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The clinical psychology treatment of bipolar.


Unpublished essay relating to Bipolar from my undergraduate psychology and anthropology university studies. I share my essays to track my growth and evolution through my research process and writing but also to inspire other academics at different stages of the journey. I have currently completed my Bachelor of Arts double majoring in psych and social anthropology and am currently working on my Masters of Arts Social Anthropology.

Essay submitted: 17/09/2022


Bipolar disorder is a mood disorder that can have life altering effects on those who suffer from this disorder, due to the intense behavioral reactions that are a symptom of this disorder. in this essay I discuss the symptoms that can occur during mood episodes after bipolar onsets.


There is no defining cause for bipolar and many academics have created theories or related past theories and research to attempt to explain how and why bipolar onsets so that we can prevent and manage the symptoms of bipolar and if there are any pre-identifying factors to look for.

I looked at two theories and how they support each other in this essay.


First, I discuss Beck’s cognitive theory which bases around how the negative thoughts those with depression have around self, the world and the future can trigger bipolar depressive episodes and secondly, I look at the behavioral approach system dysregulation theory and how environmental factors can contribute to the highs and low of mood episodes that are connected to the theory of cognitive schemas in Beck’s cognitive behavioral theory.


In the final part of my essay, I look at psychotherapy as a clinical psychological treatment alongside medicine and how the theories mentioned in this essay help to guide the recommendation of psychotherapy and an integrated approach to treatment in managing and also as preventing symptoms of bipolar.


Bipolar disorder is a disorder of the brain. Bipolar disorder causes changes in a person’s moods, energy, and ability to function (American Psychiatric Association, 2021). People with bipolar experience mood episodes, these episodes cause people with bipolar changes in their moods, energy, and ability to function due to the intense emotional mood episodes (American Psychiatric Association, 2021). People with this condition experience fluctuations in their mood episodes from the extremely elated mood of mania, hypomania the milder mania, the very low moods of depression or a mix of both (Health Navigator, 2022).


There are three categories of Bipolar, Bipolar I, Bipolar II & Cyclothymia. Manic symptoms are the common and defining feature in each of these disorders, but what differentiates the disorders is how severe and how long lasting the manic symptoms are (Kring & et al, 2018). Bipolar disorder will be different for everyone.


The defining cause of bipolar disorder still remains unclear and unexplained but there is a number of different factors that are believed may play a role, they include: genetics, brain chemicals, social and environmental factors, and substance abuse (Health Navigator, 2022).

Bipolar is among one of the most heritable of disorders (Kring & et al, 2018), genetic factors are predicted to account for about 60 – 80% of the cause of the disorder (Health Navigator, 2022) but the onset of bipolar can be triggered by external events and the first episode usually most commonly happens in late teens to early adulthood, however it is not limited to these age brackets.


The first theory I am going to discuss in this essay is Beck’s cognitive theory. This theory is not directly related to all aspects to bipolar, which is hard as there is no defining cause for bipolar yet but because this cognitive model is now applied to a wide range of disorders (Southam-Gerow et al, 2011) it does relate to the depression symptoms and the cognitive thinking we find in bipolar. Beck’s theory centers around a cognitive triad of an individual's negative beliefs around self, their world and the future being the defining features of depression (Southam-Gerow et al, 2011) and centers around our thinking influences our emotional and behavioral experiences and vice versa instead of just our experiences influencing our thinking.


Beck’s main argument was that depression was because of one’s view of oneself, instead of one having a negative view of oneself due to depression (Allen, 2003). Beck’s cognitive theory focuses on thought processes that become habitual and automatic through cognitive schemas. Cognitive schemas are beliefs that have formed from early experiences in life that lead to the formation of dysfunctional beliefs (Allen, 2003) and thoughts that become habitual and automatic (Southam-Gerow et al, 2011).


Psychosocial risks for bipolar that can trigger an onset includes but not limited to, a childhood history of physical or sexual abuse and more generally an association between the experience of stressful (or major) life events (Berk et al, 2007), it is within these experiences we see the cognitive schemas beliefs form and set the stage for an onset of a major depressive episode and why I believe Beck’s cognitive theory is insightful to understanding the depressive mood episodes of bipolar disorder.


