Bipolar Disorder Treatment

Living with bipolar disorder can feel like being on an emotional rollercoaster. One moment you might feel energized and full of ideas, and the next you may find yourself in a fog of exhaustion, sadness, or self-doubt. These shifts in mood and energy are more than emotional highs and lows, they’re signs of a complex, treatable mental health condition that affects how you think, function, and connect with others.

At Cognitive Behavioral Therapy & Assessment Associates (CBTAA), we understand the challenges of living with bipolar disorder. We specialize in providing therapy that’s not only research-backed, but personalized to your unique experience. Whether you’re newly diagnosed, navigating symptoms that don’t seem to fit any one category, or seeking support alongside medication management, our team is here to help.

{{divider="/external-components"}}

Understanding Bipolar Disorder

Bipolar disorder is a mood disorder defined by episodes of emotional highs (mania or hypomania) and lows (depression). These shifts are more than moodiness, they affect how you think, sleep, behave, and function.

Bipolar disorder is more common than many people realize. According to data from the National Comorbidity Survey Replication, an estimated 2.8% of U.S. adults experienced bipolar disorder in the past year, with similar rates between men (2.9%) and women (2.8%). Over the course of a lifetime, approximately 4.4% of adults in the United States will experience bipolar disorder. That means millions of people are navigating the same challenges, and many are finding relief through proper treatment and support. What many people don’t realize is that bipolar disorder isn’t one-size-fits-all. It includes several types, each with its own symptom patterns and challenges.

{{divider="/external-components"}}
{{internal-ad="/external-components"}}

Bipolar I Disorder

Bipolar I Disorder is characterized by at least one full manic episode. Mania is a distinct period of elevated or irritable mood accompanied by heightened activity or impulsivity that significantly impairs functioning. During manic episodes, individuals may speak rapidly, leap from one idea to the next, take on multiple unrealistic projects, or engage in risky behavior such as unprotected sex, reckless driving, or excessive spending. They may feel euphoric, powerful, or invincible, or conversely, irritable and restless. Sleep often decreases dramatically, yet the person still feels physically energized.

In some cases, mania includes symptoms of psychosis, such as delusions or hallucinations, which may make it difficult for the individual to distinguish what’s real from what isn’t. These episodes can escalate quickly and are often severe enough to require hospitalization for safety or stabilization. While depression isn’t “required” for a diagnosis of Bipolar I, most people with the condition also experience major depressive episodes, which can last weeks or months and include deep sadness, hopelessness, fatigue, and suicidal thoughts.

Bipolar II Disorder

Bipolar II Disorder involves a pattern of at least one major depressive episode and at least one hypomanic episode, without ever experiencing a full manic episode. Hypomania is a milder form of mania that can still include increased energy, decreased need for sleep, heightened creativity or productivity, and a feeling of being “on.” However, unlike mania, hypomania does not cause severe impairment or require hospitalization. For many people, it may even feel pleasant or productive, leading them to overlook or dismiss these episodes entirely.

The depressive episodes associated with Bipolar II, however, tend to be more frequent and longer-lasting than in Bipolar I. These periods can include persistent sadness, low motivation, feelings of worthlessness, difficulty concentrating, and changes in sleep or appetite. Because the hypomanic periods may not seem problematic, individuals with Bipolar II are often misdiagnosed with depression alone, delaying appropriate treatment. Understanding the full cycle—both the lows and the subtle highs—is critical to getting the right care.

Cyclothymic Disorder (Cyclothymia)

Cyclothymia is a chronic mood condition that involves frequent mood fluctuations over an extended period, typically two years or more in adults (one year in children and teens). These shifts move between hypomanic symptoms and depressive symptoms, but neither set of symptoms meets the full criteria for a hypomanic or major depressive episode. That means the emotional swings are less extreme than in Bipolar I or II, but they are more persistent and can be just as disruptive to daily life.

People with cyclothymia often describe themselves as feeling emotionally inconsistent or like they’re constantly “off balance.” They may experience brief periods of high energy, creativity, or restlessness, followed by stretches of low mood, fatigue, or withdrawal. These changes can be subtle and hard to track, especially because there may be few stretches of emotionally neutral mood in between.

While cyclothymia is sometimes seen as a “milder” form of bipolar disorder, the instability it causes can lead to difficulties in relationships, self-esteem, and functioning over time. Left untreated, cyclothymic disorder can progress into Bipolar I or II. Therapy can help by increasing self-awareness, identifying patterns, and developing strategies to stabilize mood and build more predictability into daily life.

