başa çıkma ve problem çözme stratejileri geliştirilmesi ve duygudurum takibine yönelik müdahalelerin yapılması ile klinisyen için önemli bir hareket alanı sağlamaktadır.…”