Category: Bipolar Disorder

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Bipolar Disorder Cognitive Behavioral Therapy (CBT) Mental Health Therapy

CBT For Bipolar Teens: What It Is And How It Helps

Cognitive behavioral therapy (CBT) has a long history as one of the most effective and successful talk therapy methods to be developed in modern psychotherapy. But what is it, and how does CBT for bipolar disorder in teenagers help?

Understanding the power of therapy is important; more than just a friendly conversation, an experienced therapist leads and guides a patient through a structured, long-term dialogue and goal-oriented mission plan, helping patients learn to identify and isolate the thoughts and behaviors that characterize their mental health problems and make improvements day by day.

For people with bipolar disorder, a chronic mood disorder that can drastically change a person’s mindset, personality, and behavior, therapy can be one of the most powerful tools to mediate symptoms and lead a fulfilling and normal life. This is especially important for teens – an early assessment and treatment, like CBT for bipolar disorder, can help teens develop the coping skills they need to continue to take control of their disorder for years to come and recognize when they need outside help and support.

What is Bipolar Disorder?

Bipolar disorder is a mood disorder, the same class of condition as severe or chronic depression. Indeed, depression is one of bipolar disorder’s most common symptoms, in addition to mania or hypomania.

Where depression is a debilitating and inescapable level of sadness and anhedonia (joylessness), mania is the opposite, albeit similarly debilitating mental state, where people experience restlessness and boundless energy in addition to dangerous feelings of grandeur, a loss of natural inhibition, and heightened irritability. It is not uncommon for symptoms of true mania to be severe enough to lead to hospitalization. Meanwhile, hypomania involves a lower intensity of symptoms than regular mania.

A case of bipolar disorder can be classified in multiple different ways.

  • Bipolar I involves at least one severe manic episode, with potential (but not necessary) depressive episodes.
  • Bipolar II describes both hypomanic and depressive episodes, but never just one or the other. A person who has experienced a severe manic episode has bipolar I, even if they experience hypomanic episodes from time to time.
  • Cyclothymia is described as a form of bipolar disorder that features milder symptoms than both bipolar I and II, with moderate symptoms of hypomania and depression. Cyclothymia is only diagnosed after at least two years of chronic mental health symptoms.
  • Other forms of bipolar disorder are either classified as a specified bipolar and related disorder or an unspecified bipolar and related disorder. The former describes symptoms that don’t quite match bipolar I, II, or cyclothymia, while the second is used to label patients who are likely struggling with bipolar disorder but have not been fully or thoroughly assessed yet.

Rapid Cycling in Bipolar Disorder

It should also be noted that, in only about one in ten cases, bipolar disorder can be rapid cycling. In cases of rapid cycling bipolar disorder, depressive and/or manic episodes occur more than four times a year. The average bipolar cycle takes months, contrary to popular belief. People who struggle with bipolar disorder are not constantly changing and shifting in their emotional state from extreme highs to extreme lows. Their mania comes and goes, as does their depression (if they get depressed).

Symptoms of bipolar disorder can take time to properly recognize and professionally assess. Mental health professionals must work with a patient to identify their symptoms and past episodes, and rule out potential conditions that may otherwise explain certain symptoms or might interfere with a diagnosis, such as:

One of the reasons it is important to correctly diagnose a teen with bipolar disorder is that bipolar disorder requires a different treatment process from any of the above mental health issues.

There are also specialized mood stabilizer medications that are typically only prescribed for patients with bipolar disorder. Medication can help moderate-severe symptoms. But medication alone is often insufficient to completely manage bipolar disorder. This is where therapies such as CBT for bipolar disorder and a one-on-one psychotherapy approach become important.

What is Cognitive Behavioral Therapy?

Cognitive behavioral therapy is a form of psychotherapy developed through the combination of two different forms of talk therapy, namely cognitive therapy and behavioral therapy. Both of these treatment methods were developed separately and for different mental health problems.

Cognitive therapy is characterized by a thought-based approach. Patients learn to identify and alter problematic thoughts through a combination of thought exercises, and by learning to separate the thoughts that trigger their negative moods from healthier thinking patterns. The idea, in many cases, is to take a patient away from blaming the past or themselves and to work on being more mindful of how their own thoughts can spiral them into different situations.

