Psychotherapy for Bipolar Disorder in Santa Barbara

Because my bipolar went untreated for so long, I spent many years looking in the mirror and seeing a person I did not recognize or understand.
- Alyssa Reyans

What is a Bipolar Disorder?

Bipolar is characterized by extreme changes in mood
Bipolar is characterized by extreme changes in mood

Bipolar Disorder is characterized by extreme changes in mood ranging from mania (restless, euphoric, grandiose, reckless) to depression (extreme sadness, crying, despair, low self esteem). In the recent past it was often referred to as manic-depression.

Because of the pattern of highs and lows it can vary for each person, for some mania and depression can last for weeks or months. For others, bipolar disorder can take the form of frequent and dramatic mood swings.

After years of clinical experience and research, mental health clinicians have come to understand that it is important to distinguish between the two major types of bipolar illness.

Bipolar I has more of a manic focus, although there still can be periods of major depressive episodes. During these periods of mania an incredible amount of work and achievement can occur; the depressive "crash" often comes later.

Bipolar II diagnosis requires the lifetime experience of at least one episode of major depression and one episode of hypomania. Hypomania is different from mania because of the absence of thought disturbance and grandiosity. Bipolar II typically results in serious impairment in work and social functioning.

Bipolar Disorder is Complex
Bipolar Disorder is Complex

The diagnostic picture for Bipolar disorder is complex. To oversimplify, individuals with Bipolar I feel more manic, and clients with Bipolar II feel more depressed. However both feel significant , often dramatic, changes in mood.

When experiencing these bipolar symptoms it is essential to work with a mental health professional to find an accurate diagnosis in order for treatment to be effective.

What is the Prevalence of Bipolar Disorder?

Bipolar disorder affects approximately 5.7 million adult Americans or about 2.6% of the population age 18 and over.

The median age for the onset of the disorder is around twenty five years old although the disorder can start in late childhood and occur as late as the forties and fifties.

An equal number of men and women develop bipolar disorder and it is found in all ages, races, ethnic groups, and social classes.

There appears to be a genetic link to Bipolar Disorder
There appears to be a genetic link to Bipolar Disorder

There appears to be a genetic link to the disorder. Research indicates that individuals diagnosed with a bipolar disorder have at least one close relative with the disorder, or at least one relative with a history of major depression.

Bipolar Disorder can also affect children and adolescents. When one parent has the disorder the risk to their children of developing the disorder is between fifteen to thirty per cent. When both parents have the disorder it increases to fifty to seventy five per cent.

Up to a third of the 3.4 million children and adolescents diagnosed with depression may actually be experiencing the onset of a bipolar disorder. Many adolescents diagnosed with depression develop a bipolar disorder within five years of the depressive onset.

When manic, adolescents , in contrast to adults, tend to be irritable and prone to destructive outbursts rather than to elation or euphoria.

When depressed, adolescents with the onset of bipolar disorder, will have physical complaints such as headaches and tiredness, poor school performance, social isolation and extreme reaction to rejection or failure.

The World Health Organization reports that Bipolar Disorder is the sixth leading cause of disability in the world.

Results of recent research by the National Institute of Mental Health indicate that untreated bipolar disorder can result in nine year reduction in the expected life span and one in five clients being at risk for suicide.

Because there is hope, this information should be viewed from the perspective that early diagnosis and treatment are not only essential but crucial to living a healthy and satisfying life.

It is also important to note that a diagnosis does not define our totality as a human being.

Is the Treatment of Bipolar Disorder Effective?

Research indicates that effective treatment of bipolar disorder, like the treatment of most serious mental health problems, necessitate a complete treatment plan that includes psychotherapy, medication assessment, education, lifestyle management, and social and familial support.

Psychotherapy is essential to effective treatment because it provides a place to learn to cope with intense emotions, to deal with stress, to handle interpersonal issues and create a healthy lifestyle.

Stress is a strong trigger for symptoms to become worse
Stress is a strong trigger for symptoms to become worse

Lifestyle management includes monitoring daily functioning, avoiding "self medicating" through drugs and alcohol, developing a realistic exercise program, and minimizing unnecessary stress. Stress is a strong trigger for symptoms to become worse.

Through the psychotherapeutic process clients are educated about the illness. Clients learn to avoid the potential problems that occur with bipolar illness as well as learn how to the handle setbacks that can happen during treatment.

Medication assessment is essential. Medication has proven very effective in the treatment of bipolar illness. However "one size does not fit all", there are different options regarding medication.

Clients often utilize medication early in treatment to decrease symptoms. Some clients, after consultation with physician and therapist, continue medication throughout and after treatment to minimize the high and lows of bipolar illness.

Whatever the decision regarding medication it is important that the therapist and physician coordinate bipolar treatment. Because of confidentiality laws this can only occur with client written consent.

It is essential that alcohol and other drugs not be utilized to "self medicate". Alcohol and other drugs can only increase the symptoms and result in treatment being less effective.

There are clients that decide not to take any medication and utilize psychotherapy as their primary treatment modality. This can work for clients highly committed to psychotherapy and to developing effective strategies to deal with all aspects, including the physiological symptoms, of bipolar illness.

Whatever the decision regarding medication there needs to be an ongoing assessment of potential physical health issues that can occur throughout the psychotherapeutic process.

It is important to develop a strong support system
It is important to develop a strong support system

As with any significant health problem it is important to develop a strong support system which includes family, friends, and support from others who are living with the disorder. In this regard significant work and planning occur within as well as outside of psychotherapy.


You are more than a Diagnosis

It is important to realize that a diagnosis is not an ending, but a beginning. Having a clear diagnosis assists in acknowledgement of a problem so solutions can be developed to resolve the problem.

A Diagnosis is Important, but you are more than a Diagnosis
A Diagnosis is Important, but you are more than a Diagnosis

A diagnosis can also bring relief because it can explain thoughts, feelings and behavior that previously weren't understandable. A clear diagnosis can result in feeling less alone and alienated from others.

It is essential that psychotherapy also focus on the total person. This means exploration of strengths as well as problems. The trap of any diagnosis is that it can result in defining our entire being. That trap limits the true understanding and experience of who we are as a total person.

The treatment psychotherapeutic approaches that have proven most effective with bipolar illness include, but aren't limited to, Cognitive-Behavioral Therapy, Interpersonal and Rhythm Therapy, and Couples and Family Therapy.

Treatment can end the many years of suffering
Treatment can end the many years of suffering

Although there is more limited research, because bipolar disorder is often connected to the family of origin, Psychodynamic Psychotherapy has proven effective with individuals interested in developing a deeper understanding of the impact of the disorder on their inner lives.

Research also indicates that learning Mindfulness Meditation techniques can help control many of the symptoms of bipolar illness.

Mindfulness Meditation assists in regulating depression, anger, agitation, anxiety, and most importantly, stress. Stress is the leading cause of the reemergence of symptoms and behavioral dysfunction.

The reality is that treatment is effective and can decrease the many years of pain and suffering that often results when there is denial and fear (stigma) of seeking help. It is important to know that there is someone who really understands and who is willing to be a partner in the healing process.

If you don't like something, change it. If you can't change it, change the way you think about it.
Mary Englebreit

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