/CBT/bipolar disorder

/cbt_bipolar

resource: bipolar disorder: a cognitive therapy approach. Newman, Cory F. et al. 2002. American Psychological Association.

case:
univ of pennsylvania, early 1990s
bipolar I, currently depressed

intake eval
DSM-
Hamilton Rating Scales (Hamilton 1960), other self-report measures
Beck Depression Inventory (BDI; A.T. Beck et al 1961)
Beck Hopelessness Scale (BHS; same 1964)
speculate on Axis II
adjunctive bibliotherapy:
Moodswing. Fieve. 1989.
weekly assessment inventories:
daily mood log, Chronorecords. peter why brow and mark bauer at u penn
DTR, daily thought recorder. one of the most fundamental and important of the CBT techniques
use whenever he feels angry or hurt
good at spotting prodromes to depression and mania. buy himself time to use CBT stragegies, seek support fr social network, consult with psychiatrist in case medications were warranted
depression: getting up late in the morn, uncommunicative with SO, not caring to play music, having streams of pessimistic and cynical thoughts about himself and future
mania: becoming argumentative too easily, staying awake until early morn, urge to telephone people at odd hours on the spur of the moment, "don't care" attitude that should worry him (money), going out of his way to learn personal things about other women
CBT works best when pts accumulate knowledge about themselves in a thematic way fr session to session, leading to a broadening of their perspectives about themselves, world, future [cognitive triad?].
self help: scheduling productive activities, getting feedback fr others, delaying the urge to act impulsively (delay 48 hours)

"stages", Lam et al 1999 and Scott's 1996a
Stage 1: beginning treatment
session 1-2
socialization into cognitive model
setting goals
-cbt: focus on pt's mental and behavioral approach to life- constructive outlook on life, less stress, more confident w/o being too confident, more adept at solving his problems; improve quality of life, learn to live w/ his meds, be less apt to extreme mood cycles and relapses in fxning
-learning a series of psychological skills, controlling the bipolar disorder, reducing future vulnerability

Stage 2: applying the cognitive model routine
sessions 4-8: learing the strategies and techniques of CBT
COGNITIVE TRIAD a). reflection of his beliefs about relationships, formed fr his parent's relationships, maintained by his views of his affairs b). fxn of daily interactions betw him and wife, perceived and treated each other c). overall result of his general views of himself, world, future COGNITIVE TRIAD.
homework-
combat abandoment schema: catalogue as many memories of wife showing him attention and affection
take square aim at his entitlement schema: write about what he was willing to contribute to wife's life
: list examples of ways that he trusted or didn't trust himself
sessions 9-14: experiencing improved moods, behaviors, hopefulness

Stage 3: using CBT to manage serious new problems
sessions 15-17: crisis intervention
sessions 18-36: actively dealign with increased stressors and symptom elevation
sessions 37-39: couples sessions
sessions 40-41: medication problems and cognitive therapy

Stage 4: consolidating gains and guarding against risk of relapse

sessions 42-46: preparing for the future
sessions 47-48: saying farewell