Rapid Cycling

Rapid Cycling describes a pattern where someone with bipolar disorder has four or more mood episodes– either manic, hypomanic or pressive, all within a single year. These episodes have to meet the usual criteria for bipolar disorder and be clearly separated by periods of more stable mood, or by a shift to a different type of episode.

This pattern can make bipolar disorder especially tough to manage because mood changes may feel like they come on quickly or unpredictably. Some people cycle over the course of weeks, while others may notice changes within the same week.

If mood swings are happening many times within a single day, though, that is often a sign of something different. In bipolar disorder, moods usually shift over the course of days or weeks. In cyclothymia, people may move between moderate highs and moderate lows from day-to-day. But when extreme emotional shifts happen several times in the same day, it is more likely related to Borderline Personality Disorder. This is one reason mood disorders are sometimes middiagnosed early on.

Because of this, one of the first steps in treatment is for your therapist to carefully map out a timeline of your mood changes. This helps clarify whether the pattern is due to bipolar disorder, cyclothymia, borderline personality disorder, or something else.

Individuals with rapid cycling often feel frustrated by how frequently their emotional state changes, and they may struggle to maintain routines, relationships, or work obligations. Treatment for rapid cycling typically involves a combination of mood-stabilizing medication and targeted therapy to track patterns, reduce reactivity, and increase coping capacity.

Understanding which type of bipolar disorder you’re experiencing is key to developing an effective treatment plan. At CBTAA, your therapist will work with you to understand what you’re experiencing and build a plan that supports stability over time.

{{divider="/external-components"}}

Common Symptoms of Bipolar Disorder

Bipolar disorder affects people in different ways, but most symptoms fall into two categories: those that occur during manic or hypomanic episodes, and those that happen during depressive episodes. Recognizing these patterns is often the first step toward getting the right support.

Symptoms of Mania or Hypomania:

• A noticeable shift in mood—feeling unusually high, energized, or irritable
  
  
• Needing much less sleep than usual, without feeling tired
  
  
• Racing thoughts or jumping quickly between ideas
  
  
• Talking faster than normal or feeling pressure to keep talking
  
  
• Feeling overly confident or invincible
  
  
• Taking on too many projects or setting unrealistic goals
  
  
• Engaging in risky or impulsive behaviors (e.g., excessive spending, unsafe sex, reckless driving)
  
  
• Getting easily distracted or feeling unable to focus
  
  
• Physical agitation or restlessness
  
  

Symptoms of Bipolar Depression:

• Feeling persistently down, empty, or hopeless
  
  
• Losing interest in things you used to enjoy
  
  
• Low energy or constant fatigue
  
  
• Sleeping too much or too little
  
  
• Changes in appetite or weight
  
  
• Trouble focusing or making decisions
  
  
• Feeling worthless or overwhelmed by guilt
  
  
• Moving or speaking more slowly than usual
  
  
• Thoughts of death or suicide
  
  

Some people experience mixed episodes, where signs of depression and mania show up at the same time; for example, feeling hopeless but also restless and agitated. These combinations can be especially distressing, and they often make it harder to recognize what’s going on without professional support.

{{divider="/external-components"}}

How Therapy Helps with Bipolar Disorder

Bipolar disorder is a complex mood condition marked by shifts between depression and mania or hypomania. Effective treatment focuses on stabilizing mood, preventing relapse, regulating emotions, and restoring day-to-day functioning. Therapy plays a central role by offering psychoeducation about the nature of bipolar disorder, helping clients detect early warning signs of mood changes, and teaching strategies to manage triggers and lifestyle factors that influence stability.

Medication is often the foundation of treatment, but therapy provides the structure and coping skills that support long-term wellness. In sessions, clients learn how to spot the first signs of mood shifts and take proactive steps to reduce their impact—whether that means adjusting sleep routines, lowering stress, or practicing coping strategies outside of therapy. Therapy also strengthens problem-solving skills, supports emotion regulation, and helps repair relationships that may have been strained by past episodes.

Just as important, therapy fosters self-compassion. Living with bipolar disorder can be overwhelming, and many people struggle with guilt or shame after an episode. Healing begins not with self-criticism, but with understanding your brain, your patterns, and your strengths. By combining insight with actionable skills, therapy helps build a foundation for stability, resilience, and a better quality of life.

