Therapy for bipolar disorder
If you’re experiencing intense mood shifts that affect your daily life, you’re not alone. Bipolar disorder impacts about 3 percent of Canadians, and reaching out for support is an important step toward stability. A therapist who understands this condition can help you manage mood episodes, notice early signs, and build a more balanced and meaningful life.
What is bipolar disorder?
Common signs and symptoms
Bipolar disorder involves extreme mood swings that cycle between periods of intense highs (mania or hypomania) and periods of intense lows (depression). During a manic episode, you might feel on top of the world with limitless energy, need very little sleep, talk rapidly, make impulsive decisions, or take risks you normally wouldn't. You might spend money recklessly, start multiple projects at once, or feel invincible. During depressive episodes, the symptoms mirror depression: overwhelming sadness, loss of interest in activities, changes in sleep and appetite, difficulty concentrating, and sometimes thoughts of suicide. Some people experience mixed episodes where symptoms of mania and depression occur simultaneously, which can be particularly distressing. Between episodes, many people have periods where their mood feels relatively stable.
Types of bipolar disorder
Bipolar I disorder involves full manic episodes lasting at least one week, often severe enough to require hospitalization, plus depressive episodes. Bipolar II disorder involves hypomanic episodes (less severe than full mania) and major depressive episodes. Many people with Bipolar II spend more time in depression than hypomania. Cyclothymic disorder involves chronic fluctuating moods with periods of hypomanic and depressive symptoms that don't meet full criteria for episodes. According to the Canadian Psychological Association, genes and brain chemistry play a strong role in bipolar disorder, though stress and life events can trigger episodes. Risk factors for relapse include substance use, irregular sleep, and not taking medications as prescribed.
Statistics in Canada
Source: Health Canada, and Centre for Addiction and Mental Health.
The real impact of bipolar disorder
Relationships and social life
Bipolar disorder can place real pressure on relationships. During manic periods you may act or speak in ways that feel out of character, and during depressive periods you may pull away from people you care about. Loved ones can feel unsure how to respond, and misunderstandings can build over time. Therapy supports clearer communication, helps rebuild trust, and strengthens connection even during difficult moments.
Work or school performance
Mood changes can affect focus, reliability, and motivation at work or in school. Mania may lead to overcommitting or conflict, while depression can make basic tasks feel overwhelming. These patterns can create challenges with deadlines, attendance, or productivity. Treatment helps build routines, manage symptoms, and support steadier performance in daily responsibilities.
How therapy helps with bipolar disorder
Overview of why professional support matters
Therapy plays a valuable role. Medication can help stabilize mood, while therapy helps you notice early warning signs, manage stress, stay consistent with treatment, and build practical coping skills. Research shows that combining therapy and medication leads to better outcomes than relying on medication alone. Working with a therapist who understands bipolar disorder gives you guidance, structure, and support as you navigate daily life with this condition.
What happens in therapy
Therapy for bipolar disorder is highly structured and practical. Your therapist will help you learn to monitor your moods, identify triggers and early warning signs, develop a crisis plan for when you notice symptoms escalating, address medication adherence challenges, work through the grief and adjustment of living with a chronic condition, and develop healthy routines around sleep, stress management, and daily activities. You will likely keep mood charts or use apps to track your symptoms between sessions. The goal is to increase the time you spend stable and decrease the severity and frequency of mood episodes.
Evidence-based approaches that work
Cognitive Behavioural Therapy (CBT)
CBT is recommended as an evidence-based adjunct treatment for bipolar disorder. In bipolar-specific CBT, you learn to identify triggers of mood episodes, challenge distorted thoughts that occur during depression or mania, recognize early warning signs, develop a detailed relapse prevention plan, and practice behavioral strategies for managing symptoms. CBT helps you become an expert on your own patterns so you can intervene before episodes become severe.
Psychoeducation
Psychoeducation is the most studied and recommended intervention for bipolar disorder. It involves learning everything about your condition: what bipolar disorder is, how medications work, why sleep and routine matter, how to recognize warning signs, and how to develop self-management skills. Research shows that even brief psychoeducation programs (6 sessions) can significantly reduce relapse rates. Understanding your illness empowers you to take an active role in your treatment.
