Evidenced-Based Practice in Cognitive-Behavioral Therapy for Bipolar Disorder

The provided content focuses on evidence-based practices in cognitive-behavioral therapy (CBT) for bipolar disorder. The articles discuss various forms of CBT, including mindfulness-based cognitive therapy and cognitive-behavioral therapy, as well as their effectiveness in improving symptoms and quality of life for individuals with bipolar disorder. Additionally, the content touches on the importance of psychoeducation, collaborative empiricism, and behavioral interventions in treating bipolar disorder.

Running head: COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
Cognitive behavioural therapy for bipolar disorder
Name of the Student
Name of the University
Author Note

1COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
Introduction
Bipolar disorder is considered as one of the prevalent and serious kind of psychiatric
disorders (Walker, McGee & Druss, 2015). Cognitive behavioural therapy is one of the best
studied procedures with evidential good results (Hutton & Morrison, 2013). In most of the
research studies it has reported improvements in the life quality of the bipolar patients treated
by CBT with reduced frequency and mood episodes duration along with reduced
hospitalisation and increased compliance. But in order to standardise the diagnostic criteria,
more studies are required to determine the efficacy of CBT. Therefore in this discussion, the
efficacy of the cognitive behavioural therapy in treating the disorder will be evaluated and
critically analysed.
Bipolar disorder
Bipolar disorder (BD), one of the serious and prevalent disorder is reported to affect
almost 3% of the world population causing substantial damage to the professional and
personal life of the patients with suffer from BD (Asherson et al., 2014). This disorder had
received increased attention in the past few years and had persuaded the doctors to
characterise bipolar disorder as one of the important social issues. Along with understanding
the essential components of the symptoms for controlling the occurrence evidential studies
have suggested that structured psychotherapy can also be used to modify the disease course
(Costa et al., 2010). Recent studies have showed that therapeutic approaches such as
Cognitive behavioural therapy (CBT) that aimed in improving the patient’s life showed
effective results in treating the patients with BD (Sipe & Eisendrath, 2012).

2COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
Cognitive behavioural therapy
In treating the bipolar disorder, the most-studied techniques are cognitive behavioural
therapy (CBT) and psychoeductaion. CBT is a group based interventions depending on the
premise that mental disorders are manipulated by cognitive factors. In this structured
psychotherapy certain goals are established between the heap provider and the patient
(Cranston, 2015). The effectiveness of CBT had been established through controlled studies
that led to significant changes in dysfunction of behaviours and cognition that might have
interfered with the adhered pharmacological treatment (McManus et al., 2012). Following
this psychotherapy patients have recorded increased compliance rates along with reduced
hospitalization with 6 months of this therapy and follow-up for the next 6 weeks (Knöchel et
al., 2012). CBT interventions goals in preventing and managing the cognitive, behavioural
and affective symptoms related to depression or maniac episodes along with cooperation
from patients and sometimes from the family too (Juruena, 2012). These interventional
strategies are thought to reduce the negative effects of interpersonal and psychosocial areas
thereby improving the life of the patients with BD (Mohr et al., 2013). The CBT interventions
are conducted by certain strategies such as providing treatment education to the patients and
their family along with making them aware of the common problems linked with this disease;
educating them to monitor the occurrence and the depressive or maniac severity such as by
making mood chart; providing facility to adhere to the pharmacological treatment; facilitating
psychological strategies such as ability of cognitive behaviour to manage stress that can
hinder the treatment or inculcate the maniac or depressive episodes (Costa et al., 2010). This
can be done by controlling the circadian rhythm, training on social skills, recording daily
thoughts and problem solving and lastly educating them to reduce the stigma and trauma
along with diagnosis (Dobson & Dobson, 2016).

3COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
Effectiveness of CBT on bipolar disorder
Cognitive–behavioral therapy conjunct with BD patients’ pharmacotherapy modifies
the disease course (Reinares, Sánchez-Moreno & Fountoulakis, 2014). All studies,
comprising individual or group showed improved patterns in mood and social behaviour
which gained with further follow-up. CBT gives positive outcomes for BD prognosis and can
be used from onset of BD (Parkins, 2013). There are numerous evidences about the efficiency
of CBT on treating BD patients are discussed below.
Evidences
a. CBT on individual: Cognitive behavioural therapy intervention is considered as one
of the best studied example for treating BD in the field of psychiatry (Geddes & Miklowitz,
(2013). First study was conducted in 1984 understand the adherence of lithium therapy on 28
patients. Half of the group who received CBT interventions with 6 sessions showed increased
compliance with reduced hospitalization and recurrence rates than the other half of the group
who received lithium therapy (Prasko et al., 2013). In 2000, study conducted by Lam et al.
showed increased compliance to medication with fewer BP episodes on 25 patients followed
by 12 to 25 sessions (Searson et al., 2012). In 2001, 21 patients were addressed to 25 sessions
of CBT and showed significant result when compared with the untreated 21 patients showing
reduced relapse rates and lesser hospitalization (Isasi et al., 2014). Scott et al. performed on
253 patients with severe and different stages of comorbidites through a randomised
multicenter study. Among the 127 patients, only 40% among them obtained the objective
with 20 sessions. No difference was observed between the control and the group taken
concluding that adjunction of CBT is more effective than treating the individuals showing
less than 12 stages of BD (Yatham et al., 2013). In 2010, the combined treatment comprising

4COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
psychoeducational, CBT and pharmacological was conducted on half of 40 patients with
refractory BD showed effective results (Stratford et al., 2015). In 2014, 951 patients with 857
having major depression and rest with BD were evaluated through CBT for severed mood
dysfunction in an acute setting and showed significant reduction in symptoms, self-harm,
substance abuse with improve life (Jeremian, 2014). A recent study on meta-analysis
concluded that majority of the studies depicted a short-term effectiveness in minimising BD
relapse rate thereby improving the severity of mania rather than depression and effects get
minimised with time (Berlim, Tovar-Perdomo & Fleck, 2015).
b. CBT on group: Palmer et al. in 1995 conducted group CBT on 6 BD patients for 17
weeks based on pharmacotherapy maintenance, in which 2 patients showed effective CBT
results. Group mindfulness CBT with 8 sessions showed increased reduction in depression,
anxiety and mania with reduced mood episodes (Bream et al., 2017). Another study showed
no difference related to recurrence time, episodes count in 18 CBT sessions (Abreu, 2016). A
latest study for 20 sessions on compared group who had only pharmacotherapy and after 6,
12 months and 5 years of evaluation showed reduced symptoms of BD than the controls
(Wiles et al., 2013).
c. Mindfulness-based cognitive therapy (MBCT): This is a combined therapy with
CBT associated with meditation focussing on BD. In 2010, 23 groups comprising 15 BD
patients went through at least 4 MBCT sessions. Though they showed reduced depression by
mindfulness technique but the effect reduced with time (Willett & Lau, 2015). In 2012, 12
patients of BD group with 8 controls had electroencephalography studies (EEG) just before
and after the MBCT treatment for 8 weeks. The EEG studies should improvement in right
frontal cortex with increased attention and activated level (Howells et al., 2014). Perich et al.
conducted MBCT by comparing with the usual treatment with 95 BD patients in 2013 and
did not find any significant difference in the duration or recurrence of the mood phases. But

5COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
significant difference was noted in anxiety symptoms (Perich et al., 2013). This same group
was analysed by incorporating meditation practice with a sample of 34 BD patients and found
that mindfulness meditation if practiced for minion 3 weeks improved the symptoms of
depression and anxiety (Miller, 2014).
Another study was conducted on female-specific unit for treating BD. In this study it
showed positive outcome by treating her with combined CBT, restabilising on psychotropic
medications along with a female specific unit (Palmer, 2013).
Comparing CBT with other interventions
In the last few years the field of psychology had adopted the evidence based practice.
But still there are some controversies for the fast adoption of cognitive behavioural therapy
(CBT) over the other treatment methods. There are some studies which proved that the CBT
is the most effective treatment for number of disabilities of mental health (Gale, 2017). In
addition the CBT treatments are generally short in duration and the results are more stable
than other treatment methods. There are some traditional therapists who raised the voice
against the CBT, because they said that in mental problems there is much complication which
is impossible to cure in short period of time (Deckersbach, Eisner & Sylvia, 2016).
In the perspective of “Systemic Treatment Enhancement Program for Bipolar
Disorder”, patients under the intensive psychotherapy showed that they need very short time
span to recover and also the recovery rates were very high. In 2008 and 2012, 2 experiments
were done by the help of randomized control theory. In 2008, 29 bipolar patients were
selected and were divided into two groups, first group got 7 patients of psychotherapy and
other got 13 sessions of CBT. After one year the people of the second group were found with
less depressed mood and using less amount of antidepressant (Berk et al., 2014). In 2012,
experiments comprising 76 patients with bipolar disorder with Susan and divided into two

6COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
groups, the first group received the CBT and second received the supportive therapy. The
report of the groups showed no changes in symptoms or relapse rates.
In 2000 years Parekh et al. compare the society I didn't found any significant change
in the city group despite of longer and individual treatment (Reinares, 2017). Later they
analyzed some other patients into different groups into different groups for investigating the
changes in the early Mania symptoms and ascertained that both the groups have similar
improvements in bipolar disorder. In a recent review on different psychological interventions
for bipolar disorder the authors stated that CBT is very much effective in reducing the
depressive symptoms of bipolar disorders. Hence we can use the CBT as the better way for
improving the depressive and anxiety symptoms of bipolar disorder.
Conclusion
Thus it could be concluded that bipolar disorder is recorded as one of the most
prevalent and serious mental disorders. The aim of this article is to prove that the cognitive
behavioral therapy one of the popular and mostly used psychotherapy for the bipolar patients.
Some of the studies explained the cognitive therapy efficiency in different phases of the
bipolar disease. Studies showed that the patient treated with CBT had improvement with the
reduction in both mood swings and depression, some patient also showed that they are now
reduced the intake of antidepressant. Thus to treat the bipolar disorder the cognitive
behavioral therapy can be used effectively.

7COGNITIVE BEHAVIOURAL THERAPY FOR BIPOLAR DISORDER
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