Table of Contents
Bipolar is a multifaceted disorder that comes with a many different treatment options depending on the characteristics and symptoms. Many research studies have been done on causality, frequency and best intervention practices which helps when evaluating this disorder.
The behaviorist view as applied to bipolar discusses how many different factors play a role in psychopathology especially when it comes to attitudes towards treatment.
Characteristics of Bipolar
Bipolar is categorized by experiencing both manic and depressive episodes. The manic episodes that occur with bipolar almost always occur before or after a period of depression (Butcher, Hooley, & Mineka, 2013). “A person who experiences a manic episode has a markedly elevated, euphoric, and expansive mood, often interrupted by occasional outbursts of intense irritability or even violence—particularly when others refuse to go along with the manic person’s wishes and schemes” (Butcher et al., 2013, p. 237-238).
According to Riedel, Heiby, and Kopetskie (2001) where they looked at the different factors that came with a person having a manic episode which includes inflated self-esteem, racing ideas, talkativeness, decreased sleep, increased activity, and increase in risk-taking behaviors. And these symptoms have to occur over the same period of time. In addition, a person must show impairments within their social and occupational functioning. (Butcher et al., 2013). Bipolar symptoms can show up at any time in a person’s life and is the sixth leading cause of mental illness worldwide (Sachs, 2007).
When a behaviorist sees an individual with bipolar disorder and they see the emotional-motivational, sensory motor, and language-cognition (Riedel, Heiby, & Kopetskie, 2001) A behaviorist believes that “the deficits in bipolar cognitive functioning may engender poor problem solving and deficit the ability to foresee potential risks in certain actions” (Riedel, Heiby, & Kopetskie, 2001, p. 520).
Treatments and Interventions
The research that has been done on the inventions and treatments are different from person to person and not every professional use the same ones. In a research study that was done by Cochran (1984), a total of 28 participants were assigned at random to either lithium treatment alone or lithium treatment with cognitive and behavioral therapy. Cochran (1984). It was found that after six months participants who completed psychotherapy had a lower rate of relapse and adhered to the medication.
Cognitive Behavioral Therapy
Cognitive-behavioral therapy is grounded on the idea that psychiatric symptoms are from maladaptive behaviors and cognitive patterns (Vieta et al., 2009). Cognitive-behavioral therapy helps an individual change patterns of their thinking and unhelpful behavior. Butcher, Hooley, and Mineka, (2013) said cognitive behavioral therapy “is a relatively brief form of treatment (usually 10 to 20 sessions) that focuses on here-and-now problems rather than on the more remote causal issues that psychodynamic psychotherapy often addresses” (p. 250). Using cognitive behavior therapy with a person with Bipolar disorder is the thought that people have other beliefs that influence certain things in their life. “Core beliefs are essentially viewed as filters which selectively attend to and magnify that information, which is congruent with the belief system, while minimizing and devaluing that in- formation which is not” (Gregory, 2010, p. 461).
There are different CBT therapies that are suggested that a clinician can use with people with bipolar disorder. For instance, daily thought records, problem solving, and activity scheduling would all fall under the cognitive behavioral therapy umbrella. Gregory (2010) states “that cognitive behavioral therapy is not mean to replace pharmacological treatments but instead it is meant to complement it. There are certain factors to cognitive behavioral therapy that are important.” Gregory (2010) believes “that the onset of a manic episode must be caught early in order to utilize cognitive behavioral therapy and still the person may need pharmacological treatment first.” He also believes that with cognitive behavioral therapy rapport between clinician and client is important just like in other therapies.
There have been many different studies that looked at the medications to treat bipolar disorder both in long and short term. According to Geddes and Miklowitz (2013) “in recent guidelines quetiapine and olanzapine–fluoxetine combination is the front-line recommendations. Quetiapine can be initiated early and leads to more symptomatic improvements. A combination of olanzapine and fluoxetine is also believed to lead to symptomatic improvements (Geddes & Miklowitz, 2013). Very little evidence exists of effective strategies for patients who do not respond to first-line treatments” (Geddes & Miklowitz, 2013, p. 1674). It has been said that the best medication to treat bipolar disorder is lithium which was established in 1949 a man named John Cade and is still used today.
There are many different benefits of using this type of medication such as it reduces suicide manic and depressive episodes. (Geddes & Miklowitz, 2013). Chou (2011) has stated the use of this medication is only used due to the long history rather than medication trails. He also said that “some are more effective for treating or preventing mania (e.g., lithium, dival- proex, carbamazepine, aripiprazole, olanzapine). Others are more effective for treating or preventing depression (e.g., lamotrigine, quetiapine)” (Chou, 2011, p. 58). Thus, when looking at using psychopharmacology as a treatment option a combination method could prove to be the most beneficial approach.
Psychoeducation is defined as “information-based behavioral training aimed at providing BP patients with a theoretical and practical approach to understanding and coping with the consequences of their illness, which thus allows them to change their attitudes toward and beliefs about the illness, and provides specific coping strategies” (Vieta et al., 2009, p. 495).Vieta et al. (2009) said that a majority of European studies have seen a decrease in noncompliant behavior and hospitalization in bipolar clients who received psychoeducation. It is suggested that psychoeducation should take place when the client in euthymic due to the fluctuating in functioning when in a manic state.
When reviewing the effectiveness of psychotherapies “Meta-analyses consistently show that disorder-specific psychotherapies [cognitive-behavioral therapy (CBT), interpersonal, family, and group] augment mood stabilizers in reducing rates of relapse over 1–2 years” (Miklowitz & Scott, 2009, p. 110). Treatments like CBT can be helpful and are more cost effective. When a person with bipolar disorder use multiple types of treatments, there can be a higher rate of success than with just medications alone. (Miklowitz & Scott, 2009).
Neurophysiological Underpinnings of Bipolar
Bipolar disorder can have different neurophysiological underpinnings. The mutation of the gene DISC1 can increase the chances of a person being diagnosed with Bipolar (Carlson, 2013). In children the gene RORB is linked with rapid cycling such as what is seen in Bipolar (Carlson, 2013). Moore et al. (2000) “found that four weeks of lithium treatment for bipolar disorder increased the volume of cerebral gray matter in the patients’ brains, a finding that suggests that lithium facilitates neural or glial growth” (p. 1241).
Attitudes Towards Treatments of Bipolar
No matter what mental illness it Is, there is a huge stigma around it, and this can be felt by those who are trying to get treatment. Kessing et al. (2005) found that, “A large proportion of the patients (40–80%) had erroneous views as to the effect of antidepressants. Older patients (over 40 years of age) consistently had a more negative view of the doctor-patient relationship, more erroneous ideas concerning the effect of antidepressants and a more negative view of antidepressants in general” (p. 1205) When it come to a person getting treatment their beliefs and attitudes play an important role.
Bipolar disorder is one of the most misdiagnosed and diagnosed later in life. When we look at bipolar from a behaviorist perspective, it is rooted in the ideas that people with bipolar disorder have learned to cope by using grandiose, self-labeling and denial. (Riedel, Heiby, & Kopetskie, 2001). Research has found that getting treatment is one of the keys to a better life. Although there are different forms of treatment for bipolar disorder, research has suggested that it should be multifaceted. One thing is clear, the attitude towards treatment is important in symptom management.
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