Psychotherapy for Bipolar Disorder

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For Bipolar Disorder

Hvovi BhagwagarClinical Psychologist, Manashni

World Bipolar Day, March 30th 2017

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Types of Bipolar


Psychotherapy is not the first line of treatment

Bipolar is a Bio-Chemical Condition


Pharmacotherapy

• Strongest support:• Lithium (1949)– recommended by APA Practice Guidelines• ¾ report side effects, leads to discontinuation and

hospitalization• Mood stabilizers are less effective in reducing depressive

symptoms• Psychotherapy is adjunct to pharmacotherapy• Know about medications!

http://www.dbsalliance.org/site/PageServer?pagename=about_publications_fpom


PSYCHOTHERAPY FOR BIPOLAR DISORDER

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How to select a trained mental health practitioner

• Look for the word psychologist or psycho-therapist not “counsellor”

• Request for credentials- reputed university, training in researched therapies such as CBT, REBT, EMDR

• Ask them for psycho-education about your condition (if they know less than you, please shift)

• Choose between two experienced therapists based on “good-fit”


Types of Psychotherapy

•Cognitive Behavioral Approaches (CBT/REBT)

•Brief Solution Focused Therapy

•EMDR•Family/couples therapy•Support Groups


What does Psychotherapy do?

Teaches the benefit of remaining calm or at least neutral when faced with difficult situations. If you are upset by your problems, you now have 2 problems: 1) The problem, and 2) Your upsetness.


What does a trained therapist do?

1. Assessment • Extensive history-timelines of the

episodes. • Psycho-diagnostic evaluation (to

rule out comorbidity)• Monitor psychiatric intervention• Recommend other Medical

interventions if needed

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2. Psycho-education• Explain the disorder

o BD runs in familieso “Bio-psycho-social model”o Negative triad

• Explain Brain Physiology• BP needs to be treated with both

medication and psychotherapy

• Family education/therapy



3. Treatment• Promote adherence with medication

regimens

• Regulate daily schedule

• Activity and mood analysis• Challenging Negative thinking• Reduce risk of suicide• Identify triggers that increase the risk for

relapse


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An example of psycho-education

Hvovi Bhagwagar, World Bipolar Day 2017


Situation Automatic thought(s)

Emotion Alternative response Outcome

Reprimanded by boss for not meeting targets Stress- body rigidity, more craving for coffee and non-veg food

Felt I had done much less than required My luck had come to an end. All women are bad bosses

Angry 90%

Anxiety90%

• Disqualifying the positive• Fortune teller • Mental filter• Generalising: Whats the worst? Shifting me to another job role- I can handle thatDon’t make it personal: the requirement is tough. Perspective: Client pressure is making boss agitated and critical.

Anger 30% or less Anxiety 20%

Example of a Mood Log


Day 1 Day 2 Day 3 Day 46-7 am

7-8 Morning routineA = 2, p = 0

8-9 Drive to workA = 3, p = 3

9-10 Finish documentA =5, p = 4

10-11 TherapyA =5, p = 4

11-12Noon

Sit outsideA =2, p = 4

12-1 pm LunchA = 1, p = 3

1-2 Staff meetingA =4, p = 3

Example of Activity Schedule


2-3 3-4 Write letters

A =3, p = 3

4-5 Conference callA = 3, p = 2

6-7 DinnerA = 2, p = 2

7-8 T.v.A =2, p =2

8-9 TV 9-10 TV

10-11 TV 11-12 mid Sleep

Example of Activity Schedule

Conclusions

Watching too much T.V. * No physical exercise * Much less time with friends than before * Few pleasurable activities


What can YOU do for yourself?


Self-help for depression

• Differentiate depression caused by external factors Vs bipolar downs

• Maintain a routine as much as possible• Avoid disrupting biological rhythms

(sleep, eating)• Keep thought logs and mood diaries

which identify triggers• Increase pleasurable activities• Work on negative thoughts with your

therapist


Managing Hypomanic/Manic Episodes

• Recognize warning signs-don’t be in denial• Interventions and Rules

Medical solutions first Two-person feedback rule for “great ideas” Limit cash payments• To counteract impulsivity:

Give car keys or credit cards to someone to keep Rules about staying out late or giving out phone # Avoid alcohol and substance use Minimize stimulation 48-hours before acting rule


• Identify what worsens the manic episode (certain drugs, substances like coffee or alcohol)

• Maintain structure and be disciplined• Sleep! Even if it means an extra dose of

medication• Aerobic exercise too stimulating- try

yoga• Keep thought logs and mood diaries

which identify triggers

Managing Hypomanic/Manic Symptoms


Prodrome= “running before”. The period that precedes a mood episode is known as the “prodromal phase.”

How do you detect prodromes?Know about BipolarBe a detective-analyse previous mood episodes“Check-in” with yourself daily-mood chartsIs it characteristic of you?Employ another set of eyesDon’t be paranoid, just alert and cautious

Spotting Icebergs From Miles Away: Carrie Elizabeth Lin

Prodrome detection-

Using Early Warning Signs In Bipolar Disorder Relapse Prevention


Sample Log:

1. What were the most severe symptoms or behaviors that ultimately led to the end result (e.g., suicide attempt, suicidal thoughts or feelings, psychosis, hopelessness)?

2. What was the approximate date when the episode was at its most severe? ____________

3. What symptoms or behaviors do you recall before things got to their worst, but when you were almost “past the point of no return”?

4. What are the earliest warning signs you can remember? 5. What was going on in your life that might have triggered or made you vulnerable

to the mood episode (e.g., stress at work, relationship problems, lack of social connection, financial problems, other health problems, alcohol or drug use)?

6. What was the approximate date the triggers or vulnerabilities started? ____________

Identifying Early Warning Signs From Prior Bipolar Disorder Mood Episodes


Self Help books


Mobile Apps

Thought DiaryDAYLIO


Finally I end with a quote from the guru himself….

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THANK YOU!

Hvovi Bhagwagar9821321132

[email protected]

Psychotherapy for Bipolar Disorder

Health & Medicine

Transcript of Psychotherapy for Bipolar Disorder