Interpersonal and Social Rhythm Therapy (IPSRT)
IPSRT is specifically designed for bipolar disorder. It focuses on stabilizing your daily routines and social rhythms (sleep-wake cycles, mealtimes, social activities) because disrupted routines can trigger mood episodes. IPSRT also addresses interpersonal conflicts and life transitions that might destabilize your mood. This approach recognizes that biological vulnerability and environmental factors interact to influence your symptoms.
Family-Focused Therapy (FFT)
Family-Focused Therapy involves your family members or close support people in your treatment. They learn about bipolar disorder, how to recognize warning signs, communication skills to reduce conflict, and problem-solving strategies. Research shows FFT improves medication adherence and reduces relapse rates. Having educated, supportive family members significantly improves outcomes.
What to expect from therapy for bipolar disorder
First session: what happens
Your first session involves a thorough assessment of your mood history, including the frequency and severity of manic and depressive episodes, what triggers your symptoms, how bipolar disorder has affected your life, your current medications, and your support system. Your therapist will ask detailed questions about your sleep patterns, substance use, and stress levels. Together, you will identify goals for therapy and begin developing a monitoring system to track your moods. This is also when you discuss whether you are currently in a mood episode or relatively stable, which affects the initial treatment focus.
Timeline: when people typically see progress
Therapy for bipolar disorder is typically longer-term than for other conditions, often lasting 12 to 20 sessions or more. Early sessions focus on education and crisis planning, which provides immediate benefit. Over several months, you will notice you are better at recognizing warning signs, more consistent with medications, and developing healthier routines. The real measure of success is reducing the frequency and severity of mood episodes over time. Some people continue with periodic maintenance sessions for years to sustain stability.
Between sessions: homework and practice
Between sessions, you will track your moods daily using charts or apps, maintain regular sleep and wake times, practice identifying negative thought patterns, implement your routine stabilization plan, and monitor for early warning signs. Your therapist may ask you to keep a sleep diary, track medication adherence, or notice specific triggers. This between-session work is crucial because bipolar disorder requires consistent daily management, not just weekly therapy sessions.
Measuring success: what improvement looks like
Success with bipolar disorder means achieving stability and preventing or minimizing mood episodes. You will spend more time in the normal mood range, recognize warning signs early and intervene before full episodes develop, maintain consistent medication use, function well at work or school, rebuild and maintain relationships, and feel confident in your ability to manage your condition. Recovery does not mean you will never have mood symptoms again, but it means they are less frequent, less severe, and less disruptive to your life.
Find a therapist who specializes in bipolar disorder
Choosing the right therapist matters. Each province in Canada has its own regulations, which is why working with a recognized professional can make a real difference in your care. Stellocare takes the uncertainty out of the process by listing only verified therapists you can trust.
The right therapist for you
No therapists found with these specialties in Ontario.
Try selecting a different province.Additional resources for managing bipolar disorder
Community services
Mood Disorders Association of Ontario (MDAO)
MDAO offers peer support programs, educational resources, and advocacy for people living with mood disorders including bipolar disorder. They provide support groups, webinars, and the "Laughing Like Crazy" program that addresses difficult issues through humor.Visit MDAO website.
Bipolar Wellness Centre
An online resource developed by Canadian researchers that provides activities and webinars about improving quality of life in areas often affected by bipolar disorder. Includes evidence-based self-management tools and quality of life assessments.Access Bipolar Wellness Centre.
AMI-Quebec (Action on Mental Illness)
AMI-Quebec offers support groups specifically for people living with bipolar disorder and separate groups for their families and friends. They provide education, guidance, and advocacy across Quebec.Learn about AMI-Quebec support groups.
CAMH Centre for Youth Bipolar Disorder
For youth and families affected by bipolar disorder, CAMH offers specialized clinical services, research programs, and educational resources focused on adolescent-onset bipolar disorder in Toronto.Visit CYBD.
Self-help techniques
Establish Stable Routines
- Sleep schedule: Go to bed and wake up at the same time every day, even weekends. Irregular sleep is one of the most common triggers for mood episodes.
- Regular meals: Eat at consistent times. Skipping meals or irregular eating can destabilize your mood.
- Daily structure: Create a predictable schedule for work, activities, and rest. Routine is protective.
Monitor Your Moods
- Daily mood tracking: Use a simple chart or app to rate your mood, energy, and sleep quality every day. Patterns will emerge.
