More threads by Miette


Hello everyone,
I was wondering if anyone here could relate to a problem I've had. Over the course of being diagnosed and treated for bipolar disorder, I have been attempting CBT along with the meds.

I find it hard to be consistent with CBT, for when I am manic, I feel like the world is great and I'm awesome and I don't need to work on self-improvement :eek:

Likewise, if I am depressed, I feel as though there is no point in trying to improve myself.

There seems to be a small window of opportunity between the mania and depression where I can do some quality work with CBT, but it quickly gets dropped once I have a dramatic mood swing. :(

I purchased "Feeling Good" by David Burns and am working through it slowly, when the time is right. I don't mind seeing a psychologist, I have it covered by insurance, but I feel like I am wasting their time as well if I keep stopping and starting.

I realise that a lot of my difficulties are probably due to medication-obviously I have not been on an effective mood stabilizer. I am now taking lithium, and hopefully that will help me make progress.

Has anyone here successfully incorporated CBT into their treatment for bipolar illness?
i am not bi-polar but i have recently recovered from depression using a combination of anti-depressants and cbt. the cbt at first made me feel worse because i was writing out the negative things i was thinking, and i didn't have the hang of coming up with the positive, realistic thoughts to counter those. however with a little practice it started to work. being depressed it is very hard to think there is any point in trying, but you just have to make that commitment to do it, even if you think it's pointless. the thing is once you have a few successful tries you realize it does help. the other trick is to do it regularly, at least once a day for 10-15 minutes, no matter what your state of mind is. this is where self-discipline comes in, and i admit that isn't always easy. you just have to keep trying.


Hi ladybug,
Thanks for answering. I do agree with what you are saying about the depression. I found it very, very hard to come up with positive thoughts to counter my negative thoughts when I was feeling that way.

You're right, I do have to try and do it more regularly. I've been quite lax about it so I'm probably losing out on some of the benefits.

Thanks again :)
miette, are you trying to do the cbt on your own or have you had some guidance from a therapist at any point? i found working through the exercises with my therapist most helpful. i don't think i would have been able to do them on my own at first.

also once you start with a therapist you are sort of committed to do the work - you know you'll be discussing the mood logs. it might not be a bad idea to get started with a professional. you can also bring up you don't want to waste anyone's time, so a solution can be discussed together to make sure that doesn't happen.

Daniel E.
BTW, the latest journal articles seem to say that CBT is beneficial for mild-to-moderate bipolar disorder. For severe bipolar disorder with more than 12 mood episodes/relapses, CBT seems to be less effective (not surprisingly):

Cognitive and behavioural therapy (CBT) tends to diminish depressive symptoms, improve treatment adherence and reduce the risk of depressive and manic relapses. CBT effect appears to diminish in patients with a history of over twelve episodes.

Cognitive behavioral treatments of bipolar disorder: current knowledge and perspectives (Sept. 2006)

Our findings corroborate previous bipolar disorder research in demonstrating the value of CT [cognitive therapy], particularly immediately post-treatment, and indicate some continuation (albeit diminishing) of benefits in the succeeding 12 months. These findings suggest that psychological booster sessions may be crucial for maintaining the beneficial effects of cognitive therapy.

A randomized controlled trial of cognitive therapy for bipolar disorder: focus on long-term change. (Feb. 2006

Although pharmacotherapy is the mainstay of treatment strategies for bipolar disorder, research over the last 5 years suggests that combining psychologic interventions with drug treatment increases overall effectiveness, mostly by further protecting from relapse or recurrence. We aimed at critically examining the relevance and effectiveness of psychosocial approaches to bipolar illness by doing a systematic review of the current literature. Currently, most studies show that patients receiving psychologic treatments have significantly fewer relapses, reduced hospitalization rates, and increased treatment adherence. Psychoeducation, family-focused psychoeducation, and cognitive-behavioral therapy seem to be the most efficacious interventions in the prophylaxis from recurrences in medicated bipolar patients. Recent studies have shown that psychologic approaches do not have the same "weight" in all bipolar patients. Pharmacologic treatment and psychologic interventions are complementary and share many goals, such as avoiding recurrences and improving clinical outcome. A wise combination of these two approaches may help bipolar patients to achieve a better symptomatic and functional recovery. Further research should focus on determining the therapeutic value of each ingredient of the tested psychologic interventions.

Evidence-based research on the efficacy of psychologic interventions in bipolar disorders: a critical review. (Dec. 2005)


ladybug-I've seen a psychologist before... he's the one who recommended "Feeling Good" to me. We have 10 free sessions with a psychologist per year, provided by the university, so that is why I went. I think they tend to recommend the books because they know they have to work with that time constraint. Seeing someone is definitely an option for me, and it sounds like you really found it beneficial... I'm glad that it worked for you. May I ask how long you went for?

Daniel, thanks so much for posting those abstracts. I'm new here, so I must say it is very refreshing to find a forum where people are reading the literature and are not militantly anti-meds. This place is exactly what I was looking for! Anyways, I'm definitely in the 12-or-more episodes category, so perhaps I shouldn't expect CBT to "fix" everything, but I have found some benefit from it and find myself using the techniques in my everyday life.
miette, i started the cbt work just about at the start of august (if i remember correctly) and am just about finished. so all in all it took me 4 months. i have the impression though that for others it could be done in less time, so it kind of depends on the person. i have the same book as you.
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