Cognitive Behavioral Therapy for Bipolar Disorders - Research Proposal Example

?Running Head: DOES COGNITIVE BEHAVIORAL THERAPY WORK BEST FOR BIPOLAR I OR BIPOLAR II DISORDER? Does Cognitive Behavioral Therapy work best for Bipolar I or Bipolar II Disorder? Insert Name Insert Grade Course Insert Instructor’s Name 9 March 2011 Outline Introduction Research Questions Research Hypothesis Basis and Purpose of the Research Identification of Variables Significance of the Problem Review of the Literature Operational Definitions Data collection method References Does Cognitive Behavioral Therapy work best for Bipolar I or Bipolar II Disorder? Introduction Most psychologists have undertaken research in the past regarding the relationship between Cognitive Behavioral Therapy and the bipolar disorder. There are also studies on the differences between bipolar I and bipolar II disorders. Primarily, bipolar patients have been found to be having a high personal and family history of suicidal attempts compared to the bipolar I patients. Other aspects that were found to be common among bipolar II patients include interpersonal conflicts, breakdown of families and instability in marriage (Marneros and Goodwin, 2005, p. 95). What a psychotherapist is supposed to realize is that, people who have a high risk of falling from grace are those with a bi-polar disorder. They are also most likely to get into problems because of failing to adhere to advice or due to the state of their moods. This may lead them into several behaviors that may be risky. It is however paramount for any given psychotherapist to realize that some patients may be required to fail for quite a while before learning from their mistakes and acquiring mastery. Therefore, important nuances for management are being able to leave the door open for the patient to come back at another stage or showing a certain level of leniency in the course of psychotherapy. This is suitable rather than doing away with psychotherapy to someone who seems not to be compliant (Yatham, 2010, p. 350). Nonetheless, since a bipolar disorder may be progressive with the accumulation of episodes, and it may readily show response to interventions been done at a period early enough during the sickness, attempts to engage patients in treatment early enough are of paramount importance. Moreover, a set of problem strategies that are family based, cognitive, behavioral, and interpersonal have been detailed to apply to those who have the condition of bipolar II (Yatham, 2010, p. 350). Arguments have been put forth in support of the well being plans for patients with bipolar II disorder. The axiom ‘knowledge of power’ is the underlying one for the strategies. It is observed that the often-used strategies are ensuring enough sleep, being able to manage stress, being aware of early warning triggers and signs, taking suitable medication and seeking relevant professional support (Yatham, 2010, p. 350). It is therefore in the scope of this research to establish whether Cognitive Behavioral Therapy (CBT) works well for Bipolar I or Bipolar II. Research Questions There are three research questions in this study: The first one is what is the comparison between bipolar I and bipolar II disorders; the second one is how does Cognitive Behavioral Therapy work for bipolar I and bipolar II; and lastly, between bipolar I and bipolar II disorder, which one appears to have Cognitive Behavioral Therapy working better for? Research Hypothesis The first hypothesis reveals that using Cognitive Behavioral Therapy will lead to significant outcomes for the case of bipolar I than bipolar II. On the other hand, according to the null hypothesis, there will be no significant difference between the outcomes of using Cognitive Behavioral Therapy in bipolar I and bipolar II. Basis and Purpose of the Research The basis of this research is to ensure that answers have been provided for the above hypotheses to the extent of the effect of Cognitive Behavioral Therapy on bipolar I and bipolar II disorders. The research is particularly intended to find out whether Cognitive Behavioral Therapy affects bipolar I disorder more than it does affect bipolar II or whether it affects both of them in an equal manner. This research will be done to help patients suffering from bipolar disorder and their family members discover the significance of using Cognitive Behavioral Therapy to treat either bipolar I or bipolar II disorder. Identification of Variables Variables are sets of personal characteristics that are measured in any given research. Variables can be measured either numerically or in form of categories. Age and height are examples of the former while presence or absence of a disease could exemplify the latter (Abramson, 2008, p. 101). Variables are of two kinds: dependent and independent. The variable whose presence or absence affects the other variable is referred to as the independent variable while the one that is manipulated based on the dependent variable is the dependent variable. Therefore, in the present study, the independent variable is the Cognitive Behavioral Therapy since its application can result to an effect in a patient with either bipolar I or bipolar II disorder. On the other hand, the dependent variables in the study are the two