A number of therapies can be helpful for individuals with bipolar disorder and PTSD. Of course, there is no one-size-fits-all model for treatment, but I will share some of the best evidence-based treatments for both disorders. Specific to bipolar disorder, Interpersonal and Social Rhythm Therapy (IPSRT) is the gold standard of care for managing mood symptoms and preventing mood episodes. The premise of the therapy is that individuals with mood disorders have more sensitive circadian rhythms (our internal biological clock) so structure and routine as well as disruptors to routine can be helpful in managing mood symptoms. Another big component of IPSRT is the interpersonal piece in that our relationships have a huge impact on our mood. Of course trauma symptoms can really affect our relationships and in turn our mood so IPSRT can simultaneously address underlying trauma symptoms while targeting mood symptoms as well in the context of relationship functioning.

Dialectical Behavior Therapy (DBT) is another treatment commonly used for bipolar disorder. While it was originally developed for individuals with borderline personality disorder (BPD), it has been shown to be effective in addressing a wide variety of concerns including mood symptoms. DBT is a skills-based therapy with four modules: mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness. Mindfulness teaches us how to be in the “here and now” in spite of the stress of daily life. Distress tolerance provides useful skills when someone is in the thick of a more painful emotional situation.  Emotion regulation on the other hand offers a framework for understanding the relation between mood and emotion, even in the absence of intense feelings or immediately painful situations. Lastly, interpersonal effectiveness provides guidance on how to navigate relationships through skills like assertiveness. All of these modules together provide a subset of skills that can help individuals with bipolar disorder proactively as well as reactively respond to stressors as they arise to mitigate the severity and frequency of mood symptoms.

These days, there are a wide variety of trauma therapies. That being said, they are not all created equal and some have a much larger evidence base than others. Of note, trauma work can be incredibly difficult and potentially destabilizing so it is best to approach exploring trauma when mood symptoms have been stable for a reasonable period of time. You and your clinician can collaboratively decidedwhen that might be. In terms of the trauma therapies I most commonly recommend, Prolonged Exposure (PE) and Cognitive Processing Therapy (CPT) are two treatments that have significant efficacy and widespread applicability. PE is an exposure therapy designed for individuals with PTSD. Its premise is that the avoidance of trauma symptoms prevents a deeper processing of traumatic memories that in turn maintains trauma symptoms over time. The goal of PE is to tell your narrative in a safe environment so that new learning can take place in the hopes that these memories and symptoms will have less power over time. CPT is relatively similar although it is writing-based and more focused on schemas (a mental framework for how you understand the trauma) and stuck points (sticky thoughts / beliefs) that reinforce beliefs such as self-blame / shame common to individuals with trauma histories. Similarly, STAIR Narrative Therapy (Skills Training in Affective and Interpersonal Regulation) is a wonderful therapy designed for complex trauma (repeated exposure to multiple traumatic events). STAIR has two parts; the first focuses on emotion regulation skills similar to DBT and the second is similar to PE with a focus on narrative storytelling.

While there are so many other trauma therapies available these days such as EMDR (Eye Movement Desensitization and Reprocessing), Somatic Experiencing, and Internal Family Systems (IFS), the mechanisms of recovery are actually quite similar to narrative storytelling. The goal of most trauma therapies is habituation to trauma symptoms (whether somatic, emotional, or cognitive) to facilitate healing over time. EMDR and SE are different from narrative approaches due to their focus on targeting aspects of the bodily experience that talk therapy does not always adequately address. IFS is a somewhat more controversial therapy that does not yet have a substantive body of literature to support its efficacy. It is based on the idea that our psyche is composed of different parts that can be in conflict with one other and thus the goal is to understand and harmonize them to facilitate more self-compassion.

These are just a few recommended therapies for bipolar disorder and PTSD. New treatments are frequently being designed and explored. It can be helpful to engage in your own independent reading in collaboration with your therapist to design the right treatment program for you. That being said, with the influx of misinformation online (especially social media), it is crucial to utilize reliable sources in considering different approaches.