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is the most effective, evidence-based approach for treating bipolar-disorder, especially when paired with medication. CBT helps you identify how thoughts, behaviors, and routines impact mood, and supports you in making intentional changes that reduce emotional instability and change in your behaviors.

Through CBT, you can start to recognize patterns that contribute to mood shifts, like irregular sleep, high stress, or perfectionistic thinking, and be provided tools to shift those patterns in real time. The focus is not just on insight, but on action. Your therapist will help you build a structured, repeatable rhythm to your days that supports consistency even when emotions fluctuate.

Behavioral Activation

During depressive episodes, CBT includes behavioral activation, a structured process of re-engaging with life, even when motivation is low. Instead of waiting to feel better before taking action, behavioral activation helps you take small, manageable steps that can lead to meaningful change in mood and energy.

Your therapist might help you identify a few simple, value-aligned activities, like going for a short walk, listening to music, making your bed, or connecting with a friend, and then gradually increase engagement from there. Over time, these actions build a sense of momentum and personal agency, helping to disrupt the cycle of avoidance that depression can create.

Interpersonal and Social Rhythm Therapy (IPSRT)

Another core therapy for bipolar disorder is Interpersonal and Social Rhythm Therapy (IPSRT). IPSRT focuses on stabilizing daily routines including sleep, meal times, and activity levels. Research shows disruptions in biological rhythms are strongly linked to mood episodes. By creating a more predictable daily structure, IPSRT helps regulate mood swings and reduce relapse risk.

IPSRT also addresses interpersonal challenges, such as conflict, role transitions, or loss, which can trigger or worsen symptoms. This therapy can be delivered on its own or as part of a CBT framework. For many people with bipolar disorder, learning to align lifestyle rhythms with mood stability becomes a cornerstone of long-term recovery.

Dialectal Behavior Therapy (DBT)

Dialectical Behavior Therapy (DBT) is especially helpful for people with bipolar disorder who struggle with intense emotions, impulsive behavior, or thoughts of self-harm. It was originally developed for individuals with chronic emotion dysregulation, but its structured, skills-based approach makes it highly applicable to bipolar disorder, especially in cases involving mood instability, mixed episodes, or difficulty managing transitions between emotional states.

What sets DBT apart is its dual emphasis on acceptance and change. Rather than pathologizing emotional extremes, DBT acknowledges the reality of emotional sensitivity while also equipping clients with concrete tools to navigate life more effectively. It’s especially beneficial for individuals who find themselves caught in cycles of emotional overwhelm, interpersonal conflict, or self-destructive behavior.

DBT is organized around four core skill areas:

Mindfulness

Mindfulness is the foundation of DBT and teaches you how to observe your thoughts, feelings, and bodily sensations without judgment. For people with bipolar disorder, this can be especially powerful during early signs of mood escalation or during mixed episodes when internal experiences feel chaotic. Practicing mindfulness helps you create a pause—a moment of awareness that can interrupt automatic reactions and allow for more intentional decision-making.

Emotion Regulation

This skill set helps you understand what emotions are, where they come from, and how to manage them more effectively. DBT teaches strategies for reducing emotional vulnerability through activities like getting regular sleep, eating consistently, and engaging in meaningful movement. It also helps you identify when emotions are useful, and when they may be driven more by mood symptoms than reality. Learning how to ride out intense feelings without acting on them is often a game-changer for clients with bipolar disorder.

Distress Tolerance

Distress tolerance skills are designed to help you get through acute emotional crises without making things worse. These tools are especially useful during periods of suicidal ideation, urges to self-harm, or severe agitation. Rather than suppressing or avoiding pain, DBT teaches ways to cope using grounding strategies, self-soothing, distraction, and radical acceptance to survive the moment while maintaining long-term goals.

Interpersonal Effectiveness

Mood symptoms can strain relationships, especially when irritability, impulsivity, or isolation are involved. DBT’s interpersonal effectiveness module teaches assertiveness, boundary-setting, and healthy communication. For individuals with bipolar disorder, this can mean learning how to ask for support when needed, repair trust after an episode, or advocate for stability in romantic, family, or workplace relationships.

