1) Psychotherapy is an adjunct treatment for bipolar disorder aimed at teaching patients to remain calm when faced with difficult situations and restructuring negative thought patterns. It involves psychoeducation, developing daily schedules and activity plans, and monitoring for early warning signs of mood episodes. 2) When selecting a therapist, patients should choose a trained mental health professional with experience treating bipolar disorder using evidence-based therapies like CBT. 3) Self-care involves maintaining routines, identifying triggers, engaging in pleasurable activities, keeping mood and thought diaries, and recognizing and responding to early signs of mood changes.

1. PSYCHOTHERAPY
FOR BIPOLAR
DISORDER
Hvovi Bhagwagar
Psychotherapist, Manashni
WORLD BIPOLAR DAY 2018
1

2. Mood Disorders
4/9/2018Hvovi Bhagwagar, APR2018 2

3. Bipolar is a Bio-
Chemical Condition
Psychotherapy is not
the first line of
treatment
4/9/2018 Hvovi Bhagwagar, APR2018 3
Strongest support- Lithium (1949)– recommended
by APA Practice Guidelines

4. Pharmacotherapy
• Mood Stabilisers and Anticonvulsants typically
given
• Combined with Anti Psychotics and Benzos
• Anti-depressants given with caution
• Blood tests to be done regularly
• During manic phases risk of non-adherence
increases.
• Psychotherapy is adjunct to pharmacotherapy
• Know about medications!
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5. What
questions
should I ask
my doctor?
• What are the side effects and risks of the medication you
are recommending?
• When and how should I take this medication?
• Are there any foods or other substances I will need to
avoid?
• How will this drug interact with my other prescriptions?
• How long will I have to take this medication?
• Will withdrawing from the drug be difficult if I decide to
stop?
• Will my symptoms return when I stop taking the
medication?

6. How often
should I talk
with my
doctor?
During acute mania or depression
-Once a week minimum to monitor symptoms, medication
doses, and side effects.
-After the acute phase has been managed visits will be once a
month to once in 3 months.
During an emergency:
-Suicidal or violent feelings
-Changes in mood, sleep, or energy
-Changes in medication side effects
-An acute medical illness or need for surgery, extensive
dental care, or changes in other medicines you take
-A change in your medication situation, such as
pregnancy
Source: Treatment of Bipolar Disorder: A Guide for Patients and Families
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7. Take
medication
responsibly
Use a daily reminder/medication saver system
Throw away old medications or those you are no
longer taking.
Medications work best when you are making other
healthy choices. Don’t expect a pill to fix a bad diet,
lack of exercise, or an abusive or chaotic lifestyle.
Reduce or discontinue the use of alcohol. Alcohol is
a depressant and makes recovery even more
difficult. It can also interfere with the way your
medication works.
Source: Depression and Bipolar Support Alliance

8. Links of
interest in
medication
management
1. Overview of common medications, including mood stabilizers, antipsychotics,
and antidepressants. (NAMI)
https://www.nami.org/Learn-More/Treatment/Mental-Health-Medications
2. Covers the negative effects of antidepressant medication on the course of
bipolar disorder, and new drug options for the depressive phase.
https://www.psychologytoday.com/us/articles/200205/wrestling-bipolar-
disorder
3. Information on Lithium
https://labtestsonline.org/tests/lithium
4. Learn about generic and brand name drugs for bipolar disorder and how to
make smart medication choices.
http://www.dbsalliance.org/pdfs/GenericRx.pdf

9. PSYCHOTHERAPY
9

10. 10
• Visit a trained psychologist or psycho-therapist
who has experience with mental health issues,
not a “counsellor”
• Request for credentials- reputed university,
training in researched therapies such as CBT,
REBT, EMDR
• Ask them for psycho-education about your
condition (if they know less than you, please
shift)
• Choose between two experienced therapists
based on “good-fit”
How to select a trained mental health practitioner

11. Types of Psychotherapy
•Cognitive Behavioral
Approaches (CBT/REBT)
•Brief Solution Focused
Therapy
•EMDR- Eye Movement
Desensitization and
Reprocessing
•Psycho-analysis
11

12. What does Psychotherapy do?
Teaches the benefit of remaining
calm or at least neutral when
faced with difficult situations.
If you are upset by your problems,
you now have 2 problems:
1) The problem
2) Your upsetness.
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13. What does a trained therapist do?
1. Assessment
• Extensive history-timelines of the
episodes.
• Psycho-diagnostic evaluation (to
rule out comorbidity)
• Monitor psychiatric intervention
• Recommend other Medical
interventions if needed
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14. 2. Psycho-education
• Explain the disorder
o BD runs in families
o “Bio-psycho-social model”
o The Depression Negative triad
• Explain Brain Physiology
• BD needs to be treated with both
medication and psychotherapy
• Family education/therapy
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What does a trained therapist do?

