Cognitive behavioral therapy (CBT) for bipolar disorder (BD) involves education about the condition, the rationale for treatment, and the factors that influence it. It can help change someone’s thoughts and actions.

According to a 2021 review, CBT can help with all types of BD except acute mania, a type of sudden and severe mania. CBT may also treat co-occurring conditions, such as anxiety.

The average CBT duration is 20 sessions. A doctor may recommend it in addition to medication and other forms of therapy.

Keep reading to learn more about CBT for BD, including whether it is effective, how it works, how long it takes, alternative therapies, and questions to ask a doctor.

A woman looking out of the window considering CBT to treat their symptoms of bipolar disorder -2.Share on Pinterest
Yana Iskayeva/Getty Images

Yes, CBT can help manage BD.

BD is a mental health condition that causes shifts between mania and depression. Signs of mania episodes may include feeling very joyful, talking fast, and a decreased need for sleep. In contrast, depressive episodes may include sadness, talking slowly, and atypical sleep patterns.

Research notes that because medication treatment alone is not effective, the need for psychosocial interventions is undeniable. Experts recommend CBT as the second-line treatment behind medication for all types of BD except acute mania. CBT has different parts, but the most valuable for BD is the education component.

Evidence indicates that CBT as an add-on treatment for BD may help with:

  • noncompliance with medication
  • the loss of function, whether socially, occupationally, or cognitively
  • partial responses to treatment

CBT can also treat co-occurring conditions, such as:

  • anxiety
  • substance use disorders
  • sleep disturbances

Additionally, research from 2018 reports that CBT is effective in prolonging remissions and preventing recurring episodes.

CBT works in the following three ways.

Education

The treatment starts with teaching a person about BD, which healthcare professionals call psychoeducation. This includes:

  • common patterns in BD
  • the rationale for treatment and the importance of adherence
  • common social, biological, and psychological factors that influence it

Interventions to change thoughts and behaviors

These typically follow education and include:

  • recognizing and replacing negative thoughts that are present in depression
  • teaching stress and sleep management skills
  • promoting problem-solving and conflict resolution
  • treating cooccurring psychological conditions

Interventions to prevent or reduce severity of episodes

This entails training in how to identify future episodes early or engage in quick interventions once they occur. Strategies may include family meetings.

The time necessary to produce results varies. However, research states that the average CBT treatment regimen consists of 20 sessions.

There is no standard length of CBT because it depends on the severity and subtype of BD, along with other factors. Some people see an improvement following a few sessions, but others frequently need several months of treatment.

Sessions typically last about an hour and occur once weekly.

These include the below:

Interpersonal and social rhythm therapy

An older review from 2007 explains that interpersonal and social rhythm therapy (IPSRT) seeks to reduce the erratic nature of someone’s daily routines, involving:

  • meals
  • sleep-wake cycles
  • times of rest versus activities

Simultaneously, IPSRT aims to enhance the performance of primary social roles and foster an improved quality of interpersonal relationships.

A 2020 clinical trial with 44 participants who had BD suggests that it may improve symptoms. However, more research is necessary to confirm the results.

Family-focused therapy

Family-focused therapy (FFT) is an intervention for adults and children with BD and their caregivers. It involves education about the condition and training in problem-solving and communication skills.

A review from 2016 examined research on the value of FFT for BD. The authors found that in eight clinical trials, the combination of FFT with mood stabilizer medications may offer benefits over shorter programs of psychoeducation and medication.

Benefits included quicker recovery and decreased symptom severity, frequency of mood episodes, and recurrences.

The following are questions a person may wish to ask a doctor:

  • How many CBT sessions may be necessary?
  • What are the expected results?
  • If CBT is not effective, are there alternative therapies?
  • What is the cost per session?
  • Do you accept insurance?

Cognitive behavioral therapy (CBT) for bipolar disorder starts with education about the condition and follows with interventions to change thoughts and behaviors.

CBT is the second-line treatment behind medication to treat BD. It may help with various aspects, such as noncompliance with medication and a loss of function in someone’s occupation or social capabilities. The average duration of CBT is 20 sessions.

Alternative psychotherapies to CBT include interpersonal and social rhythm therapy and family-focused therapy. Limited research suggests that both may offer benefits for the condition.