Table 1

Typical cognitive therapy interventions in bipolar disorder

General coping strategies Relapse prevention
Education and increasing knowledge Identifying and modifying dysfunctional beliefs
Discussing symptoms, effect on lifestyle Stressful events (specific personal meaning)
Information about treatments and outcome High-risk behaviours (alcohol, drug use)
Encouraging questions, providing information Relapse ‘signature’: identify two or three symptoms that are early-warning signs of relapse (avoid using mood, as misattributed as health)
Sleep, eating, exercise routines Identify three components: depression-specific, mania-specific and idiosyncratic
Structured daily diary
Determine action plans, e.g. increasing self-regulation and self-monitoring
Mood, thoughts, behaviours Identify and modify core beliefs
Changes in symptoms with events or treatment
Crisis management strategies
Adherence management Hierarchy of coping: stepwise action plan
Assume patient will not always adhere to medication regimen Avoidance of major decisions
Prior agreements for action with family and clinicians
Explore fears, attitudes and thoughts
Discuss advantages and disadvantages
Identify factors that increase or decrease risk of non-adherence