It allows for reflection on possible triggers of episodes and identification of stressors and past patterns. Retrospective mood monitoring can also help identify previously unrecognised illness episodes. However, reflecting on past episodes can be distressing and anxiety-provoking. Patients need reassurance about the process and that these thoughts relate to the past and not the present. Prospective mood monitoring: This form of monitoring is typically done on a daily basis, whereby patients record mood, anxiety and sleep, along with a journal note that can be used to identify possible triggers.
The role of psychotherapy in bipolar disorder
Many mood monitors also record whether medication was taken as prescribed and phase of menstrual cycle. This detailed approach allows for the identification of triggers, and can help develop insight into the illness and aid with adherence. It also provides a vehicle to identify symptoms of illness early and monitor response to treatment, and provides information on the course of an illness episode. It serves as a collaborative tool between patient and physician and can enhance the therapeutic alliance.
Relapse and suicide prevention plans are written plans of actions that will be taken when warning signs or symptoms are developing or the patient becomes suicidal. They are written by the patient when well, and are devised to be a salient reminder of useful coping strategies. It also typically includes what the service provider will do, such as agree to see the patient urgently if certain warning signs develop.
Current evidence suggests that psychosocial interventions are valuable in the adjunctive management of bipolar disorder. They should be utilised as a routine component of management, and as early after diagnosis as feasible. Psychosocial therapies are more valuable if commenced when a patient is euthymic. Future research will refine what type of psychosocial intervention is most beneficial for particular patients at particular stages of their illness, and determine ways to address cognitive deficits and comorbid disorders. No matter how long it is since a patient has been diagnosed with bipolar disorder, do not assume that he or she has a good knowledge of the illness.
Provide written material that can be referred to later and can be passed on to family and friends. Linking with local support groups can help to reduce feelings of isolation and stigma through sharing of information and experiences. It can be useful to include family members in basic information sessions — this requires prior consultation with the individual patient. Publication of your online response is subject to the Medical Journal of Australia 's editorial discretion. You will be notified by email within five working days should your response be accepted.
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Volume Issue 4 Suppl. The role of psychotherapy in bipolar disorder.
Med J Aust ; 4 : S Topics Mental disorders. Abstract Adjunctive psychosocial interventions for bipolar disorder target many of the issues that are not addressed by medication alone, including non-adherence, efficacy—effectiveness gap and functionality. The target of psychosocial interventions Medication non-adherence Non-adherence to medication is a major cause of relapse in bipolar disorder.
Efficacy—effectiveness gap Although medications play a vital role in reducing relapse, relapse can occur even when medication adherence is optimal. Functionality Functional improvement following an illness episode takes considerably longer than symptomatic recovery. Types of adjunctive psychosocial interventions Although there are distinct theoretical approaches to the psychosocial treatment of bipolar disorder, there is a blurring of boundaries between them, with a number of shared components.
Psychoeducation The underlying principle of psychoeducation is information and education, which are typically given in a didactic manner.
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Cognitive behaviour therapy Based on the treatment of unipolar depression, CBT has been used as an adjunct to medication in bipolar disorder. Interpersonal and social rhythm therapy Based on the interpersonal psychotherapy model of depression and informed by the importance of regular social rhythms in bipolar disorder, 36 interpersonal and social rhythm therapy explores pathways to relapse, including disruptions to social and circadian patterns, non-adherence to medication, and stressful life events. Family therapy Interpersonal family stress contributes to relationship breakdown and lack of perceived social support, and high expressed emotion may contribute to relapse.
Online therapy A rapidly growing area for the management of mental illnesses is that of online therapies. Overlapping components Studies of psychosocial interventions for bipolar disorder clearly indicate they have a role in adjunctive treatment of the illness. Education and information Written materials that reinforce information are useful, and can also be passed on to friends and family.
Support and collaboration Linking patients and their carers to local support groups can help reduce feelings of stigma and isolation. Personal illness profile and mood monitoring A personal illness profile and mood monitoring can be adopted as part of the routine care of patients with bipolar disorder, and serve as a key tool in the longitudinal mapping of mood, medication changes, psychosocial stressors, and so forth.
Action plans Relapse and suicide prevention plans are written plans of actions that will be taken when warning signs or symptoms are developing or the patient becomes suicidal. Conclusions Current evidence suggests that psychosocial interventions are valuable in the adjunctive management of bipolar disorder.
Coping with Bipolar Disorder
As much as possible, relate education and information to the patient using examples. View this article on Wiley Online Library. The pharmacological treatment of bipolar disorder in primary care. Medication non-adherence in bipolar disorder: a patient-centered review of research findings. Clin Approach Bipolar Disord ; 3: Factors associated with treatment nonadherence among US bipolar disorder patients. Hum Psychopharmacol ; Bipolar Disord ; 9: Scott J, Pope M. Nonadherence with mood stabilizers: prevalence and predictors. We also have web based studies exploring the benefits of psychoeducation and relapse prevention and a study of providing web based parenting support for bipolar parents.
In addition to intervention studies we have also conducted work on the psychological processes associated with bipolar disorder including try understand more about both the positive and negative experiences that people living with bipolar disorder report.
Recent work has highlighted the importance of how people explain their experiences to themselves in influencing the extent to which life events lead to mood episodes. I continue to have strong links with the NHS at national and local level including co-leading the only demonstration site for bipolar disorder treatment selected by the Improving Access to Psychological Therapies programme. I have active research collaborations with the University and with national and international colleagues mainly US and Canada. Talking about personal recovery in bipolar disorder Oral presentation. Institute of Psychiatry Visiting an external academic institution.
New developments in the psychological treatment of bipolar disorder Invited talk. Ideas Festival Participation in conference. Theory and management of anxiety and substance use in bipolar disorder Invited talk. Developing effective psychological interventions for bipolar disorder Invited talk. Understanding Bipolar Disorder: Why some people experience extreme mood states and what can help Invited talk.
Understanding recovery in bipolar disorder: Moving beyond relapse prevention to service user informed treatment targets. Invited talk. Psychological therapy for bipolar disorder Invited talk. It is characterised by periods of elevated mood mania and low mood depression.
Related Coping with Bipolar Disorder: A CBT-Informed Guide to Living with Manic Depression
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