- Know your warning signs: Learn what happens before you enter a mood episode. For mania: decreased sleep, racing thoughts, irritability. For depression: social withdrawal, fatigue, loss of interest.
- Early intervention: When you notice warning signs, contact your doctor or therapist immediately. Early action can prevent full episodes.
Medication Adherence
- Take medications consistently: Even when you feel well. Most relapses occur when people stop their medications.
- Use reminders: Set phone alarms, use pill organizers, or try medication reminder apps.
- Talk about side effects: If side effects bother you, talk to your doctor about adjustments rather than stopping on your own.
- Understand why medication matters: Medication corrects the brain chemistry imbalances that cause mood episodes. It's not a crutch or weakness.
Manage Stress and Triggers
- Identify your triggers: Life stress, conflict, seasonal changes, sleep disruption, or substance use can trigger episodes. Know what affects you.
- Limit stimulants: Caffeine, nicotine, and energy drinks can trigger mania. Be cautious.
- Practice stress management: Regular relaxation, exercise, and mindfulness help maintain stability.
Build Your Support System
- Educate loved ones: Help family and friends understand bipolar disorder so they can support you effectively.
- Create a crisis plan: Write down what loved ones should do if they notice warning signs. Include emergency contacts.
- Join a support group: Connecting with others who understand bipolar disorder reduces isolation and provides practical advice.
What to Avoid
- Alcohol and drugs: Substance use dramatically increases risk of mood episodes and interferes with medication effectiveness.
- All-nighters and irregular sleep: Even one night of poor sleep can trigger mania in vulnerable individuals.
- Stopping medication when you feel good: Feeling well means the medication is working, not that you don't need it anymore.
Common questions about therapy for bipolar disorder
How long does therapy take?
Therapy for bipolar disorder often starts with about twelve to twenty sessions to build stability. Many people continue with occasional maintenance sessions to support long-term wellness and prevent relapse.
Do I need medication?
Medication is usually necessary because it helps stabilize mood in ways therapy alone cannot. Therapy works best alongside medication by helping you manage stress, recognize early signs, and stay consistent with treatment.
What if I'm in a manic episode right now?
If you are currently experiencing mania, contact your doctor or psychiatrist immediately. Therapy is most effective once you are more stable, though a therapist can still offer safety planning and short-term support.
How do I know if therapy is working?
You may feel stable for longer periods, notice early warning signs sooner, manage stress more effectively, and follow routines more consistently. Fewer or less intense mood episodes over time is the clearest sign of progress.
What if I've tried therapy before and it didn't help?
Bipolar disorder often requires specialized therapy. If past therapy did not help, the approach may not have been specific to bipolar disorder. Try working with a therapist who uses evidence-based treatments and ensure your medications are optimized.
Related concerns
References
- Canadian Psychological Association. (2025). "Psychology Works" Fact Sheet: Bipolar Disorder. Retrieved from https://cpa.ca/psychology-works-fact-sheet-bipolar-disorder/
- Health Canada. (2024). Message from the Minister of Mental Health and Addictions and Associate Minister of Health – World Bipolar Day. Retrieved from https://www.canada.ca/en/health-canada/news/2024/03/message-from-the-minister-of-mental-health-and-addictions-and-associate-minister-of-health--world-bipolar-day.html
- Centre for Addiction and Mental Health (CAMH). (2024). Bipolar Disorder. Retrieved from https://www.camh.ca/en/health-info/mental-illness-and-addiction-index/bipolar-disorder
- Centre for Addiction and Mental Health (CAMH). Centre for Youth Bipolar Disorder. Retrieved from https://www.camh.ca/en/science-and-research/institutes-and-centres/centre-for-youth-bipolar-disorder
- Statistics Canada. (2023). Mental disorders and access to mental health care. Retrieved from https://www150.statcan.gc.ca/n1/pub/75-006-x/2023001/article/00011-eng.htm
- Schaffer, A., Isometsä, E. T., Tondo, L., Moreno, D. H., Turecki, G., Reis, C., ... & Yatham, L. N. (2015). International Society for Bipolar Disorders Task Force on Suicide: meta-analyses and meta-regression of correlates of suicide attempts and suicide deaths in bipolar disorder. Bipolar Disorders, 17(1), 1-16.
- Yildiz, A., Nikodem, M., Vieta, E., Correll, C. U., & Baldessarini, R. J. (2015). A network meta-analysis on comparative efficacy and all-cause discontinuation of antimanic treatments in acute bipolar mania. Psychological Medicine, 45(2), 299-317.
