Bipolar: CBT Interventions for Hypomanic and Depressive Episodes

On the last track we discussed the best case scenario technique.  I find the best case scenario technique can be implemented early in therapy for increasing a bipolar client’s self-esteem regarding depressive episodes.

On this track we will discuss the Cognitive Behavior Therapy compassionate perspective technique.  There are four steps in the compassionate perspective technique.  The four steps are to foster an understanding of equality through human struggle, to provide the client with a sense of self worth, to qualify the client’s understanding of the concept, and to validate the client. 

Do you recall Betsy, age 39, from track 1?  After her son was born, Betsy’s mood brightened almost at once.  Betsy’s husband David stated, "The crying spells and hours of silence disappeared and I thought she was herself again.  But then, one Friday night I came back from catering a banquet and found Betsy wearing nothing but her underwear and she was icing a cake. 

"Two other cakes were on the counter and the kitchen was a mess.  She said she’d made one for each of us and that she wanted to party.  I started to change the baby because he was crying, but she wanted to drag me off to the bedroom.  She said, ‘Please, sweetie, it’s been a long time.’  I mean, even if I hadn’t been dead tired, who could concentrate on sex with the baby crying like that?" 

However, David gave in and took his wife to the bedroom.  David stated to me, "Then just after we started, you know, she started crying.  She screamed at me to get off of her and told me she was worthless.  She said she didn’t deserve me." 

How might you have responded to David?  What do you think might have helped Betsy?

4-Step "Compassionate Perspective" CBT Technique
I discussed the compassionate perspective technique.  I felt that the use of this technique might help Betsy in putting her struggle into perspective and give her a feeling of self worth, which may in turn help decrease the intensity of her depressive episodes. 

Step #1: The first step in the compassionate perspective technique is to foster an understanding of equality through human struggle.  I stated to Betsy, "Take a good look at yourself through the lens of compassion.  Compassion exposes the essence of your humanness.  In order to really understand this concept, it helps to look at what you understand about yourself.  First, we all live in a world in which we must constantly struggle to meet basic needs or we will die.  Almost all of your energy goes into these basic needs. 

"You do the best you can with what you’ve got.  But the available strategies you have for meeting your needs are limited by what you know and don’t know, your conditioning, your emotional make-up, the degree of support you receive, your health, your sensitivity to pain and pleasure, and so on.  And throughout this struggle you are aware that both your intellectual and physical abilities will inevitably deteriorate and despite all your efforts you will die.  The same is true for everyone."  Betsy began to see that others struggled through life much the same as she did. 

Step #2: For the second step in the compassionate perspective technique, I wanted to provide Betsy with a sense of self worth.  I stated, "Regardless you carry on.  That is the key point.  In the face of struggle you carry on.  That’s why you’re still here today.  You continue to live and feel no matter what.  If you let this awareness soak in and really feel the struggle, you may begin to get a glimmer of your real worth."  Betsy slowly began to understand. 

Step #3: The third step in the compassionate perspective technique is to qualify the client’s understanding of the concept.  I asked Betsy what she thought all this meant.  Betsy stated, "So the degree of success is irrelevant?  The only thing that really counts is the effort.  Well, I do try hard to be a good wife.  I just lose my mind sometimes." 

Step #4: The fourth step in the compassionate perspective technique is to validate the client.  I responded to Betsy, "Do you think you’re the only one?  Lots of people lose their minds sometimes.  But nonetheless, you keep trying.  That makes you worth a lot." 

Think of your Betsy.  Would it help your client to see that the source of his or her worth is in the effort he or she puts into life?

On this track we have discussed the compassionate perspective technique.  There are four steps in the compassionate perspective technique.  The four steps are to foster an understanding of equality through human struggle, to provide the client with a sense of self worth, to qualify the client’s understanding of the concept, and to validate the client. 

Peer-Reviewed Journal Article References:
Dhokia, M., Elander, J., Clements, K., & Gilbert, P. (2020). A randomized-controlled pilot trial of an online compassionate mind training intervention to help people with chronic pain avoid analgesic misuse. Psychology of Addictive Behaviors. Advance online publication.

Eyal, T., Steffel, M., & Epley, N. (2018). Perspective mistaking: Accurately understanding the mind of another requires getting perspective, not taking perspective. Journal of Personality and Social Psychology, 114(4), 547–571.

Grégoire, S., Chénier, C., Doucerain, M., Lachance, L., & Shankland, R. (2020). Ecological momentary assessment of stress, wellbeing, and psychological flexibility among college and university students during acceptance and commitment therapy. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 52(3), 231–243.

Martins, M. J. R. V., Castilho, P., Carvalho, C. B., Pereira, A. T., Santos, V., Gumley, A., & de Macedo, A. F. (2017). Contextual cognitive-behavioral therapies across the psychosis continuum: A review of evidence for schizophrenia, schizoaffective and bipolar disorders. European Psychologist, 22(2), 83–100.

Sprecher, S., Zimmerman, C., & Abrahams, E. M. (2010). Choosing compassionate strategies to end a relationship: Effects of compassionate love for partner and the reason for the breakup. Social Psychology, 41(2), 66–75.

QUESTION 2
What are the four steps in the compassionate perspective CBT technique? To select and enter your answer go to Test.