CBT for Bipolar in Teens

Behavioral therapy aims to address and alter the things we do. By focusing on actions, behavioral therapy can help teens learn better coping skills, stress management options and identify maladaptive behavior that contributes negatively to their mental health. A big part of behavioral therapy is learning to change these negative behaviors, and encourage positive action.

A combination of thought analysis and maladaptive behavioral pattern recognition can help teens with bipolar disorder through intensive one-on-one sessions, usually lasting an hour or longer.

Research shows that individuals undergoing cognitive behavioral therapy for bipolar disorder usually had fewer hospitalizations, fewer episodes, and lower rates of medication use while improving their psychosocial functioning, reducing the severity of their manic symptoms, and reducing depression.

Do I Need Treatment?

If you or a loved one are struggling with consistent and recurring depressive thoughts, as well as occasional symptoms of mania or manic thought – from completely uncharacteristic feats of performance at work or school after months of being in a slump or unusual energy levels and a change in personality – you may want to talk to a counselor or therapist about getting a professional assessment for your mental and physical health.

Bipolar disorder can be a lifelong condition, and though some people can cope with mild symptoms while undiagnosed, it can be a debilitating condition for millions of others.

Get the help you deserve today. Reach out to Visions Treatment Centers for more information.

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Bipolar Disorder

How to Spot the Signs of Bipolar Disorder in Teens

Bipolar disorder is one of several mental health conditions known as mood disorders. These conditions are characterized by problems with mood regulation, usually involving low mood (depression). While it’s normal to feel blue sometimes, a person with a mood disorder will feel a sudden and drastic dip in emotion.

For bipolar disorder in teens, symptoms of low mood are also paired with periods of mania, wherein the individual experiences irrational happiness and elevated mood, high irritability, high energy levels, restlessness, and a heavily inflated self-esteem. These two states cycle off one another, usually once or twice a year.

While bipolar is more often diagnosed in adults, it may be underdiagnosed in teens. This is a condition that is not as well understood as some other mood disorders such as major depressive disorder, but we have come to learn much about it over the last few decades.

Understanding Bipolar Disorder

Previously known as manic depressive disorder, bipolar disorder is a condition characterized primarily by symptoms of mania alongside periods of depression. We generally understand that it occurs in the brain and is partially hereditary, but researchers are still identifying how and why it occurs.

Many functions in the brain are related to mood regulation, and any one of them may play a contributing role in the development of a bipolar disorder. Some teens experience full-blown mania and depression, with symptoms ranging from excessively risky behavior and delusions of grandeur to suicidal tendencies, while others experience milder symptoms, known as hypomania.

External factors may also play a role – stress, trauma, and even diet can contribute to mood changes. Bipolar disorder is a lifelong condition, and can be generally split into two types:

Bipolar 1

Bipolar 1, also referred to as bipolar I disorder, refers to any type of bipolar disorder with “full” mania, usually referring to the severity of the manic symptoms. Symptoms of depression in patients with bipolar 1 may range from mild to severe, and some cases of unipolar mania (mania without depression) are often also categorized under bipolar 1 (at an estimated rate of 1-3 percent among bipolar 1 patients).

Bipolar 2

Bipolar 2, also referred to as bipolar II disorder, refers to cases of bipolar disorder with severe depression but mild mania (hypomania).

Other key forms of bipolar disorder include cyclothymia, which refers to milder symptoms of mania and depression, as well as rapid cycling bipolar disorder, wherein episodes of mania and depression occur more than four times in a single year. Anyone with bipolar disorder may also have “mixed” episodes, wherein an overwhelmingly depressive episode may have some periods of mania, and an overwhelmingly manic episode may feature depressive thoughts.

Identifying bipolar disorder in teens can be a challenge. The symptoms are more obvious in adults, as most people generally learn to regulate their mood and emotions over the years, while teens are expected to be more impulsive and whimsical. This can mean that a teen’s chaotic tendencies and sulking mood may mask symptoms of a mood disorder like bipolar.

While there are no physical tests to determine a positive diagnosis for a mood disorder, certain hallmark symptoms can help set bipolar disorder apart from “normal” teen behavior. If a teen is suspected to be struggling with a mental health condition, they can work with a licensed psychiatrist to determine whether an accurate diagnosis can be made, and whether treatment is needed.

