This in the ninth in a series of blog posts about Cognitive Behavioural Therapy for a range of issues. This blog will focus on CBT for Bipolar Disorder.
1. What is Bipolar Disorder?
Bipolar disorder is characterized by the occurrence of episodes of mania or hypo mania and episodes of depression. To meet diagnostic criteria for bipolar 1 disorder at least one manic episode must have occurred. A manic episode is defined as persistently elevated or irritable mood and persistently increased goal-directed energy for at least 1 week. This must last for most of the day and be present almost every day. During this period 3 or more of the following must be exhibited: inflated self-esteem, decreased need for sleep, pressure of speech, racing thoughts, distractibility, increased goal-directed activity, excessive involvement in risky activities.
To meet diagnostic criteria for bipolar II disorder one or both episodes of both hypomania and depression must have occurred. No manic episodes are required for a diagnosis of bipolar II disorder. Hypomania is defined as a lesser degree of mania, with a persistent mild elevation of mood.
2. Predisposing Factors
Predisposing factors may include: early exposure to stressful or traumatic events, witnessing a parent with similar difficulties, substance use or previous difficulties with anxiety or other mental health difficulties.
3. Precipitating Factors
Precipitating factors include stressful life events such as moving house, new jobs, interpersonal conflict or relationship breakdowns.
4. Perpetuating Factors
Perpetuating factors include unhelpful coping strategies such as engagement in risky behaviours, disrupted sleep patterns, isolating self from family or friends, substance use, avoiding activities such as work.
5. Protective Factors
Protective factors include: support from family and friends, regular bedtime routine and exercise regime, development of healthy coping strategies.
6. Case Example
Derek has started a new job in a new area of town he is unfamiliar with. This change in routine has led to sleepless nights. Derek has started having a drink before bed to help him to get to sleep. This has led to difficulties concentrating the next day at work. Derek worries that his difficulties concentrating will get him in trouble with his boss. Derek experiences racing thoughts that he will be fired and starts to drink more.
This can be understood within a CBT formulation as follows:
Predisposing factor: Predisposing factors are unknown.
Precipitating factor: Derek’s new job may have been a trigger for him experiencing stress and disrupting his sleep routine as a result.
Perpetuating factors: Derek’s sleep disruption is a perpetuating factors as this maintains his stress and impairs his concentration. Derek’s use of alcohol is also a perpetuating factor as this also impacts negatively on his mood and impairs his work production. Derek’s negative automatic thoughts are further perpetuating factors as these keep him up at night and make him feel stressed.
Protective factors: Derek is motivated to keep his new job and wants to do well. It sounds like Derek previously had a regular sleep routine.
7. How does CBT work for other mental health conditions?
To find out more about how Cognitive Behavioural Therapy work for other specific mental health conditions such as low mood & depression or anxiety disorders please read our series of blog posts on this topic:
- A Guide to Cognitive Behavioural Therapy
- Cognitive Behavioural Therapy for Anxiety Disorders
- Cognitive Behavioural Therapy for Depression
- Cognitive Behavioural Therapy for Health Anxiety
- Cognitive Behavioural Therapy for Social Anxiety
- Cognitive Behavioural Therapy for Panic Disorder
- Cognitive Behavioural Therapy for Obsessive Compulsive Disorder
- Cognitive Behavioural Therapy for Separation Anxiety
- Cognitive Behavioural Therapy for Specific Phobia