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Cognitive Behavioral Therapy for Bipolar Disorder: Adherence & Symptom Management

Learn about the importance of therapy for bipolar disorder, addressing adherence issues and managing symptoms through cognitive-behavioral techniques to prevent relapse and improve overall functioning. Find insights, strategies, and practical tips from clinical psychologist Monica Basco, Ph.D.

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Cognitive Behavioral Therapy for Bipolar Disorder: Adherence & Symptom Management

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  1. Cognitive-Behavior Therapy for Bipolar Disorder Monica Basco, Ph.D. Clinical Psychologist University of Texas at Arlington Department of Psychology

  2. Why Therapy for Bipolar Disorder? • Patients do not understand their illness • Adherence is poor • Breakthroughs are common • Psychosocial sequelae • Stress

  3. Depression& Mania Changes in Cognition & Emotion Insomnia, stress, & other symptoms Targets for Therapy Changes in Behavior Psychosocial Problems Decreased Psychosocial Functioning

  4. Primary Goal of CBT is Relapse Prevention

  5. Methods for Preventing Relapse • Educate patients and family members • Develop an early warning system • Improve adherence • Control subsyndromal symptoms • Reduce stress, solve problems

  6. What about denial?

  7. Facilitating Adjustment • Help patient explore alternative explanations for symptoms • Challenge negative automatic thoughts • Examine advantages and disadvantages of each action • Explore the meaning of having Bipolar Disorder • Use the Cognitive Triad

  8. Develop an Early Warning System

  9. Symptom Summary Worksheet

  10. Symptoms of Depression

  11. Symptoms of Mania

  12. Lifestyle Management • Importance of consistency with medication • Good sleep hygiene • Avoidance of alcohol and drugs of abuse • Consistent daily schedule or routine

  13. Sleep Enhancement • Reduce stimulation early in the evening • Reduce caffeine intake • Deal with worries before bedtime • Make an action plan for tomorrow • Relaxation exercises

  14. Symptom Management

  15. THINGS TO AVOID Overstimulation Arguments Confrontations with others Sleep loss Overextending oneself Taking Chances

  16. Address Cognitive Distortions • Catch it! – Identify common thinking errors • Control it! – Keep it from affecting actions • Correct it! – Use logical analysis methods

  17. Improve Cognitive Processing • Slow it! - Reduce stimulation, relax • Focus it! - One thing at a time • Structure it! - Use formal problem solving, examine choices

  18. CBT for Improving Treatment Adherence

  19. CBT Model of Adherence Everyone is capable of adherence if the treatment is: • Acceptable • Understandable • Manageable

  20. Many things can interfere with adherence.

  21. If the obstacles to adherence can be identified, they can be removed with CBT methods.

  22. STEP 1: Conditions for Adherence • Does the patient agree that he or she has bipolar disorder? • Is the idea of medication treatment acceptable? Any hesitations? • Does the patient understand that treatment is continuous? • Is the patient organized enough to take medications regularly? Can anyone help?

  23. Step 2: Identify Obstacles • What could keep you from taking your medication everyday? • What kinds of things in the past might have kept you from taking medication regularly? • Everyone has trouble sticking with treatment. Has it ever been a problem for you?

  24. Common Obstacles • Medication – Side effects, dosing schedules in conflict with patient’s lifestyle • Competing advice – from family, friends, PDR, internet, other MDs • Poor therapeutic alliance - trust • Practical issues – forgetfulness, money • Personal adjustment – denial, negative attitudes about medication, anger

  25. Step 3: Troubleshooting • Can the regimen be adjusted to address potential obstacles? • What can be done to avoid the most common obstacles? • Is a reminder system needed? • Do negative cognitions need to be addressed? • If the patient runs into problems, what should he or she do? • How can you help?

  26. References • Basco, M.R. & Rush, A.J. (2005). Cognitive-Behavioral Therapy for Bipolar Disorder. 2nd Edition. New York: Guilford Press. • Basco, M.R. (2006). The Bipolar Workbook: Tools for Controlling your Mood Swings. New York: Guilford Publications

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