Table 1 Description of the content of the CBT programme
Session | Content description |
|---|---|
Session 1: Introduction to the programme | Introduce the CBT model, flight or fight response. Discussion of these components in relation to BD, education about different types of anxiety in BD and how it may vary depending on the mood state |
Session 2: Relaxation training | Practice and describe the different types of relaxation training, progressive muscle relaxation activity, controlled breathing practice and other forms of relaxation for BD |
Session 3: Anxiety and the importance of thoughts | Adaptive basis of the components of anxiety, explanation of automatic thoughts in anxiety, different types of classic thinking errors that can occur, discuss in a group how these may be different in mania and depression with BD |
Session 4: Challenging anxious thoughts | Define worry and its role in maintaining anxiety, introduce the idea of challenging automatic thoughts, asking and answering disputing questions and constructing rational responses |
Session 5: Behavioural experiments | Negative predictions and how they can impact on anxiety; constructing behavioural experiments, what behavioural experiments are and how they are important in treating anxiety; and discuss timing and mood states in BD |
Session 6: Graded exposure | Avoidance and safety behaviours how it maintains anxiety in BD, describe what graded exposure is and its role in treating anxiety and describe exposure stepladders and how they are important in countering avoidance and safety behaviours |
Session 7: Problem-solving | Problem-solving and the relationship between this and worry solvable worries and unsolvable worries and different steps in problem-solving: identify and define the problem, generate possible solutions/options list and evaluate alternatives and implement plan |
Session 8: Assertiveness | Assertiveness and how this can be related to anxiety; talk about the differences in non-assertive, assertive and aggressive responses and protective skills when using healthy assertion |
Session 9: Conclusion | Revision, plan for continuing to manage anxiety and BD and discuss potential stressors that may arise when implementing the plan and how they should be managed |