Early Symptoms and Warning Signs of Bipolar Disorder in Teens

Teens can get moody and irritable, and there will be moments when they sulk or become sad over matters adults might not find as important. But normal adolescent behavior can be distinguished from symptoms of bipolar disorder in teens by the severity and pattern of these mood changes and behaviors. Symptoms of depression and mania are unprovoked, often severe, and debilitating. During episodes of depression, teens may exhibit signs of:

    • Suicidal ideation and self-harm.
    • Wanting to die (not necessarily suicidal).
    • Extremely low self-esteem and frequent self-deprecation.
    • Long periods of sadness.
    • Despair and helplessness.
    • Feeling lonely or unwanted.
    • Trouble sleeping, or sleeping in.
    • Sudden changes in appetite, and rapid weight gain/loss.
    • No longer showing interest in old hobbies.
    • Unexplained aches, mostly headaches and stomach aches.

During episodes of mania, teens may exhibit signs of:

    • Extremely inflated ego and sense of self.
    • Heightened irritability.
    • Short or no sleep, unrealistically high energy levels.
    • Speaking much faster than usual, switching topics and interests frequently.
    • Delusional thinking (believing things to be true when they aren’t).
    • Lowered inhibition, much more risk taking than usual.
    • Racing thoughts, unable to slow down.
    • Anxious energy (feeling uncomfortable with one’s own overactivity).
    • Other signs of psychosis (a break from reality) including mild hallucinations.

Cases of cyclothymia may be harder to recognize, but if your teen is suddenly acting strange and experiencing unprovoked signs of low mood or excitability, talk to them and ask them about how they have been feeling. Their emotions and mood might be tied to stress at school, the loss of a friendship, or a budding relationship suddenly breaking off.

But if symptoms persist or worsen or are unrelated to what’s going on in their life, it may be worth talking to your teen about visiting a mental health provider – especially if symptoms are interfering with school and everyday life. Only a licensed psychiatrist can make a professional diagnosis of your teen’s condition, should anything be wrong.

Bipolar Disorder and Co-Occurring Issues

Bipolar disorder in teens can be difficult to spot and diagnose, as it may co-occur with the use of mood- and perception-altering substances, as well as other co-occurring mental health conditions. Some common co-occurring mental health issues include:

    • Anxiety disorders
    • Conduct disorders
    • Personality disorders
    • Developmental disorders (ADHD)

What Does Teen Bipolar Disorder Treatment Look Like?

While there is no cure, bipolar disorder can be managed via a combination of therapy and medication. Mood stabilizers, including lithium, can be used to help teens reduce the severity of their symptoms and lead healthier lives.

Therapy is critically important as the other half of the equation, helping teens recognize their symptoms and identify aberrant thoughts, and manage stressors and situations that might aggravate their mental health.

Support is also an important part of long-term treatment. Friends and family play a role in helping a teen when they can’t help themselves and learning more about their loved one’s condition so they can differentiate between an episode and normal behavior and call the right people in emergency situations.

Depending on the severity of the condition, treating bipolar disorder in teens can be incredibly challenging. But with the right support and diligent treatment, the worst can be avoided, and a teen’s quality of life can be dramatically improved.

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Bipolar Disorder Dialectical Behavioral Therapy (DBT) Mental Health Recovery Therapy Treatment

A Brief Overview of DBT – Dialectical Behavioral Therapy

In this brief overview of Dialectical Behavioral Therapy (DBT), we are illustrating the efficacy of  DBT for the treatment of patients with suicidal behavior, bipolar disorder, and borderline personality disorder. DBT has been shown to reduce severe dysfunctional behaviors in clients. DBT uses validation has a tool to the client accept unpleasant thoughts and feelings rather than react to them in a dysfunctional way.  Simply put, dialectical means that two ideas can be true at the same time. Validation is the action of telling someone that what they see, feel, think or experience is real, logical and understandable. It’s important to remember that validation is non-judgmental and doesn’t mean you agree or even approve of the behavior you are validating.

 

Over the last year, Visions has effectively trained the staff to be DBT informed. We hold regular DBT skills groups at our residential and outpatient facilities. We have adopted and incorporated DBT skills into our day-to-day interactions with clients and are finding it to be incredibly beneficial.

 

I took some time to speak to Jesse Engdahl, MA, RRW, about his observations and experience with running the DBT skills group. He said, “We are happily surprised that it’s (DBT) become a community within a community. It’s set itself apart through the kids’ commitment to not only use the skills but in their support of each other. There is a high level of trust. We have kids coming into IOP who’ve felt marginalized and who hadn’t felt a broader amount of support, but find their place in DBT.”

