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  • Jeannie Herman, LPC, NCC

Treatments for Bipolar Disorder

Updated: Jul 8, 2023

There are several challenges involved with the treatment of Bipolar Disorder (BD) (Steinkuller & Rheineck, 2009). BD is typically treated with prescription medications to balance the effects of the depressive and manic episodes which are characteristic of BD; however, the outcomes are often unsatisfactory in maintaining clients’ physical health and providing an adequate quality of life. Many clients who take medication continue to be affected by manic or depressive symptoms even after taking their prescriptions regularly for a year or more (Culver et al., 2007; Leahy, 2007; Miklowitz & Otto, 2006; Rizvi & Zaretsky, 2007). This inefficacy and the sometimes unpleasant side effects can cause clients to quit taking their medications. It is quite common for BD clients to discontinue there use of medications especially when there are experiencing a manic episode. Research has shown that approximately 60% of bipolar clients actually take less than 30% of the medications that were prescribed to them (Culver et al., 2007; Rizvi & Zaretsky, 2007).

Studies are showing that the optimal treatment for clients who suffer from BD involve a combination of both medication and psychotherapy; the two together have shown significant results for the long-term outcomes in clients’ lives (Culver et al., 2007; Leahy, 2007; Miklowitz & Otto, 2006; Rizvi & Zaretsky, 2007). The prime therapeutic goals when working with a client who has BD is treatment of acute manic and depressive episodes, decreasing the risk of suicide, preventing relapse, and development of skills that help the client achieve awareness and control over symptoms (Culver et al., 2007).

Psychoeducation (PE) has been shown to be a useful psychosocial intervention because it trains clients to recognize the early symptoms of mania which can prompt them to acquire immediate assistance in treating episodes, often with mood stabilizing medications such as lithium and anticonvulsants (Hollon & Ponniah, 2010). Clients most often receive PE in the context of a group and sometimes include the families of the clients (Rizvi & Zaretsky, 2007). Participants learn to use self-management tools which include self-care workbooks, they watch videos which educate them on the diagnosis, course, treatment, and management of BD, and they create prevention plans for possible relapses (Miklowitz et al., 2007).

Family-focused therapy involves the family further and has been shown to be effective in increasing the families ability to create structure, assist the client with adhering to the treatment, and in delaying or reducing instances of relapse (Morris et al., 2007). There are six main aspects of family-focused therapy which are (1) to help clients and their families understand bipolar disorder; (2) to accept that episodes are likely to occur again; (3) to accept the need for medication; (4) to bring understanding that the client is not the disorder; (5) to distinguish events that trigger episodes and to build coping skills for these triggers; and (6) to recreate healthy relationships within the family following an acute episode. Family-focused therapy also helps clients and their families process emotional reactions to BD and assist them in developing coping strategies that decrease “high-expressed-emotion attitudes” that have been correlated with an increased risk of relapse in the client (Miklowitz et al., 2007).

Cognitive-behavioral therapy (CBT) has been shown to be effective in the treatment of BD (Steinkuller & Rheineck, 2009). CBT therapists assist the client in altering thoughts, behaviors, and emotions that present themselves in association with manic and depressive episodes which helps the client manage their symptoms and halt the progression of episodes. The therapist challenges negative thoughts that clients have about themselves, establish healthy interpretations of situations and experiences, and deconstruct belief systems that are dysfunctional (Miklowitz et al., 2007). Research has shown that there may be additional benefits for client with BD when CBT is offered very early on in the illness (Jones & Burrel-Hodgson, 2008).

Though little, if any, research has been done on the efficacy of Gestalt therapy in the treatment of BD, Daan Van Baalen , M.D. (2010) presents an intriguing case study on the subject. His client, who had been diagnosed with bipolar I disorder with a psychotic episode, achieved profound results in managing her manic and depressive episodes by learning to control her “ups” and “downs”. Van Baalen and his client experimented with different methods that could alter her energy and mood such as posture changes, movements, altering breath rhythm and depth, and wearing different colors. The client found that she had some control over her moods and energy levels and this lessened her anxiety about the potential of having future episodes. The therapist also worked with the client in bringing more awareness to the triggers of episodes and also in being able to identify initial symptoms of an episode. Using these skills, the client was able notice when she was moving into mania or depression and take steps to terminate their progression.

Culver, J. L., Arnow, B. A., & Ketter, T. A. (2007). Bipolar disorder: Improving diagnosis and optimizing integrated care. Journal Of Clinical Psychology, 63(1), 73-92. doi:10.1002/jclp.20333

Hollon, S. D., & Ponniah, K. (2010). A review of empirically supported psychological therapies for mood disorders in adults. Depression And Anxiety, 27(10), 891-932. doi:10.1002/da.20741

Jones, S. H., & Burrell-Hodgson, G. (2008). Cognitive-behavioral treatment of first diagnosis bipolar disorder. Clinical Psychology & Psychotherapy, 15(6), 367-377. doi:10.1002/cpp.584

Leahy, R. L. (2007). Bipolar disorder: Causes, contexts, and treatments. Journal Of Clinical Psychology, 63(5), 417-424. doi:10.1002/jclp.20360

Miklowitz, D. J. (2007). The role of the family in the course and treatment of bipolar disorder.Current Directions In Psychological Science, 16(4), 192-196. doi:10.1111/j.1467-8721.2007.00502.x

Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Kogan, J. N., Sachs, G. S., & ... Wisniewski, S. R. (2007). Intensive psychosocial intervention enhances functioning in patients with bipolar depression: Results from a 9-month randomized controlled trial. The American Journal Of Psychiatry,164(9), 1340-1347. doi:10.1176/appi.ajp.2007.07020311

Morris, C. D., Miklowitz, D. J., & Waxmonsky, J. A. (2007). Family-focused treatment for bipolar disorder in adults and youth. Journal Of Clinical Psychology, 63(5), 433-445. doi:10.1002/jclp.20359

Rizvi, S., & Zaretsky, A. E. (2007). Psychotherapy through the phases of bipolar disorder: Evidence for general efficacy and differential effects. Journal Of Clinical Psychology, 63(5), 491-506. doi:10.1002/jclp.20370

Steinkuller, A., & Rheineck, J. E. (2009). A review of evidence-based therapeutic interventions for bipolar disorder. Journal Of Mental Health Counseling,31(4), 338-350.

Van Baalen, D. (2010). Gestalt therapy and bipolar disorder. Gestalt Review, 14(1), 71-88.

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