Basics of Therapy

The process of cognitive behavioral therapy involves therapists teaching patients methods they can use to become aware of and then examine their distorted thinking and perceptual processes and then perform reality testing upon their distorted judgments so as to make them more accurate. Thoughts influence patients' perceptions of the world, and in turn those perceptions become patients' reality. Distorted thoughts lead to unstable or faulty perceptions. For example, people experiencing a manic episode might falsely conclude that they have endless energy, and as a result may overexert themselves while exercising. They may take multiple aerobics classes or run for hours. Although their perception is that they are tireless, their body will soon give them a true reality check. The eventual fatigue and emotional crash can add to the physical and psychological distress they experience. Improving patients' capacity for effective reality testing helps them to become more aware of situations when they are acting in unusual or potentially self-damaging ways, and helps them to stop potentially harmful behaviors before they become truly harmful.

Monitoring and Grading Mood. One useful technique is a method for helping the patient predict or recognize an impending episode. This is done using a graph and diary that records and grades the effect of the patient's mental state on energy and physical activity.
There are a number of charts for doing this. With one method the patient makes a time line across the page and a vertical line on the left side of the time line with a range from -5 to +5:

* -5 to -1 indicates the depressive phase. Minus five is the most severe depressive state and requires hospitalization. At this score, the patient's psychomotor responses are almost entirely negative. The patient is unable to function, has no appetite, and can barely get out of bed. As the scale moves up to zero, the depressive state lessens, so that minus one connotes subdued mood with slightly less energy than normal.
* Zero is normal.
* Plus one to five indicates the manic phase. For example, plus one indicates a slightly more active and energetic state than normal. Plus five is the most severe manic state, where the patient is incapable of slowing down, experiences impaired thinking and judgment, and sleeps at least two hours less than normal.