You can learn to manage your symptoms by looking after yourself. Self-care is how you take care of your diet, sleep, exercise, daily routine, relationships and how you are feeling. You are best positioned to recognise areas of your life that needs change.
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What lifestyle changes can I make?
Making small lifestyle changes can improve your wellbeing and can help your recovery.
Routine helps many people with their mental wellbeing. It will help to give a structure to your day and may give you a sense of purpose.
This could be a simple routine such as eating at the same time each day, going to bed at the same time each day and buying food once per week. Just building habits and creating a plan can make a world of difference.
Your healthcare professionals should offer you a combined healthy eating, exercise and sleep programme.
What are support groups?
You could join a support group. A support group is where people come together to share information, experiences and give each other support. Just as the SharingBipolar Community is an online support group helping people across the world, a local support group will help you focus in the area where you live.
You might be able to find a local group by searching online. Currently the charity ‘Bipolar UK’ offers face to face support groups in some areas of the country.
What are recovery colleges?
Recovery colleges are run by healthcare providers. They offer free courses about mental health to help you manage your symptoms. They can help you to take control of your life and become an expert in your own wellbeing and recovery. You can usually self-refer to a recovery college. In the UK the NHS runs recovery colleges.
Unfortunately, they aren’t available in all areas. To see if there is a recovery college in your area; use a search engine like Google.
Wellness Recovery Action Plan (WRAP)?
The Wellness Recovery Action Plan or WRAP for short, is a self-designed wellness process. Use a WRAP to get well, stay well, achieve your goals and make your life your own.
It was developed in 1997 by a group of people who were searching for ways to overcome their own mental health issues and move on to fulfilling their life dreams and goals. Since then it has become a tried and tested method leading to a better life for many sufferers worldwide.
Learning to spot early signs of mania or depression is important in self management. The WRAP looks at areas like how you are affected by your illness and what you could do to manage them.
There are guides that can help with this. You can ask your healthcare professional to make one with you or ask them for a template of one.
Only I know aspects of my life that need improving, it's time to make changes!
learn: self help
Set Goals, Celebrate Wins!
No-one likes to feel that they have failed at something. Especially when you have no control over the obstacle you are attempting to overcome. Understand your limitations and set boundaries, if you can’t manage to do something alone, ask for help.
Ensure your progress is bitesize and achievable. Create an action plan with steps to manage your condition. If you need to, you can do extra each day but celebrate the small wins; with every success you are closer to climbing a mountain!
A win could simply be getting up in the morning, or speaking on the telephone. Making a meal or doing your weekly shopping are challenges you should be proud of.
learn: coping mechanisms
Mental Training
Cognitive Behavioural Therapy (CBT)
CBT as a coping mechanism for the symptoms of Bipolar Disorder involves education about the condition, the rationale for treatment, and the factors that influence it. It can help change someone’s thoughts and actions.
According to a 2021 review, CBT can help with all types of bipolar except acute mania, a type of sudden and severe mania. CBT may also treat co-occurring conditions, such as anxiety.
The average CBT duration is 20 sessions. A doctor may recommend it in addition to medication and other therapy or treatments.
CBT can help manage Bipolar Disorder.
Research notes that because medication treatment alone is not effective, the need for psychosocial interventions is undeniable. Experts recommend CBT as the second-line treatment behind medication for all types of bipolar except acute mania. CBT has different parts, but the most valuable for this condition is the education component.
Evidence indicates that CBT as an add-on treatment may help with:
- noncompliance with medication,
- the loss of function, whether socially, occupationally, or cognitively, and
- partial responses to treatment.
Additionally, recent research suggests that cognitive behavioural therapy is effective in prolonging remissions and preventing recurring episodes.
CBT also treats simultaneous conditions that can exacerbate symptoms, such as:
- anxiety,
- autism,
- post traumatic stress,
- avoidant personality issues,
- obsessive compulsive disorder,
- substance use disorders, or
- sleep disturbances.
Education and Awareness
The treatment starts with teaching a person about bipolar, which healthcare professionals call psychoeducation. This includes:
- common patterns in bipolar,
- the rationale for treatment and the importance of adherence, or
- common social, biological, and psychological factors influencing it.
Interventions to change thoughts and behaviours
These typically follow education and include:
- recognising and replacing negative thoughts that are present in depression,
- teaching stress and sleep management skills,
- promoting problem-solving and conflict resolution, and
- treating cooccurring psychological conditions.
Interventions to prevent or reduce severity of episodes
This entails training in how to identify future episodes early or engage in quick interventions once they occur. Strategies may include family meetings with or without close friends.
There’s no hard or fast rule…
The time necessary to produce results varies. However, research states that the average CBT treatment regimen consists of 20 sessions.
There is no standard length of CBT because it depends on the severity and subtype of bipolar, along with other factors. Some people see an improvement following a few sessions, but others frequently need several months of treatment.
Sessions typically last about an hour and occur once weekly, meetings can be conducted online however; there is normally ‘homework’ for the sufferer to undertake. The benefits of CBT are directly related to the amount of work put in to the process.
I wish there was a quick fix, I guess I'll just have to put the effort in!
Interpersonal and social rhythm therapy
An older review from 2007 explains that interpersonal and social rhythm therapy (IPSRT) seeks to reduce the erratic nature of someone’s daily routines, involving:
- meals,
- sleep-wake cycles, and
- times of rest versus activities.
Simultaneously, IPSRT aims to enhance the performance of primary social roles and foster an improved quality of interpersonal relationships. A 2020 clinical trial with 44 participants who had bipolar disorder suggests that it may improve symptoms. However, more research is necessary to confirm the results.
Family-focused therapy
Family-focused therapy (FFT) is an intervention for adults and children with bipolar and their supporters. It involves education about the condition and training in problem-solving and communication skills.
A review from 2016 examined research on the value of FFT for bipolar. The authors found that in eight clinical trials, the combination of FFT with mood stabiliser medications may offer benefits over shorter programs of psychoeducation and medication. Benefits included quicker recovery and decreased symptom severity, frequency of mood episodes, and recurrences.
So… What now?
Cognitive behavioural therapy (CBT) for bipolar disorder starts with education about the condition and follows with interventions to change thoughts and behaviors.
CBT is the second-line treatment behind medication to treat bipolar. It may help with various aspects, such as noncompliance with medication and a loss of function in someone’s occupation or social capabilities.
The average number of CBT sessions is 20.
Alternative psychotherapies to CBT include interpersonal and social rhythm therapy and family-focused therapy. Limited research suggests that both may offer benefits.
Questions to ask
The following are questions a person may wish to ask a doctor or healthcare practitioner:
- How many CBT sessions may be necessary?
- What are the expected results?
- If CBT is not effective, are there alternative therapies?
- What is the cost per session?
- Can I attend remotely?