types of disorder: bipolar I and bipolar II. These two can change depending on the application of Cognitive Behavioral Therapy hence resulting to desired outcomes in a patient that is suffering from them. Significance of the Problem The Cognitive Behavioral Therapy model for treating the bipolar II disorder puts focus on hypomania and depressive phases. It is normally applied in the correction of dysfunctional thinking styles that pre-exist and maladaptive mental schemas that, after an episode has occurred, interact with the behaviors and life events to not only aggravate the symptoms but also prolong the episode. For those individuals that show a relationship between their dysfunctional thoughts and the current state of the mood, Cognitive Behavioral Therapy strategies may be used to not only change but also challenge their cognitions that are state – dependent. Current research indicates that Cognitive Behavioral Therapy may be more effective in the preliminary phases of the illness and in those individuals that do not encounter regular recurrences (Parker and Eyers, 2008, p. 158 - 159). Cognitive errors such as maladaptive assumptions, thoughts that are automatic and dysfunctional personal schemas are applicable to the two phases of bipolar II disorder: hypomanic and depressive phases. The negative styles of thinking that often occur include black and white thinking, mind reading, and overgeneralization. Automatic thoughts that occur during the hypomanic phase may be either opportunistic or overoptimistic, while those in the depressive phase concentrate on interpretation of events in an excessively pessimistic manner. While hypomania is attributed to increased self-confidence and grandiosity, depression is attributed to a low self-esteem. The cognitive approaches are being able to teach patients to be able to reframe their irrational thoughts and hence challenging them, finding out the present evidence, looking for other explanations, and refuting ideas that are irrational using Socratic questioning (Parker and Eyers, 2008, p. 159). The content of automatic thoughts in both hypomania and depression is driven by maladaptive assumptions. For instance, a depressed individual who is in a quiet social gathering may interpret the whole situation in a manner suggesting that no one likes talking to him or her. The behavioral withdrawal that may result may then lead to a reinforcement of the maladaptive assumption that makes the person conclude that he/she is worthless due to people ignoring him in a social gathering. However, for the same situation, in a hypomania state, the person is likely to make an interpretation of the same situation in a manner suggesting that he is the most worth to be listened to. This may be followed by behavior that goes hand in hand with this belief such as, interjecting in other people’s conversation and singing with a loud voice (Parker and Eyers, 2008, p. 159). Review of the Literature The literature review of this study aims at supporting the hypothesis highlighted earlier. Previously, six studies were carried out to find out the efficacy of CBT for bipolar disorder. Five of the studies revealed that better outcomes are achieved when CBT is administered together with medication compared to medication alone or a combination of non-skills therapy with medication. One of the studies that were not investigating the overall benefit of CBT, people with at most twelve episodes of illness in their lifetime, revealed therapeutic outcomes from CBT. On the other hand, those people whom had at least twelve episodes in their lifetime deteriorated in their condition. What should be noted here is that, four studies that were carried out entailed individuals with bipolar II disorder, as well as those with bipolar I disorder (Last, 2009, p. 117). Several studies have been carried out using different methodologies to establish the efficacy of CBT towards bipolar disorders. All of them have indicated its usefulness and feasibility. For example, a CBT study against adherence was conducted for six months, evaluated against standard care, and after the intended period, there was demonstration of better adherence by the CBT group more than the standard care one. Generally, the CBT group was not likely to terminate treatment against health care advice, did not have many hospitalizations, and had less mania and depression episodes (Basco and Rash, 2005, p. 26). Apart from improving treatment adherence, it was established that several sessions of CBT delivered for at least six months were better than standard outpatient treatment both in dealing with prodromal symptoms and in lowering the frequency of episodes. Moreover, a CBT test was conducted on a challenging group of patients who had comorbid personality, intense medical non-adherence histories, and bipolar disorder. After some time, the patients had not only improved social functioning, but had also shown fewer symptoms. Another group used a standard medication treatment in conjunction with CBT for patients who had bipolar disorder. After several months, a comparison was drawn between these patients and those who had been accorded only standard treatment. It was discovered that those patients who had combined CBT and standard treatment did not have many manic