 

The emphasis on validation in DBT is profound. Someone suffering from borderline personality disorder often has a movie playing in their heads and when the validity of that “movie” is denied, it can create a waterfall of dysregulation which can include anxiety, depression, anger, and fear. Taking a counter-intuitive stance and validating one’s reality is has been shown to be particularly efficacious. It deescalates the anxiety, and it teaches the client to self-regulate.

 

Joseph Rogers, MDiv-Candidate and DBT skills group facilitator and mindfulness teacher succinctly illustrates the value of our DBT groups, “Our DBT skills group gives our clients the confidence that they have the ability to meet their difficulties with skills that can be found within themselves and their capabilities.  By utilizing daily skills diary cards and reporting on their results, clients are able to see where they are being effective and can acknowledge the positive outcomes they are responsible for through their actions.  DBT has the ability to move clients out of their diagnosis toward a confidence in their personhood.”

 

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Addiction Adolescence Alumni Guest Posts Bipolar Disorder Mental Health Recovery

Alumni Voices: “I’m 17, Bipolar and In Recovery”

I’m pleased to share a guest post from one of our Alumni, bravely sharing about her experience as a bipolar teen in recovery. She is not only inspiring and courageous, her post is a testament to the clarity and hope willingness and recovery brings.

“I’m 17, Bipolar and in Recovery”

How old are you when you are in the 5th grade? Ten, maybe 11 years old? I was probably closer to 11 given that I was held back in preschool. Now, who exactly gets held back in preschool? I didn’t really pay it any mind when I was in preschool, yet I still struggle with the shame of having repeated a grade so early on in my education. I remember feeling extremely uncomfortable in the 3rd grade for having to be pulled out of class to learn to read in a private room with Mrs. A, the learning specialist teacher. Learning to read had come so easily to my older sister, C; it was not the same case for me.

So back to my original question: I was 11, and I had already been diagnosed with ADHD. By the time I was in the 8th grade, I was prescribed 100 mg of Adderall per day. Well, it turns out that I did have a mild case of ADHD, yet it also turns out that ADHD is commonly misdiagnosed and mistaken for bipolar Disorder. No one found out that I had a mood disorder until I came to Visions.

 

It is not uncommon for a person who is bipolar to not want to take their medication. The first time I went through Visions treatment I was diagnosed as having mood instability and not full-blown bipolar Disorder. This mood disorder accounts for a lot of the feelings I was having before and even after I came through Visions. Before I reached the point of needing inpatient care for the first time, which far preceded the time in which it took for me to ask for it, I had experienced quite a bit of depression. I have also dealt with my fair share of manic episodes.

 

For someone with a mood instability disorder, drugs of any kind will make for a much more painful and deep depression, a much more insane manic high, and will far from help the situation. This is not to say that abusing any kind of drugs or medication, illicit or otherwise, will help anyone. Yet, when your brain chemistry is already messed up and you continue to pile any kind of chemically enhanced drugs on top of that, it makes for a manic-depressive individual.

 

It is not uncommon for a person who is bipolar to not want to take their medication. The first time I left treatment, I wasn’t taking my medication as prescribed. I missed many days in a row, I took it at different times throughout the day, and I even flushed a whole handful of my pills down the toilet. This definitely didn’t help my condition. The combination of illicit drug use, consistently missing my meds, and a variety of other unpleasant behaviors can only lead to a few options. Those of us in recovery know what those options are.

 

Given that I had already been locked up in a psych ward at the age of 14, had not yet been to Juvi, and was still breathing, the last option would be recovery.

 

I haven’t discussed my recovery much because it is not only something I deal with on a daily basis, but it is also something that I am quite insecure about. As I have already shared, I have been through Visions Adolescent Treatment twice. I once had almost a year and a half of sobriety. I had gotten sober at 15, yet I prided myself on the time I had sober, and not the work I was doing. How could I? I wasn’t actually working a program.

 

I had struggled with the idea of sobriety the moment I found out what the other residents were using in my inpatient program. I had only been smoking weed, while the other residents were in treatment for much harder drugs. I knew that I deserved to be there; my story was pretty intense, yet I still felt insecure about my drug use.

