Cognitive Behavioral Therapy for Bipolar
Pre diagnosis I didn’t know anything about therapies. The word ‘therapy’ felt very contrived, and almost an admittance of weakness. I was very judgemental towards the world of mental health and the words ‘cognitive behavioral therapy’, better known as CBT, were foreign to me.
I had no idea how life changing and instrumental they would become in my life.
I was always a lively, charismatic child. My granddad used to say, ‘Don’t knock the spirit out of her.’ As I grew up, however, I remember feeling different, always striving for happiness whilst desperate to block out an underlying sadness. In addition, my parent’s relationship became destructive and my dad drank to cope. On the outside I was a feisty young woman exuding confidence, but on the inside I felt like I was gripping onto life, powerless to its struggles.
At the age of 18 I was involved in a car accident and suffered multiple injuries. I was referred to a doctor who offered me antidepressants, but due to my ignorance of mental health I felt I could beat whatever was haunting me. I moved to university adamant to make a new start, but as ever, my wonderful memories were peppered with pain.
One day a friend found me in my bedroom listening to the same song on repeat with the curtains shut. I didn’t want to live anymore. I received counselling, but gave up after feeling that they were digging into a life I didn’t want to face.
After university I had the life that everyone dreamt of, in terms of a successful career and a beautiful flat, but I struggled, and was offered antidepressants again. Again I rejected them. I still didn’t understand mental health, and I continued to convince myself that I just wasn’t trying hard enough.
By my mid-20s my relationship had broken down, I worked long hours, I had stopped contact with my dad and my world was collapsing. I binged on drugs at the weekends and over-exercised, restricting my diet to the point where my empty stomach crunched with pain. I couldn’t eat out with friends, I couldn’t prepare meals, I was completely obsessed and began to purge in a never-ending cycle.
I lived with a fake smile behind a pane of glass. My friends finally took me to a doctor and this time I felt so desperate I took the antidepressant given to me but it triggered extreme reactions, and I was referred to see a psychiatrist.
In 2008 I was diagnosed with rapid cycling bipolar disorder and an eating disorder. I was flinging from the depths of suicidal depression to the heights of mania where everything was beautiful with perfect clarity. I was writing poetry, spending obsessively and bursting with energy.
Unfortunately, my mania reached the point of psychosis where I believed my family were conspiring against me and I had a unique relationship with God. As a result, I was admitted into a private psychiatric hospital.
Thoughts, Feelings and Behavior
I met my CBT therapist when my symptoms stabilized and I was receptive to talking therapy. I didn’t know what to expect. Since then I have read many articles that over-complicate CBT, but my trusted therapist explained it very simply to me. He taught me that the basic model of CBT was looking at how your thoughts affect your feelings, which impact your behaviour.
In my opinion, it is simply a better way of thinking. CBT has been shown to be effective for many mental health problems including anxiety, depression, panic, phobias, stress, obsessive compulsive disorder, post-traumatic stress disorder, eating disorders, bipolar disorder and psychosis.
Your thoughts as a starting point can be absolutely anything. It’s about becoming aware of them and how they impact your feelings and behaviour. We all know that throughout our mental health struggles we follow negative thought patterns that often lead to despair and feel impossible to break.
For example, as part of my depression, one of my recurring thoughts was I am nothing, so my feeling was sadness, and as a result, my action was to stay in bed and cry. An example for my eating disorder was, I am fat and disgusting, my feeling was worthlessness and my action was to restrict my diet and over-exercise. And for mania it was I want to buy things, so my feeling was excitement and my action was to shop and spend money.
CBT is all about learning to interject at different points in the cycle. Instead of thinking, no one likes me, I can’t cope, and spiralling into feelings of panic and despair, I try and train myself to ask myself why I can't cope today. Has anyone said they don’t like me? Am I feeling down and tired in general? Have I taken my medication? These interventions enable me to rationalize my thoughts and help me to prevent panic attacks, self-harming, purging food or anything else that might have a negative effect on me.
They also help me to identify triggers in the future. When I have overwhelming feelings that are spiralling out of control I remind myself of what has happened before. For example, what has been the result of my panic attack? I have been scared, tearful and out of breath but I have always lived through it. Do I want to respond to my thoughts and feelings in the same way or try something different?
I use distraction techniques such as texting a friend, calling a trusted one, practising relaxation, watching a film, listening to music, going out, it can be anything that works for you, or all of the above in quick succession. The key is recognizing and interrupting those thoughts right at the very beginning before they’ve had a chance to gain momentum and feel out of control.
Unravelling a Web of Thoughts
Believe me, this process is not easy, or a quick fix. Fundamentally, you have to talk about why you think those initial thoughts in the first place. It became very clear to me that although a seemingly confident person, I had low self-esteem, never felt good enough and was desperate for acceptance and security whilst developing mental health issues.
I have spent hours and hours unravelling a web of thoughts that have built up through my years and left many CBT sessions feeling desperately sad with the intent to cope through my negative strategies. I even fled from one. However, something has always made me return. I had to untangle thoughts to accept my past but my CBT focused on the here and now, and how I could build a future.
I was asked constructive questions and supported in finding my own solutions. This gave me empowerment and gave me a sense of self-worth. My therapist gave me hope that I could get through the difficult periods. I now automatically challenge my thoughts every time I worry or start to think down a destructive path.
I have lived with my diagnosis of bipolar for six years now and I am 32 years of age. I have had many hospital admittances, I take medication daily and I receive regular support from health professionals. I still struggle in life but CBT has enabled me to take some of the control back and manage what, at times, feels impossible. It has encouraged me to move forwards, taught me to problem solve and I’ve learnt about myself and found things I enjoy, reducing further risk of negative thought patterns.
My therapist never told me that CBT would make the world a better place and cure my mental health problems but he did say it would relieve some of the pressure and give me a way of thinking that would help me manage it that little bit easier.
He was certainly right.
Note: Cognitive behavioral therapy for bipolar is usually recommended by a doctor or psychiatrist because treatment is dependent upon the person and not applicable to all. If someone is in a crisis, specialist emergency treatment is required.