episodes, took a shorter time in the hospital, were well for a long time prior to relapse and their psychosocial functional was significantly better (Basco and Rash, 2005, p. 27). Most of these early studies indicate that CBT can be helpful in ensuring that medical adherence is increased, enhancing psychological functioning and managing symptoms of people with either bipolar I or bipolar II disorder. Operational Definitions One of the terms in the current study that are worth being defined is bipolar disorder. Bipolar I disorder is a mental illness that is disabling, severe and recurring. Episodes of mania and depression are the characteristics of this illness. During these episodes, there is a dramatic change in behavior, mood and cognitions. Studies show that the occurrence of at least one manic or mixed episode is what defines the existence of bipolar I disorder. Episodes of major depression are experienced by people suffering from bipolar I disorder in the course of their sickness (Caballo, 1998, p. 521). On the other hand, in bipolar II disorder, an individual encounters recurrent episodes of hypomania and major depression. A diagnosis of a depressive order that is recurrent or of bipolar II disorder can transform to bipolar I disorder with at least one manic or mixed episode, taking place (Caballo, 1998, p. 521). About 1% of the United States population is affected by bipolar I. After it begins, it usually has a lifelong effect with recurrences that are episodic and threaten family bonds, life, and financial stability. Over 95% of those that suffer from bipolar disorder are affected by the recurrent episodes of mania and depression. Moreover, about 25% of affected individuals tend to attempt suicide (Caballo, 1998, p. 522). Data collection method Apart from the secondary sources of data, which are selected based on their suitability, reliability, and adequacy (Kothari, 2008, p. 111), there will be quantitative and qualitative approaches on which research will be based. Quantifiable data will be derived from quantitative methods while non-quantitative data will be drawn from qualitative approach. The participants will be patients with bipolar I disorder on one hand and those with bipolar II disorder on the other hand. Cognitive behavioral therapists will also be present to verify whether the approaches they will employ work best for bipolar I or bipolar II disorder. References Abramson, J.H. (2008). Research methods in community medicine: Surveys, epidemiological research, programme evaluation, clinical trials. West Sussex, England: John Wiley and Sons. Retrieved March 9, 2011 from http://books.google.com/books?id=bZUFfhWCug4C&pg=PA101&dq=variables+in+a+research&hl=en&ei=jOE2TYnhEMGqcaCHkIAC&sa=X&oi=book_result&ct=result&resnum=2&ved=0CCgQ6AEwAQ#v=onepage&q=variables%20in%20a%20research&f=false Basco, M.R. and Rash, A.J. (2005). Cognitive-behavioral therapy for bipolar disorder. NY: Guilford Press. Retrieved March 9, 2011 from http://books.google.com/books?hl=en&lr=&id=o2oDxFGr9C4C&oi=fnd&pg=PR1&dq=Using+CBT+leads+to+better+outcomes+for+Bipolar+I+compared+to+Bipolar+II&ots=VCp1rfG2Ip&sig=hIwJ8T_5jPE6TExYRAszZtfjgSg#v=onepage&q&f=false Caballo, V.E. (1998). International handbook of cognitive and behavioral treatments for psychological disorders. NY: Elsevier. Retrieved March 9, 2011 from http://books.google.com/books?id=LL3bVH1tte0C&pg=PA521&dq=Cognitive+behavioral+Therapy++in+treating+bipolar+I+and+bipolar+II&hl=en&ei=rM93TbaSI9CQswaWq6GKBQ&sa=X&oi=book_result&ct=result&resnum=4&ved=0CD8Q6AEwAw#v=onepage&q&f=false Kothari, C.R. (2008). Research Methodology: Methods and Techniques. Delhi: New Age international. Last, C.G. (2009). When Someone You Love Is Bipolar: Help and Support for You and Your Partner. NY: Guilford Press. Retrieved March 9, 2011 from http://books.google.com/books?id=1xpJzSG2obwC&pg=PA117&dq=Using+CBT+leads+to+better+outcomes+for+Bipolar+I+compared+to+Bipolar+II&hl=en&ei=1TR6Tc3JDIfoOceN2YIH&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCcQ6AEwAA#v=onepage&q&f=false Marneros, A. and Goodwin, F. (2005). Bipolar disorders: mixed states, rapid cycling, and atypical forms. NY: Cambridge University Press. Retrieved March 9, 2011 from http://books.google.com/books?id=MQYWMmAVxCUC&pg=PA95&dq=differences+between+bipolar+I+and+bipolar+II+disorders&hl=en&ei=NXR3TcmzAseK5Aa4lbDsBw&sa=X&oi=book_result&ct=result&resnum=1&ved=0CDAQ6AEwAA#v=onepage&q=differences%20between%20bipolar%20I%20and%20bipolar%20II%20disorders&f=false Parker, G. and Eyers, K. (2008). Bipolar II Disorder: Modelling, Measuring and managing. Cambridge: Cambridge University Press. Retrieved March 9, 2011 from http://books.google.com/books?id=h3XX7CYnNKMC&pg=PA158&dq=Cognitive+behavioral+Therapy++in+treating+bipolar+I+and+bipolar+II&hl=en&ei=kdF3TaaeNMiSswaK7bGCBQ&sa=X&oi=book_result&ct=result&resnum=4&ved=0CEIQ6AEwAw#v=onepage&q&f=false Yatham, L.N. (2010). Bipolar Disorder: Clinical and Neurobiological Foundations. Chichester, West Sussex: John Wiley and Sons. Retrieved March 9, 2011 from http://books.google.com/books?id=W6E-9UvxtOEC&pg=PA350&dq=Does+Cognitive+Behavioral+Therapy+work+best+for+Bipolar+I+or+Bipolar+II+Disorder?&hl=en&ei=wFl3TaHwIsKI4QaDvaSCCA&sa=X&oi=book_result&ct=result&resnum=1&ved=0CCwQ6AEwAA#v=onepage&q&f=false Read More