 

That statement alone is what reminds me on a daily basis that I need to be sober. Only an addict-alcoholic would feel the need to go further and to use harder. I guess that wasn’t enough for me, because after about a year and four months of sobriety, I relapsed. This time, it did not take long for me to realize how utterly unmanageable my life was.

 

I did not need to prove to anyone else that it was a good idea for me to be sober, especially not my mother. That’s another good point: Only someone who is extremely sick and in their illness would put someone they love in that much pain. I guess I still had to prove it to myself.

 

Today, when I have a moment where I think of using, I think of my family. I say to myself, “Even if I’m not an addict, I couldn’t put them through what I used to.” I believe that the “issues” I deal with are not only related to one another, but they are also a gift: Not only is my recovery a gift, but I see my bipolar disorder as a gift as well. I feel lucky to have the ability to feel things as intensely as I do. I hope that this will be that last time I am getting sober. I will take one day at a time in keeping it that way.

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Bipolar Disorder

Bipolar Children and Teens

Bipolar disorder isn’t soley an issue for the adult population—it affects children and teens as well.
Bipolar disorder is a mental illness categorized by its behavioral and mental extremes. Often called “manic depression,” this illness is clearly defined by its moods. Typically recognized as the manic stage, the sufferer may be elated or intensely “up,” even hyper. The flip side of this is the depressive stage, identified by its extreme lows, deep sadness, physical ailments, and for some, suicidal ideation.
According to NIMH, several factors may contribute to this mental illness:
  • Genes, because the illness runs in families. Children with a parent or sibling with bipolar disorder are more likely to get the illness than other children.
  • Abnormal brain structure and brain function.
  • Anxiety disorders. Children with anxiety disorders are more likely to develop bipolar disorder.
Since the causes aren’t concretely defined, scientists continue to do research, seeking more definitive answers in hopes of finding viable solutions, including a possible means of prevention.

These mood episodes can last a week or even two and are heavy in their intensity.  NIMHhas provided a listof symptoms from the two phases of bipolar disorder. Keep in mind, these symptoms are determined by their intensity and are not to be confused with the natural ups and downs of childhood emotional development.

Children and teens having a manic episode may:
  • Feel very happy or act silly in a way that’s unusual
  • Have a very short temper
  • Talk really fast about a lot of different things
  • Have trouble sleeping but not feel tired
  • Have trouble staying focused
  • Talk and think about sex more often
  • Do risky things.
Children and teens having a depressive episode may:
  • Feel very sad
  • Complain about pain a lot, like stomachaches and headaches
  • Sleep too little or too much
  • Feel guilty and worthless
  • Eat too little or too much
  • Have little energy and no interest in fun activities
  • Think about death or suicide.
Bipolar disorder is difficult to diagnose in children because symptoms often mirror other issues, for example: ADHD, conduct disorder, or alcohol and drug abuse issues. Bipolar disorder can, however, occur alongside these other issues, so it’s important to see a professional skilled in recognizing the affectations of various mental health disorders. Treatment for bipolar disorder requires the use of medication, but because the effectiveness in children isn’t as well researched, it’s wise to take note that children may respond differently to medications than adults. NIMH recommends children and adolescents take the “fewest number and smallest amounts of medication possible to help their symptoms,” additionally noting the danger in stopping any medication without the advice of a physician.
Pay attention to any side effects, and immediately tell the treating physician if you recognize new behaviors. Remember: the treatment for bipolar disorder is based upon the effective treatment of adults, which typically applies the use of mood stabilizers like lithium and/or valproate to control symptoms of mania and act as a preventative to the recurrence of depressive episodes.  Still, treatment of children and adults is still being researched. At this time, “NIMH is attempting to fill the current gaps intreatment knowledge with carefully designed studies involving children andadolescents with bipolar disorder.”  Further, scientists continue to perform studies looking at different types of psychotherapy, which would support the pharmaceutical treatment used in children and teens.  
Please see below for links to additional information (note, I also used some of these as reference for this article.)
1: https://www.nimh.nih.gov/health/publications/bipolar-disorder-in-children-and-teens-easy-to-read/index.shtml
2:  https://psychcentral.com/disorders/bipolarchild.htm
3: https://kidshealth.org/teen/your_mind/mental_health/bipolar.html#
4: https://www.webmd.com/bipolar-disorder/tc/bipolar-disorder-in-childhood-and-adolescence-topic-overview
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