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Considering the recurrent and chronic nature of bipolar disorder, optimal long-term management requires a preventive strategy that includes pharmacological treatments together with psychological therapies that have shown efficacy in bipolar disorder. Adjunctive psychological interventions, always as an added treatment to the pharmacological therapy, would ensure the effect of medication through the promotion of adherence to therapy regimen (MacDonald et al. 2016), which is often suboptimal in those with bipolar disorder (Levin et al. 2016), and would address other aspects that medication alone cannot reach.
Cognitive functions encompass the mental processes that take place in the brain, in the central nervous system, related to thinking, decision making, planning, paying attention, remembering. In recent years, the increasing prevalence of dementia in the general population has led to a growing interest in stimulating cognitive functions. This greater awareness of the importance of preserving and improving our cognitive functions has been accompanied by a proliferation of brain training programmes, especially with the expansion of new technologies. Even so, neuropsychological rehabilitation and its application in different pathologies have been in use for more than a century. While different assessments and treatment procedures for brain injury began to be developed in the 1970s, neuropsychological evaluations acquired a relevant status in the world of psychiatry in the late twentieth century, with a particular focus on schizophrenia. Currently, the study of cognitive functioning has been extended to other psychiatric illnesses, especially affective disorders such as bipolar disorder and depression.
What we do throughout life contributes to accelerating or to slowing down the ageing process. Although we tend to remember the importance of taking care of ourselves when we feel ill, good health should be considered a long-term investment. A sedentary lifestyle, obesity, tobacco, consumption of alcohol and other substances, and stress, among others, are factors that negatively affect our cells, accelerating the deterioration of tissues in our body. Good health means staying active physically, intellectually and socially, as well as carrying out healthy and regular habits, including a balanced diet and varied physical exercise. Fortunately, control of these factors is in our hands. If we manage to transform healthy behaviours into habits, the effort to maintain them will be less and will be rewarded by the motivation and perceived benefits for health and quality of life.
Every illness represents in some way a threat and increases the sense of vulnerability. The diagnosis of a chronic and recurrent mental disorder influences a person’s self-image and has a strong impact on all members of the family. In the adjustment to the diagnosis, each individual usually undergoes a process in which a variety of beliefs and emotions may arise that will have to be dealt with, in parallel to education about and acceptance of the disorder. It is common for denial to appear first, attributing what has happened to external factors. There is also a tendency for the patient to deny the chronic nature of the disorder, refusing the possibility that another episode may occur. The onset of the disease can often be accompanied by a marked sense of loss, experienced both by the person receiving the diagnosis and by his or her relatives: the loss of the healthy self together with an increase in the feeling of vulnerability, real losses as a consequence of the episodes (work is impaired, social difficulties arise, ruptures occur, family are affected, financial problems ensue, etc.) or perceived loss, sometimes erroneously, of expectations about the person him- or herself or about the future.
Stress is part of life. As discussed previously, some degree of stress can be stimulating to achieve certain goals. However, when the level of stress is maintained, the effects can be detrimental to health. Stress depends not only on the objective situation, but especially on factors related to how we interpret the situation and the resources we believe we have to deal with it. Faced with a stressful situation, the body undergoes a series of physiological reactions that involve the activation of the hypothalamic–pituitary–adrenal axis and the autonomic nervous system. What happens in the stress response is that a real or imagined problem causes the cerebral cortex to send an alarm to the hypothalamus, which then stimulates part of the nervous system to make a series of changes in the body. These include changes in the heart and breathing rates, muscle tension, metabolism and blood pressure, among others. The adrenal glands secrete corticoids which shut down processes such as digestion, growth, tissue repair and the responses of the immune system.
The following sections present the material worked on in each of the sessions, adapted for delivery to the participants. As mentioned, each thematic block will be complemented with additional information (constantly updated) in the form of mobile applications, links, audios and literature so that members can go deeper into the practice of the components on which they have worked.
Bipolar disorder, previously known as manic-depressive syndrome, is a chronic and recurrent mental illness that affects the mechanisms that regulate mood and may result in a high level of personal, familial, social and economic burden.
It is estimated that bipolar disorders affect approximately 2.4% of the global population (Merikangas et al. 2011). The illness onset typically occurs during young adulthood, although the diagnosis is often delayed, worsening the long-term prognosis (Altamura et al. 2015). Therefore, an early diagnosis is crucial to establishing an appropriate treatment plan as soon as possible.
As has been pointed out in the introduction, not only does bipolar disorder have a clinical impact but it can also affect other important areas in the lives of people who suffer from it, and their significant others. Therefore, the treatment of the disease should be comprehensive, taking into consideration different areas influenced by the illness. The sessions presented here, written in an informative way to be shared with those suffering from the illness, aim to cover clinical aspects and issues related to physical health, cognitive and psychosocial functioning, and the enhancement of well-being and quality of life. In order to address all these areas, the integrative approach was designed based on a combination of different psychological treatments previously described. Some contents of psychoeducation for patients have been combined with a session for family members, and complemented with aspects related to health promotion, mindfulness training and strategies for cognitive and functional enhancement, always adjunctive to pharmacological treatment. Therefore, the programmes represent the pillars on which the different modules of the integrative treatment were built.
While medication is hugely important in treating bipolar disorders, an integrated approach which utilizes psychological treatments can target some aspects that medication alone cannot reach. A comprehensive review of evidence-based psychological treatments is provided, followed by practical information on psychoeducation for patients and family members, healthy lifestyle promotion, mindfulness-based interventions and cognitive and functional remediation, as they represent the basis on which the integrative approach is developed. The second half of the book provides examples of sessions of integrative therapy, which can be shared with patients themselves, enhancing the effectiveness of applying the treatment. Psychotherapy for Bipolar Disorders: An Integrative Approach offers a brief but multi-component treatment framework that can also be implemented in non-specialized health centres. This approach may greatly improve the well-being and quality of life of people with bipolar disorders. This accessible text is an essential resource for psychiatrists, clinical psychologists and any healthcare provider working in mental healthcare.