Acceptance and Commitment Therapy (ACT)

Acceptance and Commitment Therapy (ACT) offers a different way of approaching bipolar disorder—not by trying to eliminate difficult thoughts or emotions, but by helping you relate to them differently. Instead of fighting your experience, ACT encourages you to accept what’s outside your control and commit to actions that align with your values, even when symptoms show up.

For people with bipolar disorder, this shift can be powerful. Mood episodes often come with internal narratives like “I’ll never be stable,” “I can’t trust myself,” or “If I start to feel good, it means something bad is coming.” These thoughts can be overwhelming, not just because of their content, but because of how tightly we grip them. ACT teaches you how to hold these thoughts more lightly, and to recognize that while you may not control every feeling or symptom, you do have control over how you respond.

A key goal in ACT is developing psychological flexibility, which means developing the ability to stay present, open, and engaged in life, even when things are hard. This doesn’t mean giving up or resigning yourself to suffering. It means building a life that reflects who you are and what matters most to you, regardless of what your mood is doing on any given day.

ACT also helps address the fear of relapse or the anxiety that often lingers between episodes. Rather than organizing your life around avoiding discomfort, ACT helps you move toward a life that feels meaningful and fulfilling, whether you’re in a period of stability or facing new challenges.

Your therapist will work with you to clarify your personal values and create goals rooted in those values. Over time, this approach helps anchor you, not in mood states, but in your core sense of purpose and identity.

{{divider="/external-components"}}

What to Expect in Your First Therapy Session

Starting therapy for bipolar disorder can feel like a big step, but it doesn’t have to feel intimidating. Your first session at CBTAA is all about building connection and understanding. There’s no pressure to explain everything perfectly or know exactly what you need. We’ll meet you where you are.

Your therapist will begin by learning more about your story: what’s bringing you in, how mood changes have affected your life, and what you’re hoping to get out of therapy. You’ll talk about your experiences with mania, hypomania, depression, or mixed states, and explore how those symptoms have shown up over time. If you’re unsure how to describe your experiences, that’s okay, your therapist will ask thoughtful, supportive questions to help guide the conversation.

This initial phase is called a therapeutic assessment, and it usually unfolds over one to three sessions. Your therapist will be looking for patterns: what makes things better or worse, what support systems are in place, and where we can begin to create real, sustainable change.

You’ll also talk through your goals. Maybe you want to better manage stress at work, rebuild trust in a relationship, prevent future episodes, or simply feel more like yourself. Whatever it is, we’ll collaborate on a treatment plan that reflects what matters to you.

By the end of your first session, you should have a clearer sense of how therapy works, what your therapist’s approach will be, and how your sessions will support you in building more stability, confidence, and direction.

How Long Does Treatment Take?

There’s no single timeline for treating bipolar disorder, because the needs, goals, and life circumstances of each client are different. Some people benefit from short-term, skills-based therapy, around 12 to 20 sessions, that focuses on managing a specific issue, like recognizing early warning signs or building a stable routine. Others choose longer-term therapy to address deeper patterns, strengthen relationships, or maintain progress across life transitions.

Bipolar disorder is a lifelong condition, but that doesn’t mean you’ll be in therapy forever. Our goal at CBTAA is to equip you with the tools, structure, and insight you need to feel more in control of your mood and your life. Therapy is designed to help you build confidence in your ability to manage ups and downs, not just during sessions, but between them and long after therapy ends.

Some clients check in weekly, others biweekly, and some transition to monthly or as-needed sessions over time. Your therapist will work with you to review progress, recalibrate goals, and ensure that treatment continues to meet you where you are.

Whether your journey is a few months or a few years, we’re here to walk alongside you with support, structure, and deep clinical expertise.

{{divider="/external-components"}}
{{clinicians="/external-components"}}

Getting Started with CBTAA

At CBTAA, our clinicians specialize in evidence-based care for mood disorders, including CBT, DBT, and ACT. Every therapist on our team is part of a collaborative, nationally trained network that prioritizes quality, compassion, and long-term support. Whether you’re newly diagnosed or have been navigating symptoms for years, we’re here to help you build stability, insight, and confidence.

Beginning therapy for bipolar disorder can feel like a big step, but you don’t have to take it alone. We start with a free 15-minute consultation to learn more about your needs and match you with the right clinician. From there, your therapist will guide you through a thoughtful intake process and work with you to create a personalized treatment plan. We offer both in-person and virtual therapy across New York City, New York, New Jersey, and Connecticut, so wherever you are, we’ll meet you there.