Raw Writing for the Real World of Bipolar

If you think that you or somebody you care about might have bipolar disorder, life is likely overwhelming at the moment as you consider numerous questions. What help is available? Who do I talk to? How do I know if I’m receiving the right care? My hope is that this article will help you navigate these issues.

Your first step should be to seek help at a clinic that utilizes empirically supported treatments (ESTs). ESTs are treatments that, through research, have been shown to be effective in eliminating symptoms of particular mental illnesses. There are some resources, such as Psychotherapy Brown Bag, that compile lists of clinics that provide ESTs, but universities in your local area are also a good place to look. Some clinicians might not know about ESTs or dispute their utility. This should be considered a troubling sign and you should seek advice elsewhere.

ESTs are empirically supported treatments. Any treatment that has been studied and data has shown to be effective in treating a particular mental illness is considered to have empirical support. The more times a finding is replicated by independent people, the stronger the support. When a treatment is shown to outperform another treatment (e.g., cognitive behavioral therapy versus psychodynamic therapy) instead of just a waitlist group, the empirical support is stronger. The American Psychological Association created a task force called Division 12 (http://www.psychology.sunysb.edu/eklonsky-/division12/index.html) whose job is to read all of the research out there and compile a list of treatments that have been shown to work for specific mental illnesses and to detail how much support they have and whether that support is controversial (e.g., EMDR has some evidence, but it is poorly done, so the evidence is controversial). Psychotherapy Brown Bag details how to use this all important website here.

A good way to think about this is as a parallel to treating physical illnesses. When we want to learn how best to treat an illness like diabetes, we study the impact of various treatments relative to one another in reducing symptoms, keeping symptoms off, minimizing side effects, etc...and then we use those results to inform our decisions as clinicians. Unfortunately, in clinical psychology, this doesn't happen much in real world practice. Instead, many clinicians simply do whatever they want and shrug off evidence indicating that many of those approaches don't work and that simply mixing and matching is not an effective way to care for a patient. Most scientists - myself included - get *very* upset about this and see it as unethical. The idea is, not everyone will benefit from a specific empirically supported treatment, but if we start with ESTs then adjust if they don't work for a particular client, we will get far better results overall.

For bipolar disorder, the primary treatment is pharmacological. There are, however, non-medical ESTs that serve as useful adjuncts. Specifically, social rhythms have been shown to reduce vulnerability to relapse, particularly with respect to manic symptoms. Check out that link above for more info on this (click on the "disorders" tab, then click on "bipolar disorder").

Some other examples of ESTs include cognitive behavioral therapy for depression, exposure and response prevention for obsessive-compulsive disorder, and dialectical behavior therapy for borderline personality disorder.

As a clinician, I have encountered individuals experiencing a many symptoms of bipolar disorder. When a client is in the mist of a manic episode, I refer them to a trusted psychiatrist who can prescribe medication capable of stabilizing symptoms. If you or your loved one are presently manic, medication must be the first step.

One manic symptoms are stabilized, a clinician should utilize a structured clinical interview to assess your past and present symptoms, not only for bipolar disorder, but other mental illnesses as well. Unfortunately, misdiagnoses in bipolar disorder are common, so it is essential that your clinician use a structured interview to fully understand all of your symptoms rather than simply making a diagnostic decision based on his or her intuition. Even the smartest, most experienced clinicians need help with this and you deserve the benefits of accurate diagnoses. It is important to assess for other mental illnesses as well because the norm is for an individual to meet criteria for more than one mental illness at one time and selecting the correct treatment hinges upon truly understanding your symptoms.

Although medication does the bulk of the work on reducing symptoms in bipolar disorder, your clinician also has other tools available. Social rhythms, which involve managing your sleep and meal schedules, are pivotal. Your clinician should work with you to develop an eating and sleeping routine that helps to reduce symptoms and prevent relapse. Additionally, some individuals benefit from cognitive-behavioral therapy (CBT) along with medication. Throughout treatment, you should ask your clinician to regularly assess progress by measuring your symptoms. This is usually done through questionnaires that ask you to rate how severely you are experiencing specific symptoms. By filling these out regularly, you can see how much progress you are making week by week.
The bottom line is, if you or somebody you know is experiencing bipolar disorder, there is help. Not all of the treatments out there are actually helpful, but if you follow this brief guideline, you should be on the right track to a healthy, symptom free lifestyle.

Michael Anestis, M.S., is the co-founder of Psychotherapy Brown Bag and a doctoral candidate in the clinical psychology department at Florida State University. He is the author of numerous publications in prominent psychological journals and his research focuses on the influence of emotions on behaviors and suicide risk. As a clinician, Michael has worked at the Florida State University Psychology Clinic as well as the Florida State Hospital, treating individuals with a variety of mental illnesses in both inpatient and outpatient settings. Michael currently teaches Abnormal Psychology to undergraduates at Florida State University, a position he has held for the past two years. If you would like to reach Michael, send an email to mikeanestis@psychotherapybrownbag.com.

Website: http://www.psychotherapybrownbag.com

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