Monica Ramirez Basco
A. John Rush

Preface


Since the publication of the first edition of this book in 1996, we have
had many opportunities to implement and evaluate our cognitivebehavioral
strategies for containing the symptoms of bipolar disorder
and for prevention of relapse. We have trained clinicians and
researchers across the United States, in South America, and in Europe
to use these methods in clinical settings. And other investigators have
worked with and modified our strategies for application to their
unique patient populations with good results. Also over the 9 years
since our original publication, new pharmacological treatments for
bipolar disorder have been developed, tested, and found efficacious.
Indeed, these are exciting and hopeful times.
Several challenges remain for clinicians and researchers. Better
detection methods are needed so that this illness can be recognized
and addressed earlier in its course. Medical and behavioral strategies
must be strengthened so that those with the illness will have fewer
residual symptoms of depression between episodes of mania and major
depression. Methods are needed to help patients use their treatment
resources more consistently so that they can receive the maximum
benefit available. These include clinical strategies that enhance
adherence to medical treatments and improvements in psychopharmacological
agents so that medications can be better tolerated. We must
also aid the efforts to destigmatize mental illness so that people can
feel more comfortable seeking psychiatric and psychological care.
Taken together, these improvements will help people gain a better
sense of control over their symptoms and help them to achieve greater
quality of life.
The methods presented in this second edition of Cognitive-
Behavioral Therapy for Bipolar Disorder represent another step toward
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the development of clinical methods for preventing relapse and for
helping patients to live with this illness. Its organization is different
from that of the first edition, to allow more flexibility for clinicians.
Rather than providing specific session-by-session instructions, it
guides clinicians toward selecting methods that address the stage of
illness and treatment and tailoring the intervention to the specific
problems and needs of patients.
Our experience has shown us that people with bipolar disorder
and their family members are often very active in seeking ways to
improve their health, to stay abreast of recent developments in treatment,
and to experiment with ways to control their symptoms. The
members of the Depression and Bipolar Support Alliance groups across
the United States as well as other self-help groups continue to make it
their mission to support and educate themselves and one another, to
convey hope, and to challenge the fields of psychiatry and psychology
to assist them in finding new ways to improve the quality of their lives.
Because people with this illness are able to play an active role in their
care, they read about and make use of treatment methods available
through therapy, in journal and magazine articles, through the visual
media, and through books. As educated consumers, they often enter
treatment already having implemented many of the methods we suggest
in this book. The flexibility of the methods described herein will
allow clinicians to bypass components of treatment about which the
patient has knowledge and skills and move ahead to the more
advanced methods offered for controlling depression and mania.
Before the cognitive-behavioral methods provided in this text can
be of help, the patient must be ready to deal with the fact that he or
she has a chronic and severe mental illness. This concept is very difficult
for people to accept. Our natural inclination as human beings is to
push away bad news. Thus, providing therapy and making it a successful
experience is as much about the timing being right as it is about the
methods being useful. If the patient is intellectually ready to learn to
manage his or her symptoms but is not emotionally ready to fully grasp
the meaning of having this life-long disorder, there will be many roadblocks
on the path to recovery. Steps toward managing the symptoms
may be followed by periods of frustration and anger with the enterprise,
perhaps even the desire to give up on treatment altogether. It
may be necessary to postpone psychotherapy or put it on hold while
the person allows him- or herself time to grieve the loss of full mental
health and of a life uncomplicated by depression and mania, medications
and therapy, and doctors and hospitals. Patience is needed by
both clinicians and patients to allow the normal process of acceptance
to occur and adjustment to solidify. When the patient is ready, the
viii Preface
cognitive-behavioral methods presented in this volume can help him
or her to regain control, to prevent succumbing to the peaks and valleys
of the illness, and to improve the quality of his or her life.
There is still much to be learned about the management of bipolar
disorder, and our patients have much to teach us. If only we can maintain
the sense of purpose as clinicians and researchers that brought us
to the mental health field, we can persevere to find answers to the significant
problems posed by this chronic

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