Shifting mood episodes are hallmarks of bipolar disorder (BP), a condition that impacts daily life and interpersonal relationships. Bipolar therapy may help — and there are more options than you may realize.

Living with BP can mean experiencing periods of depression, thoughts of loss and despair, feelings of worthlessness, and persistent energy drain.

It can also mean episodes of elevated mood known as mania, where you think you can take on the world but may find yourself not sleeping, acting impulsively, and feeling more irritable than usual.

Bipolar disorder is a lifelong condition. If left untreated, these mood episodes may impact your work, your family, your self-image, and your quality of life.

Bipolar disorder is most likely to be diagnosed in adolescence or early adulthood, with an average age of onset at 25 years, according to the American Psychiatric Association.

While bipolar disorder in children is rare, it’s still possible for children to be diagnosed with this condition.

The type of bipolar therapy that your healthcare team recommends will be based on your age, the type of bipolar disorder you’re experiencing, and your individual needs.

The goals of bipolar therapy

Many different forms of therapy exist that might help when you live with bipolar disorder. In a 2013 review of available options, researchers note the overarching goals of any bipolar therapy are:

  • improving recognition and intervention of early warning signs
  • increasing acceptance of living with BP
  • enhancing medication adherence
  • improving the ability to cope with environmental stressors
  • stabilizing social rhythms
  • connecting and communicating with family
  • re-engaging in social and occupational areas
  • reducing substance misuse
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Cognitive behavioral therapy (CBT)

CBT is one of the most well-researched forms of psychotherapy. It can be beneficial for a number of psychological conditions, such as depression, anxiety disorders, substance use disorders, and eating disorders — to name a few.

The fundamentals of CBT involve identifying unhelpful thoughts and behaviors and then instilling new, beneficial alternative reactions.

CBT for bipolar disorder can help you realize how certain thoughts and feelings influence your symptom severity. You can work on this individually or in a group setting.

Family-focused therapy (FFT)

The goal of FFT for both children and adults is to reduce overall stress by improving the relationships you have with those closest to you.

This may include resolving family conflict or helping educate family members on what it means to live with BP.

FFT asserts that with less stress, you may experience fewer circumstances of emotional reactivity in your relationships that might contribute to mood episodes.

Interpersonal and social rhythm therapy (IPSRT)

Used in both children and adults, IPSRT is a bipolar therapy aimed at improving interpersonal relationships and social rhythms — the activities (like getting out of bed) throughout the day that impact your biological functions.

In IPSRT, daily routines and sleep-wake cycles are used to help stabilize mood.

Mindfulness-based cognitive therapy (MBCT)

A variant of CBT, MBCT focuses on accepting, rather than changing, certain unhelpful thoughts as you experience them.

In this form of bipolar therapy, awareness is considered the key to allowing emotional reactivity to pass rather than manifest as BP symptoms.

Integrated care management (ICM)

The use of case management strategies to help improve outcomes in bipolar disorder is known as ICM, or coordinated specialty care (CSC). This form of bipolar therapy is about accessibility to support services so you can make informed decisions about your care in real time.

ICM can help improve treatment adherence and can keep you connected to your healthcare team for timely symptom management.

Functional remediation

Functional remediation is a group-format bipolar therapy that focuses on neurocognitive development. It strives to improve memory, executive functioning, and attention in BP.

Dialectical behavior therapy (DBT)

DBT is a skill-based approach for treating bipolar disorder that can be done in an individual or group setting. It’s a form of CBT that was originally developed to help conditions with severe suicidality features.

DBT can help you develop new skills specifically in the areas of:

  • mindfulness
  • distress tolerance
  • emotional regulation
  • interpersonal effectiveness

Electroconvulsive therapy (ECT)

If you’ve been through various medication trials and psychotherapy sessions without success, ECT may help re-map the signaling pathways in your brain responsible for resistant BP symptoms.

While you’re under anesthesia for ECT, an electrical current is applied to your scalp to induce a short, controlled seizure.

RAINBOW

RAINBOW is a bipolar therapy approach developed by professor Amy West and psychiatrist Mani Pavuluri for children between the ages of 7 and 13.

It combines cognitive behavioral therapy (CBT), interpersonal psychotherapy, and mindfulness-based approaches with skill-building and education about bipolar disorder.

Multifamily psychoeducational psychotherapy (MF-PEP)

For children between the ages of 8 and 12, multifamily psychoeducational psychotherapy (MF-PEP) is a bipolar therapy that focuses on teaching caregivers strategies for helping children manage mood episodes.

It also provides guidance on sorting through educational and healthcare systems to find support programs to help children living with BP succeed.

In a 2021 review, CBT was cited as the gold standard of bipolar therapy options due to its flexible structure, an abundance of scientific backing, and its ability to be used in almost all stages of bipolar disorder.

There’s no one-size-fits-all approach, however.

A 2019 review into evidence-based psychotherapies for BP, advises clinicians to consider CBT, FFT, or IPSRT, depending on symptoms.

The only bipolar therapy approach both reviews cited as universally beneficial was psychoeducation.

Psychoeducation’s purpose is to help you understand more about BP, its symptoms, management strategies, and the importance of medication adherence.

The more you know, and the more your loved ones know, the earlier you may be able to identify mood episode warning signs.

Early identification can lead to timely treatment and management before symptoms become severe.

In the 2019 review, the authors point out all evidence-based psychotherapies for BP involve some level of psychoeducation, and in the 2021 review, the authors state psychoeducation is the most crucial part of the CBT process.

Living with BP can cause significant challenges in social, occupational, familial, and personal life. While BP is a lifelong condition, that doesn’t mean you have to accept the impact it’s having on your self-image and relationships.

CBT is a common therapy option for BP treatment, but you do have other choices. Your healthcare team can work with you to decide which options are best based on your age, symptoms, and individual situation.