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Behavioral Therapies & Juvenile Bipolar Disorder

Juvenile bipolar disorder, also called early-onset bipolar disorder, needs long-term treatment to control the symptoms. According to the National Institute of Mental Health, "An effective maintenance treatment plan includes medication and psychotherapy for preventing relapse and reducing symptom severity." Behavioral therapy is one type of psychotherapy used to help people with bipolar disorder.

  1. Definition

    • Early-onset bipolar disorder is defined by mood swings between mania and depression. Depression is marked by low energy, sadness, slow movement, tiredness, isolation, poor concentration, feeling worthless, and sometimes thoughts of suicide. Mania is the other extreme, with nonstop talkativeness, impulsivity, inflated self-esteem, increased activity, so much energy they need little sleep, and risk-taking behavior. The moods may swing so rapidly and frequently that episodes become mixed together. The result can be a constant state of irritation. The key factor is that the symptoms interfere with the child's ability to perform daily activities at home and at school.

    Cognitive Behavioral Therapy

    • Cognitive behavioral therapy is a structured method designed to help children with bipolar disorder learn to recognize negative thoughts and inaccurate perceptions along with the resulting patterns of behavior. CBT teaches how to recognize what might trigger episodes of mania so that children can learn what steps to take to avoid a full-blown episode. It also improves coping skills for managing depression. Parents need to be involved and supportive of their child.

    Structure of Cognitive Behavioral Therapy

    • CBT uses worksheets to help the child identify a specific event and note what she was thinking at the time, how she interpreted the event and her behavior. In this manner, the child can begin to see the connection between how his thoughts influence what he does and how he feels. Once this connection is understood, the worksheets prompt children to consider whether reality supports their thoughts and percpetions. The goal is to teach how to evaluate feelings and reactions, and to identify choices. Children are given CBT homework and often are encouraged to keep a diary. Over time and with practice, they learn to identify the components of emotions and thoughts that play a complex role in bipolar disorder.

    Behavioral Modification

    • Behavior modification uses a system of rewards to encourage a desired behavior that replaces an undesirable behavior. If necessary, punishment of the behavior to be extinguished can be implemented, but, especially with younger children, focusing on the positive has better success. Behavior modification can be used to control the argumentative, oppositional and aggressive behaviors that accompany early-onset bipolar disorder. This method typically uses a chart or calendar that can be marked every time a behavior or task is accomplished. Once a certain number has been achieved, a reward is given.

    Dialectical Behavior Therapy

    • Dialectical behavior therapy combines CBT with practices drawn from Buddhist and Zen philosophies such as meditation, mindful awareness and acceptance. Using the two approaches allows DBT to teach the important lessons learned through CBT while using other techniques to encourage children to stop and think before reacting. This gives children and teens with bipolar disorder another tool for managing impulse control.

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