For Healthcare Providers

Quality of life improvement in people with bipolar disorder is a critical target for clinical attention1, 2,3. In particular, a second edition of the evidence-informed manual for Cognitive- Behavioural Therapy (CBT) for BD was published in 20105 CBT for BD draws eclectically from other evidence-based therapies for BD, and rests on therapeutic knowledge and skills familiar to many healthcare providers.

As a background to this reading, we note that an integrative approach has been recommended7

  • Improve ability to recognise changes in mood, signs of prodromal periods and to respond quickly and effectively (via pre-planning) to these prodromal symptoms
  • Increase knowledge about and acceptance of BD, including acceptance of and adherence to medication regimens
  • Encourage daily monitoring of mood and sleep
  • Improve interpersonal communication, particularly in the family
  • Improve significant others’ understanding of BD, including ability to identify and productively respond to prodromal symptoms
  • Re-engage with social, familial and occupational roles
  • Improve stress response and emotion regulation skills, especially around goals and reward activation
  • Proactively stabilise sleep/wake and other social rhythms
  • Identify and critique maladaptive thoughts and beliefs, particularly in relation to the self and the disorder
  • Reducing drug or alcohol misuse

Efficacy of psychosocial treatments for BD is improved with early identification of episodes, understanding of the triggers for mood change and key predictors of these changes, such as changes in sleep and activity.  This knowledge requires the person with BD to be mindful of changes in mood, and as such daily mood monitoring is a central element of treatment.

Motivational interviewing has proven effective in engaging this client group in discussion about the reasons why they are using substances, in considering the pros and cons of this behaviour and dealing with factors underlying ambivalence to change4,8.

Finally, a strongly collaborative working relationship, and a therapeutic approach emphasising skill-development and empowerment is recommended.

An older black woman is talking to her pharmacist about her medication.