Re:CBT for Bipolar Affective Disorder

Good questions.

Certainly, one possibility is that mania may have a stronger biological component than depression does and that, therefore, medication needs to be a more important part of treatment. I don't know of any solid evidence for or against this hypothesis.

My experience has been that you are right, cognitive interventions can be used to challenge unrealistic positive thinking in manic individuals in much the same way as we challenge unrealistic negative thinking in depressed individuals. However, several practical problems are encountered: (1) Many bipolar individuals are not good at recognizing their mania and/or underestimate the extent to which it is dysfunctional, it can be hard to get accurate self-report information (2) depressed individuals typically feel miserable and want to change, manic individuals often enjoy their mania and are not necessarily motivated to change (3) bipolar individuals may no-show for appointments and abandon homework assignments during manic episodes, thus making it difficult for us to intervene effectively (4) mania seems to impair critical thinking making it harder to challenge dysfunctional thinking.

I haven't had great success using cognitive interventions with manic clients who were not taking their medication, I've gotten much better results when they were compliant with their medication.

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