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Section 1
Cognitive Behavioral Therapy and Bipolar Disorder

Question 1 | Test | Table of Contents | Introduction

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As you know, according to the DSM, bipolar disorder is shorthand for cyclic mood disorders that include manic and depressive episodes. 

In this section, we will discuss having the client write a "best case scenario," which you might find applicable to those clients you are treating who suffer from the depressive episodes which may characterize your client’s bipolar disorder.

♦ Case Study Analysis: Betty's Bipolar Disorder
Betsy, age 39, ran a catering service.  Her husband, David, was my main source of information regarding Betsy’s behavior.  David stated, "Betsy and I already have two grown children, so I can understand why this pregnancy has upset her.  But she seems unnaturally sad." 

In our subsequent discussions, I learned from David that from around Betsy’s fourth month of pregnancy, she spent much of each day in bed.  She didn’t arise until afternoon, when she began to feel a little less tired.  Her appetite, which was voracious during her first trimester, fell off, so that by the time of delivery she was several pounds lighter than usual for a full term pregnancy. 

Betsy had to give up her catering accounts because she couldn’t focus her attention long enough to do even simple bookkeeping.  However, David stated, "Still the only time I really became alarmed was when Betsy said that she didn’t think she could survive childbirth and that I would have to rear the child without her.  I remember her saying that we’d all be better off without her.  That was scary."

How might you have responded to similar behavior in your client? 

Betsy had been diagnosed as bipolar by the therapist who recommended her to me.  I felt certain that what David had experienced was a manic episode linked to Betsy’s bipolar disorder.  After several evaluations, it was clear that Betsy was indeed bipolar. 

In this course, we will focus on treating bipolar clients like Betsy whose conditions are typified by depressive and hypomanic episodes.  Like Betsy, many such clients have low self esteem. 

♦ Cognitive Behavior Therapy Technique:  A Best Case Scenario
Regarding Betsy’s comment that her husband and child would be ‘better off’ without her, I asked her to write out a "Best Case Scenario" because I felt that if Betsy could see a positive outcome, her self-esteem might increase. 

For this CBT technique, I asked Betsy to think about the best possible outcome of her raising her child and remaining David’s wife and write it out on a scrap of paper. 

Betsy wrote, "I’ll leave the hospital with my newborn son or daughter, smiling and energized.  In a few years, we will be able to take walks in the park and as she grows up have chats over coffee or lemonade, depending on the season.  David and I will be good parents and have a happy home." 

I asked Denise to put this scenario in a place she could easily see it.  Denise framed it and put it on her bedside table.  Whenever Denise felt like staying in bed, she would look over to see her Best Case Scenario and her depressive state would be somewhat lightened. 

Think of your Denise.  Could he or she benefit from the CBT "Best Case Scenario" technique?

In this section, we have discussed the best case scenario technique.  The best case scenario technique can be implemented early in therapy for increasing a bipolar client’s self-esteem regarding depressive episodes.

In the next section, we will discuss the compassionate perspective technique.  There are four steps in the compassionate perspective technique.  The four steps are to foster an understanding of equality through human struggle, to provide the client with a sense of self worth, to qualify the client’s understanding of the concept, and to validate the client. 
Reviewed 2023

Peer-Reviewed Journal Article Reference:
Cassidy, C., & Erdal, K. (2020). Assessing and addressing stigma in bipolar disorder: The impact of cause and treatment information on stigma. Stigma and Health, 5(1), 104–113.

Dejonckheere, E., Mestdagh, M., Houben, M., Erbas, Y., Pe, M., Koval, P., Brose, A., Bastian, B., & Kuppens, P. (2018). The bipolarity of affect and depressive symptoms. Journal of Personality and Social Psychology, 114(2), 323–341.

Gilkes, M., Perich, T., & Meade, T. (2019). Predictors of self-stigma in bipolar disorder: Depression, mania, and perceived cognitive function. Stigma and Health, 4(3), 330–336.

QUESTION 1
What is a CBT technique which can be implemented early in therapy for increasing a bipolar client’s self-esteem regarding a situation? To select and enter your answer go to Test.

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