- Oud, M., Mayo-Wilson, E., Braidwood, R., Schulte, P., Jones, S. H., Morriss, R., ... & Kendall, T. (2016). Psychological interventions for adults with bipolar disorder: systematic review and meta-analysis. The British Journal of Psychiatry, 208(3), 213-222.
- Parikh, S. V., Zaretsky, A., Beaulieu, S., Yatham, L. N., Young, L. T., Patelis-Siotis, I., ... & Kennedy, S. H. (2012). A randomized controlled trial of psychoeducation or cognitive-behavioral therapy in bipolar disorder: a Canadian Network for Mood and Anxiety treatments (CANMAT) study. The Journal of Clinical Psychiatry, 73(6), 803-810.
- Yatham, L. N., Kennedy, S. H., Parikh, S. V., Schaffer, A., Bond, D. J., Frey, B. N., ... & Berk, M. (2018). Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disorders, 20(2), 97-170.
- Frank, E., Kupfer, D. J., Thase, M. E., Mallinger, A. G., Swartz, H. A., Fagiolini, A. M., ... & Monk, T. (2005). Two-year outcomes for interpersonal and social rhythm therapy in individuals with bipolar I disorder. Archives of General Psychiatry, 62(9), 996-1004.
- Miklowitz, D. J., Otto, M. W., Frank, E., Reilly-Harrington, N. A., Wisniewski, S. R., Kogan, J. N., ... & Sachs, G. S. (2007). Psychosocial treatments for bipolar depression: a 1-year randomized trial from the Systematic Treatment Enhancement Program. Archives of General Psychiatry, 64(4), 419-426.
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Victoria Nyman
Registered Psychotherapist (Qualifying) (ON)
Kate MacDonald
Registered Psychologist (AB)
Rex Cheung
Registered Social Worker (ON)
Sofia Noreen
Registered Psychotherapist (ON)
Delia Petrescu
Registered Psychotherapist (ON)
Monika Goetz
Registered Social Worker (ON)
Ivana Di Cosola
Registered Social Worker (ON)
Katharine Heimbigner-Tenor
Registered Provisional Psychologist (AB)
Anna Evans
Registered Social Worker (ON)
Irfa Samnani
Registered Psychotherapist (Qualifying) (ON)
Melanie Zimerman
Canadian Certified Counsellor
Katherine Collins
Registered Psychotherapist (Qualifying) (ON)
Peter Wong
Registered Psychotherapist (ON)
Supriya Verma
Registered Psychotherapist (Qualifying) (ON)
Joanne Prysunka
Canadian Certified Counsellor
Liv Noël Dakkak
Registered Social Worker (ON)
Kat Sevsek
Registered Psychotherapist (Qualifying) (ON)
Shiny Yang
Occupational Therapist (ON)
Natalie Bender
Registered Psychotherapist (Qualifying) (ON)
Jessica Marshall
Registered Counselling Therapist (NS)
Victoria Nyman
Registered Psychotherapist (Qualifying) (ON)
Kate MacDonald
Registered Psychologist (AB)
Rex Cheung
Registered Social Worker (ON)
Sofia Noreen
Registered Psychotherapist (ON)
Delia Petrescu
Registered Psychotherapist (ON)
Monika Goetz
Registered Social Worker (ON)
Ivana Di Cosola
Registered Social Worker (ON)
Katharine Heimbigner-Tenor
Registered Provisional Psychologist (AB)
Anna Evans
Registered Social Worker (ON)
Irfa Samnani
Registered Psychotherapist (Qualifying) (ON)
Melanie Zimerman
Canadian Certified Counsellor
Katherine Collins
Registered Psychotherapist (Qualifying) (ON)
Peter Wong
Registered Psychotherapist (ON)
Supriya Verma
Registered Psychotherapist (Qualifying) (ON)
Joanne Prysunka
Canadian Certified Counsellor
Liv Noël Dakkak
Registered Social Worker (ON)
Kat Sevsek
Registered Psychotherapist (Qualifying) (ON)
Shiny Yang
Occupational Therapist (ON)
Natalie Bender
Registered Psychotherapist (Qualifying) (ON)
Jessica Marshall
Registered Counselling Therapist (NS)