We see Berk’s theory explain the cognitive processes that happen during depression and the negative self-talk and beliefs that come from this and further on in the essay I will explain further how this theory helps to prevent episodes in preventative and ongoing bipolar disorder treatment with cognitive Behavorial therapy treatment methods.


The behavioral approach system theory offers a more integrated model for bipolar disorder, it offers a theory that a weak behavioral approach system is involved and the reason behind both mania and depressive mood episodes (Prosaic et al, 2008). The behavioral approach system, also known as BAS dysregulation theory, provides an understanding for the psychosocial and biological features of bipolar disorders (Alloy & Abramson, 2010).


The behavioral approach system dysregulation theory centers around that individuals prone to bipolar disorder have sensitivity to the Behavorial approach system and the fluctuations in activation and deactivation of the behavioral system which centers around reward are reflected in the bipolar symptoms (Prosaic et al, 2008).


A dysregulated Behavorial approach system when in a high activation state is euphoric or irritable (Prosaic et al, 2008) the same symptoms that present in an onset of mania or hypomania in a bipolar mood episode. When the behavioral approach system is in a state of low activation, this presents as decreased energy, the lows we see attached with massive depressive mood episodes in bipolar onsets.


In the behavioral approach system dysfunctional theory environmental cues are considered to trigger the behavioral system fluctuations of high and low activations, this is where we see the connection between psychosocial and biological understanding of the bipolar disorder, those with bipolar are extremely sensitive to rewards, a disturbance to the reward system can trigger cognitive changes in confidence and excessive goal pursuit (Kring et al, 2018), or the opposite, lack of confidence or drive.


The two theories I have discussed in this essay offer different explanations for the onset of bipolar but as mentioned earlier there is no defining cause yet for the onset of bipolar disorder and a range of factors can contribute to this. Both Beck’s cognitive theory and the behavioral approach dysregulation theory offer different understandings for the onset of bipolar disorder, but both can support each other as well. Beck’s cognitive theory focuses on the negative thoughts that contribute to mood episodes in bipolar disorder and how these beliefs come to be through cognitive schemas. Behavioral approach system dysregulation theory looks at how the environment and a sensitive behavioral approach system can trigger the fluctuations of the highs and lows of bipolar. Beck’s cognitive schema theory offers support for the Enivronmental factor because how individuals perceive environments and experiences will be shaped by the individuals' cognitive schemas that are formed in early experiences (Allen, 2003).


The theories both offer different information and guidance for clinical psychological treatment of bipolar disorder. Bipolar disorder up util recently was accepted to be a biological disorder (Scott, 2007) and was considered best treated with medication only, however with the theories that have been mentioned in this essay alongside others not mentioned that feature and emphasis integrated theories with psychological and social aspects alongside or in replacement of biological theories new treatment recommendations alongside medication is now recognized and recommended and there is promising future routes to therapeutic innovation (Geddes & Miklowitz, 2013) for the treatment of bipolar disorder.


Treatment of bipolar disorder conventionally focuses on acute stabilization, in which the goal is to bring a patient with mania or depression to a symptomatic recovery (Geddes & Miklowitz, 2013), we have seen recent acceptance a guidance now in place for integration of psychotherapy alongside pharmacotherapy.


Mood stabilizers alongside anti-depressants are recognized to be an important and necessary treatment for bipolar (Kring et al, 2018) and clinical medical guidelines recommend that individual with bipolar take medication for the duration of their life so this is why I will mention in this part of the essay as it is recognized as a crucial part of treatment but because this is outside of clinical psychology treatment scope I will not discuss further or place an opinion on this treatment method for this reason but instead relate it to how it can be supported by psychotherapy and vice versa.


Beck’s cognitive theory offers a prevention measure, using cognitive behavioral therapy that was designed as a treatment for Beck’s cognitive Behavorial theory. The main goals for psychotherapy for bipolar disorder are to educate the patient and family about management of stress and symptoms (Geddes & Miklowitz, 2013), and how to identify the symptoms of bipolar disorder mood episodes. Cognitive behavioral therapy also known as CBT therapy also acts a prevention and intervention as educating the individual and their family will help to predict and manage signs of recurrence, early onset but also what supports to keep a neutral lifestyle from the mood disorders.


