Cognitive Therapy Approach for Bipolar Disorder

Even though the mood swings associated with bipolar disorder must be stabilized with medication, research shows that treatment with psychotherapy helps patients to better understand the disease, learn to recognize the often subtle signs of impending mood changes, and discover new skills to manage the behavioral and emotional components. One form of psychotherapy that has proven to be successful in the treatment of bipolar disorder is cognitive therapy, which is also called cognitive behavioral therapy.

Cognitive Behavioral Therapy

• Cognitive behavioral therapy (CBT) is based on the assumption that the changing pf thoughts has an effect on feelings and subsequently changes behavior. Several different psychological theories have influenced CBT. Pavlov's classical conditioning proved that behavioral responses can be controlled by specific events. B.F. Skinner's theory of operant conditioning showed that behavior can be influenced by the consequence---that consistent positive rewards increase the behavior while negative consequences reduce the behavior. Research from other psychologists supports the concept that changing thoughts can change behaviors, and that events throughout life (especially during childhood) can create a set of false beliefs that determine future choices. Most recently, Aaron Beck's work has synthesized these theories and defined the goals, methods and results achieved with CBT.

CBT and Bipolar Disorder

• Children who are depressed or who are faced with anxiety often misperceive events. They tend to be overly critical and blame themselves for everything (whether or not it's justified), and are extremely pessimistic. Their negative thoughts create negative expectations. They often subconsciously choose to pay attention to the negative, failing to see the positive. This creates a downward spiral---negative thoughts feeding ongoing depression---that can be stopped by CBT.

CBT Process

• CBT uses highly structured teaching and materials to help children become aware of dysfunctional thoughts, how those thoughts influence their behaviors, and to learn new ways to respond to stressful events. Therapy sessions are collaborative and based on guided self-discovery. Children are given assignments typically consisting of worksheets to be used to record events, thoughts and feelings during the event, and subsequent behaviors. Additional worksheets guide children though the process of self-awareness by recording answers to questions like "What happens when I feel anxious?" or "What are my most frequent negative thoughts?" These worksheets are then used with the therapist to help the child identify whether thoughts were rational and realistic in the context of the event, to test thoughts, and identify options for more appropriate thoughts and behaviors.

Obstacles to CBT

• The implementation of CBT with a bipolar child can be interrupted by mood swings. Depression causes an inability to concentrate, and the low energy level makes it difficult, if not impossible, for the child to talk or participate. A manic episode is marked by high energy that may prevent the child from sitting still long enough to listen, let alone pay attention and learn. Both mood episodes can make it hard for children to identify their thoughts or to assess how their thoughts impacted their behavior.

Who Can Benefit from CBT?

• Since CBT requires the ability to identify and challenge thoughts, then develop alternative ways of thinking, a level of cognitive maturity is necessary. While CBT has been successful with young children facing problems such as phobias and school refusal, studies have shown that it is most beneficial for children above the age of 9. However, the methods can be adapted for use with those of younger ages. Any child who has the ability to view events from a different perspective can benefit from CBT, gaining increased self-awareness, improving self-control and learning methods of coping with the mood swings of bipolar disorder.