Cognitive-behavioral therapy (CBT) is a well studied and effective treatment for depression, anxiety, and other mental disorders, such as borderline personality disorder. CBT involves the rapid identification of distorted thoughts. We all have these, but in the midst of a mood episode these distortions grow, even to the point of losing the connection to reality. When someone is depressed, everything and everyone can become negative. Thoughts are filled with selfloathing, excessive guilt and catastrophic fears: “I’m never going to get better,” “I’m pathetic,” and “They’d all be better off without me.”
In hypomania and mania the distortions go in the opposite direction: “There’s nothing I can’t do,” “People need to pay attention to me,” “I have special gifts and I need to go out and share them with people,” “I’m superhuman,” and “I’m going to change the world.”
In CBT the first step is learning how to identify these rapid thoughts, referred to as automatic thoughts, that can quickly trigger changes in emotion, and subsequently in behavior. A good trick to catch these thoughts is that whenever you notice a change in your emotional state, stop and ask yourself what you were just thinking. With practice, people get quite good at this.
Once the distorted thought is identified, it is then challenged. “Am I really pathetic? Or am I struggling with depression? In fact, I’m working very hard to try and make myself feel better.”
CBT has been well-studied and is clearly beneficial for clinical depression. Less is known about its usefulness in hypomania, and it probably has limited utility in mania, where the ability to reason is largely disrupted. As most people with bipolar disorder spend far more time depressed than manic or hypomanic, however, being able to use CBT can be an effective treatment in warding off and decreasing depression and anxiety. CBT can be learned in a relatively short span of time: twelve to fourteen weekly sessions with an experienced therapist. There are also several good self-help books and manuals that can give you the basics, and beyond, of CBT. Because it is a learning-based therapy, the key to success will be regular daily practice. The more you do it, the better you get at it.