Combining medication treatment and cognitive-behavior therapy for bipolar disorder

Bipolar disorder (BPD) is a severe, recurrent psychiatric illness characterized by a chronic course of vacillating episodes of major depression and mania that impair functioning across many psychosocial domains (DSM-IV; DSM-IV-TR). Within each type of episode, changes occur in mood, cognitive processing, and regulation of vegetative functioning. Typical mood shifts include sadness (in depression) or euphoria (in mania). Either state can produce irritability, anxiety, and anger. In addition, both the process and the content of cognitive functioning are altered. Typical changes in process include decreased speed of thought in depression and increased speed of thought in mania. Content changes include negativity in depression and in mixed states, and grandiosity or paranoia in manic states. According to the cognitive-behavioral model of BPD (Basco & Rush, 2005), these changes in mood and cognition are accompanied by behavioral changes, typically increases in activity in mania and decreases in activity in depression. These behavioral changes, in turn, generally have a negative impact on the individual's psychosocial functioning, such as slowed work productivity, neglect of household or family responsibilities, and reduced involvement in social activities, bring negative consequences to patients as well as those in their primary support groups. In mania, risk taking, disorganized behavior, sleep loss, and reduced medication adherence quickly exacerbate symptoms, reduce quality of functioning, and create significant psychosocial problems. BPD is sensitive to stress (Goodwin & Jamison, 1990). As symptoms alter functioning, new stressors are created as a consequence. Added stress exacerbates symptoms, and functioning may decline further.