Abstract
Bipolar disorder is a mental disorder that has a very wide prevalence in the population. Currently, the mainstream therapy for bipolar disorder is medication. However, significant side effects have been found. Several non-pharmacological therapies have gained widespread attention in recent years, including psychotherapy and exercise intervention. This chapter reviews the current knowledge on the mechanisms, and efficacy of psychotherapy and exercise interventions affecting bipolar disorder. It also provides an outlook on the limitations and future development of psychotherapy and exercise intervention. The review concludes that although there have been a considerable number of studies discussing both therapies in the management of bipolar disorder. However, most of the studies suffer from low sample sizes and insufficient levels of evidence. The research and application of psychotherapy and exercise interventions in the bipolar disorder population are still in their early stages.
TopIntroduction
Bipolar disorder (BD) is a mental disorder characterized by extreme mood swings that fluctuate between episodes of mania and depression. It is a collection of cerebral conditions that trigger significant oscillations in an individual's emotional state, vitality, and overall performance. It can be categorized into various types, including Bipolar disorder I (BD-I), Bipolar disorder II (BD-II), Cyclothymic disorder, Other specified bipolar and related disorders, and Unspecified bipolar and related disorders (American Psychiatric Association, 2022). Exercise intervention (EI) and psychotherapy are two non-pharmacological therapies for BD and have become more and more popular. Considering that there is a lack of comprehensive reviews in this field, this chapter is going to give a review of the current knowledge on mechanisms, efficacy, development, and limitations faced by psychotherapy and EI affecting BD.
Diagnosis of Bipolar Disorder
In recent years, research efforts have intensified to find objective indicators for diagnosing BD. These endeavors encompass neuroimaging, peripheral measurements, and genetic studies. Neuroimaging has unveiled that individuals with BD display dysfunctions in neural circuits associated with emotional processing and regulation. Additionally, studies have identified an “overactive” reward processing circuit in certain brain regions. Structural changes accompanying these dysfunctions include reductions in gray matter volume and alterations in white matter tracts (Phillips & Swartz, 2014).
Peripheral measurements target biomarkers, with findings indicating that individuals with BD consistently show decreased levels of brain-derived neurotrophic factor (BDNF), increased pro-inflammatory cytokines, and impaired mitochondrial function (Hu et al., 2023). Genetic research, on the other hand, has been probing into specific genes associated with increased susceptibility to BD (Frey et al., 2013). However, these biomarkers have not achieved adequate internal validation, and their associations with BD lack specificity(Abi-Dargham et al., 2023). Therefore, no single biomarker has been established as a reliable diagnostic tool for BD (Sigitova et al., 2017). The diagnostic systems based on symptoms and clinical presentations, such as the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), remain the primary methods for diagnosing BD.
According to DSM-5, Bipolar Disorder Type I (BD-I) is diagnosed when individuals experience episodes of severe depression and mania. The diagnosis requires depressive episodes lasting at least two weeks and manic episodes lasting at least one week, sometimes necessitating hospitalization. Bipolar Disorder Type II (BD-II) involves hypomanic episodes and major depressive episodes. Depressive episodes in BD-II must last at least two weeks, followed by hypomanic episodes, which are less severe than manic episodes and do not significantly impair social or occupational functioning. Hospitalization is generally not required for BD-II (American Psychiatric Association, 2022).
BD frequently co-occurs with other psychiatric disorders such as attention-deficit hyperactivity disorder (ADHD), disruptive behavior disorders, anxiety disorders, and substance use disorder (Joshi & Wilens, 2009; Sesso et al., 2023). Studies have shown that about 50-60% of individuals with BD experience comorbidity either currently or over their lifetime (Messer et al., 2017). The overlapping symptoms between BD and its comorbidities complicate the diagnosis, leading to frequent misdiagnosis. One study highlighted that 69% of individuals with BD reported a history of misdiagnosis, which significantly delays appropriate treatment (Hirschfeld et al., 2003).
Key Terms in this Chapter
Cognitive Behavioral Therapy (CBT): CBT is a psychotherapy that focuses on identifying and modifying the connections between thoughts, feelings, and behaviors. It aims to help individuals recognize and challenge negative or distorted thinking patterns and develop healthier, more adaptive thoughts and behaviors. It is an evidence-based therapy widely used to treat various mental health conditions, including anxiety disorders, depression, and bipolar disorder.
Family-Focused Therapy (FFT): FFT is a psychotherapy that involves the participation of the entire family in the treatment process. It aims to improve communication, understanding, and problem-solving within the family system. It focuses on educating family members about the illness, enhancing family support, and developing effective coping strategies. The therapy aims to reduce relapse rates, improve family relationships, and promote the overall well-being of both the individual and the family as a whole.
Interpersonal and Social Rhythm Therapy (IPSRT): IPSRT is a form of psychotherapy that focuses on the relationship between disrupted social rhythms and the development or exacerbation of mood disorders, particularly bipolar disorder. It combines elements of interpersonal therapy and behavioral therapy. IPSRT aims to stabilize daily routines and improve interpersonal relationships to promote mood stability. The therapy involves setting regular daily routines, managing life events, enhancing social support, and addressing interpersonal conflicts. By regulating social rhythms and improving interpersonal functioning, IPSRT seeks to prevent relapses and improve overall functioning in individuals with mood disorders.
High-Intensity Interval Training (HIIT): HIIT refers to a type of physical activity that encompasses short, sporadic episodes of high-intensity exercise, separated by intervals of rest or lower-intensity workout.
Bipolar Disorder (BD): BD is a mental health condition characterized by extreme mood swings that fluctuate between episodes of mania and depression. BD can significantly impact daily functioning, relationships, and overall quality of life.
Exercise Intervention (EI): EI is a kind of intervention that use exercise as an effective non-medical approach to help improve both physical and mental health.
Major Depressive Disorder (MDD): MDD is a prevalent mental illness marked by persistent feelings of sadness, loss of interest, and impaired daily functioning. It often requires professional intervention, including psychotherapy and medication, to alleviate symptoms and improve overall well-being.
Psychotherapy: Psychotherapy refers to the therapeutic approach of addressing psychological and emotional issues through communication and exploration with a trained mental health professional. It aims to promote individual psychological well-being and happiness through the analysis and intervention of one's thoughts, emotions, behaviors, and interpersonal relationships.