Cognitive behavioral therapy alongside the recommended medication supports both the therapies mentioned in this essay as Cognitive-behavioral therapy presumes that recurrences of mood disorder are determined by pessimistic thinking in response to life events and core dysfunctional beliefs about the self, the world, and the future, so identifying the cognitive schemas, discussed earlier and working towards changing or managing these beliefs can help to manage the sensitive behavioral approach system that triggers bipolar onset by environmental factors in sensitivity to reward.


Psychotherapy can help you develop skills and strategies to manage the condition. It also gives a non-judgmental place to deal with any emotions (Health navigator, 2022) that come with the highs and lows of the mood episode in bipolar disorder and to learn about the symptoms of the disorder so that patients managing bipolar disorder can improve the quality of their life.

Bipolar disorder is a mood disorder that has no defined cause for onset and can be triggered by an array of different contributing factors heretic, environment, social and more. In this essay I have discussed two theories that relate and contribute to clinical psychological treatment of bipolar disorder looking at integrated treatment management that incorporate in both medicine and psychotherapy working alongside to prevent and ease the disturbances of mood episodes from bipolar disorder for both the patient and their families. Beck’s cognitive theory offers a theory that looks at how early experiences in life can create cognitive schemas, beliefs that individuals have, and it is from these cognitive schemas that our thoughts come from, it is understood within this theory that the thoughts those with bipolar have can create onset in the mood episodes.


The behavioral approach system dysregulation theory offers a different model for bipolar and exploring how a sensitive behavioral approach system in those who have bipolar disorder can be triggered environmental factors. Although the theories that have been discussed in this essay differ, Beck’s cognitive theory can support the behavioral approach system dysregulation theory with the cognitive schemas shaping how we view the environment and how the sensitivities will react to these beliefs and understandings that can trigger the mood episodes of bipolar.

Finally, we discuss how these theories help to guide clinical psychological treatment plans alongside medication, there are many psychotherapy options available but, in this essay, I have discussed the benefits of cognitive behavioral therapy in relational to the mentioned theories in preventing and managing the symptoms of bipolar disorder.


References

Allen, J. (2003). An Overview of Beck’s cognitive theory of depression in contemporary literature. Rochester Institute of Technology. Retrieved from http://www.personalityresearch.org/papers/allen.html

Alloy, L., & Abramson, L. (2010). The role of the behavioral approach system (BAS) in bipolar spectrum disorders. National library of medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2894637/

American Psychiatric Association. (2021). What are bipolar disorders? American Psychiatric Association Website. Retrieved from https://psychiatry.org/patients-families/bipolar-disorders/what-are-bipolar-disorders

Geddes, J., & Miklowitz, D. (2013). Treatment of bipolar disorder. National library of medicine. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3876031/

Health Navigator. (2022). Bipolar Disorder. Health Navigator website. Retrieved from https://www.healthnavigator.org.nz/health-a-z/b/bipolar-disorder/

Kring, A., Kyrios, M., Fassnacht, D., Lambros, A., Mihaljcic, T., & Teesson, M. (2018). Mood disorders. Abnormal Psychology, 1. 146 - 193.

Prosaic, S., Abramson, L., Harmon-Jones, E., & Alloy, L. (2008). Dysregulation of the behavioral approach system (BAS) in Bipolar Spectrum Disorders: Review of Theory and evidence. National library of medicine. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2606106/

Scott, J. (2007). Cognitive Theory and Therapy of Bipolar Disorders. Psykologi website. Retrieved from https://psykologtidsskriftet.no/2007/05/cognitive-theory-and-therapy-bipolar-disorders

Southam-Gerow, M., McLeod, B., Brown, R., Quinoy, A., & Avny, S. (2011). Cognitive-Behavioral Therapy for Adolescents. Encyclopedia of Adolescence. 100-108. https://doi.org/10.1016/B978-0-12-373951-3.00106-X



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