Talk therapy is often recommended for patients with mental illness in addition to medication. There are several different kinds of therapy used in bipolar disorder including cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), interpersonal psychosocial rhythm therapy (IPRT) and family focused therapy (FFT). Cognitive behavioral therapy is the most common. Therapists and patients work together to create personalized treatment plans and to recognize oncoming mood shifts. A new analysis shows the successes and limitations of the effectiveness of CBT on bipolar disorder.
In the article appearing in the journal Psychiatry and Clinical Neurosciences, the authors analyzed combined data from nine previous studies involving a total of more than 500 patients for a meta-analysis. This provides a larger picture of exactly how beneficial cognitive behavioral therapy is in regards to different aspects of bipolar disorder. Some of their findings contradicted earlier meta-analyses, possibly due to different types of statistical analysis and the inclusion of more recent studies.
There are several goals in CBT to treat bipolar disorder. They include helping patients accept their diagnosis, encouraging patients to take medication as prescribed, providing aids to help patients track their moods, developing new thought patterns, identifying and solving specific problems, enhancing social skills and providing assistance in stabilizing patients’ daily routines.
All of these aspects together are utilized in order to reduce symptom severity and decrease the frequency of both manic and depressive episodes. The authors of the new publication set out to find how effective CBT is for each of these categories. Here is what they found:
CBT is not consistently effective during acute bipolar depressive episodes.
Cognitive behavioral therapy is recognized for being very effective in mild to moderate cases of depression, but depression in bipolar disorder is often severe. It also has different characteristics than major depressive disorder, which is more common.
Bipolar disorder patients have abrupt-onset depressive episodes that are more frequent and last longer than in unipolar depression. They also tend to have consistent repetitive negative thinking, which can decrease the effectiveness of therapy.
CBT is consistently effective in treating mania.
The authors of the meta-analysis did find significant decreases in manic symptoms with CBT treatment. One hypothesis for this is that the rumination that occurs with depression or mixed states isn’t present in mania. So, that obstacle is avoided.
CBT is more effective when a patient is in a period of recovery. It may be intuitive to start therapy during an episode, but it appears to be less effective. When patients are manic and have a sense of grandiosity, a “can-do” attitude may make a difference in how they respond to the challenges previously extended by their therapists.
CBT can delay episode relapse, but only to a certain extent.
Consistent engagement in cognitive behavioral therapy along with medication appears to improve symptoms and quality of life over time. The tools provided to patients that help them follow the course of their illness and provide problem-solving skills can actually help prevent or delay future episodes.
However, this effect does not continue for long after patients discontinue CBT. The benefits can last as long as six months without seeing a therapist, but after one year without therapy, retaining the benefits of previous CBT is rare. Sticking with it will likely produce a better outcome for patients, even though it gets frustrating for them if they feel like no progress is being made.
Cognitive behavioral therapy definitely has benefits, though some people will respond better than others. Bipolar disorder is individualized, so it’s important each patient talk to their own doctor about what type of treatment might be most effective. This goes not only for medications, but for adding therapy, whether CBT or another type.
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