15. 3. Treatment
• Regulate daily schedule
• Restructuring Negative thinking
• Promote adherence with medication
regimens
• Reduce risk of suicide
• Identify triggers that increase the risk
for relapse
15
What does a trained therapist do?

16. Day 1 Day 2 Day 3 Day 4
6-7 am
7-8 Morning routine
A = 2, p = 0
8-9 Drive to work
A = 3, p = 3
9-10 Finish document
A =5, p = 4
10-11 Therapy
A =5, p = 4
11-12
Noon
Sit outside
A =2, p = 4
12-1 pm Lunch
A = 1, p = 3
1-2 Staff meeting
A =4, p = 3
Example of Activity Schedule…
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17. 2-3
3-4 Write letters
A =3, p = 3
4-5 Conference call
A = 3, p = 2
6-7 Dinner
A = 2, p = 2
7-8 T.v.
A =2, p =2
8-9 TV
9-10 TV
10-11 TV
11-12 mid Sleep
….Activity Schedule Contd
Conclusions
Watching too much T.V. * No physical exercise * Much less time with friends than before * Few pleasurable
activities
17

18. Managing Negative thinking
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19. Situation Automatic
thought(s)
Emotion/
Body
Sensation
Alternative response Outcome
Repriman
ded by
boss for
not
meeting
targets
Felt I had done
much less than
required
My luck has come
to an end, they
will fire me.
All women are
bad bosses
Angry 90%
Anxiety
90%
Body rigidity,
craving for
coffee and
non-veg food
• Disqualifying the positive
• Fortune teller
• Generalising
Whats the worst? Shifting me to
another job role- I can handle that
Don’t make it personal: the
requirement is tough.
Perspective: Client pressure is
making boss agitated and critical.
Anger
30% or less
Anxiety
20%
19
Example of Restructuring Negative thinking

20. What can YOU do for
yourself?
4/9/2018 Hvovi Bhagwagar, World Bipolar Day 2017 20

21. Self-help for depression
• Maintain a routine as much as
possible
• Avoid disrupting biological rhythms
(sleep, eating)
• Keep thought logs and mood diaries
which identify triggers
• Increase pleasurable activities
• Reflect on negative thoughts, make
effort to think rationally
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22. Managing Hypomanic/Manic Episodes
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• Recognize warning signs-don’t be in denial
• Interventions and Rules
 Medical solutions first
 Two-person feedback rule for “great ideas”
 Limit cash payments
• To counteract impulsivity:
 Give car keys or credit cards to someone to keep
 Rules about staying out late or giving out phone #
 Avoid Substance use
 Minimize stimulation
 48-hours before acting rule

23. • Identify what worsens the manic episode
(certain drugs, substances like coffee or
alcohol)
• Maintain structure and be disciplined
• Sleep! Even if it means an extra dose of
medication
• Aerobic exercise too stimulating- try
yoga
• Keep thought logs and mood diaries
which identify triggers
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Managing Hypomanic/Manic Symptoms

24. Prodrome= “running before”. The period that precedes a
mood episode is known as the “prodromal phase.”
How do you detect prodromes?
Know about Bipolar
Be a detective-analyse previous mood episodes
“Check-in” with yourself daily-mood charts
Is it characteristic of you?
Employ another set of eyes
Don’t be paranoid, just alert and cautious
4/9/2018 Hvovi Bhagwagar, APR2018 24
Spotting Icebergs From
Miles Away:
Carrie Elizabeth Lin
Prodrome detection-Using Early Warning Signs In
Bipolar Disorder Relapse Prevention

25. Sample Log:
1. What were the most severe symptoms or behaviors that ultimately led to the end
result (e.g., suicide attempt, suicidal thoughts or feelings, psychosis,
hopelessness)?
2. What was the approximate date when the episode was at its most severe?
____________
3. What symptoms or behaviors do you recall before things got to their worst, but
when you were almost “past the point of no return”?
4. What are the earliest warning signs you can remember?
5. What was going on in your life that might have triggered or made you vulnerable
to the mood episode (e.g., stress at work, relationship problems, lack of social
connection, financial problems, other health problems, alcohol or drug use)?
6. What was the approximate date the triggers or vulnerabilities started?
Identifying Early Warning Signs From Prior Bipolar
Disorder Mood Episodes
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26. Self Help books
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27. Mobile Apps
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Thought Diary

28. 4/9/2018 Hvovi Bhagwagar, APR2018 28

29. Finally I end
with a quote
from the
guru
himself….
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30. 30
H’vovi Bhagwagar
9821321132
hvovi.bhagwagar@gmail.com
www.manashni.com