Cory Newman, Ph.D.
At the June 9th NJ-ACT brunch-workshop Cory Newman asserted that CBT can reduce the frequency and intensity of manic episodes in bipolar patients. He argued that these patients should remain on medication, but that CBT can reduce the stress that precipitates manic episodes, keep patients on their medication, and teach patients to identify the early signs of mania and counteract their manic impulses.
Dr. Newman explained that treating bipolar patients is more difficult than treating depressed patients because some of the techniques that are effective with depressed patients can precipitate a manic episode in bipolars. For example, encouraging patients to become involved in activities can lead bipolar patients to become involved in too many activities and precipitate mania. Also while depressed patients believe they have failed when they haven’t, manic patients do real damage to their lives, losing jobs, marriages, and fortunes.
Patients can be taught to recognize and counteract some of the early signs of a manic episode: believing that they can go several nights without sleep; starting but not finishing many projects; a marked decrease in normal anxiety and an increase in unrealistic optimism; grandiosity, inappropriate sexuality, and unrealistic optimism; an increase in social gregariousness combined with poor listening to others. Dr. Newman recommended using the patient’s grandiosity by suggesting the patient consult with advisors as a president or famous person would before undertaking risky behavior.
One technique he recommended to ameliorate manic behavior is role playing with the therapist and patient reversing roles. This enables bipolar patients to see themselves as others see them, and enables the therapist to assess and teach listening skills to these impulsive, distractible, self-focused patients.
Bipolar patients often continue to experience some manic episodes even when medicated. Dr. Newman recommended keeping these patients on medication because there are some indications that repeated episodes lower the threshold for additional episodes, and medications become less effective when the patient goes off and then back on the medication. The evidence on these points, however, is not definitive at present.
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