Diagnosis: A Delicate Balance

We often chalk up the mood swings of bipolar patients to their genes and biology. But a new study suggests that bipolar patients' beliefs about their mood swings may influence whether or not they can control them.

Researchers from the University of Manchester assessed patients' convictions about their condition as well as their symptoms and day-to-day functioning. They found that patients' thinking predicted their future mood swings even when their medical history had been controlled for.

Patients who held extreme notions about their moods (such as, "I have no control over whether I get excited when something good happens to me") developed more mood problems within the study's one-month time frame. In contrast, patients who felt their ups and downs were manageable experienced fewer symptoms and better social and work functioning.

The results suggest an immense potential for talk-based therapies. "Because there's a real role for medication in this disorder, patients can think it's a strictly biological problem," says coauthor Warren Mansell. "But when we work with clients, we see that they do have quite a bit of control."—Rebecca Searles

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A TEAM-based Approach

In light of the study's findings, Mansell and his colleagues have developed a special form of Cognitive Behavioral Therapy called TEAMS (Thinking Effectively About Mood Swings) based on their model of assessing and then adjusting patients' beliefs about their mood swings and level of personal control.

Other researchers have focused on a relapse- prevention model, Mansell explains, identifying and dealing with both triggers for and signs of relapse. The TEAMS approach centers on how patients process things in the present. "If you plan your life by just telling yourself what to avoid, then you're prioritizing the bad things and the anxiety around those," Mansell says. "We're not just helping people to avoid relapse, we're helping them build a sense of self that's resilient and strong."

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