| | Module | Patient 1 (Kim) | Patient 2 (Meg) | Patient 3 (Hank) |
| | A. Psychoeducation | Patients were provided with the following information: the prevalence of bipolar disorders is about 2% and the prevalence in men and women, which reaches 5% when subthreshold bipolar conditions are included, is about the same [33, 34]. The highest risk is associated with adolescence, especially peaking between the ages of 15 and 20 [34, 35]. Bipolar disorder is prone to significant social disability and to relapse [36, 37]. It is also reported that episodes of mania and depression are periodic [38, 39] and that episodic periods can become increasingly shorter [40]. Anxiety plays a significant role as a risk of recurrence [41], and there is a tendency for worse outcomes in the presence of substance abuse [42, 43]. Suicide rates are 0.4% per year, 20 times the rate of suicide in the general population [39]. Furthermore, patients were introduced to the six most common precursors to mania (decreased sleep time, increased goal-directed activity, increased irritability, increased sociability, lost thought, and increased optimistic thinking) [23, 24, 44], and they were explained that being aware of his prodromal symptoms and developing and practicing skills to cope are the core of CBT [26]. | | B. Case conceptualization and therapeutic goal setting | When she meets a person, she thinks “Is she going to say something negative?” She reinforces the belief, “I’m worthless.” As a result, she does not leave the house and does not consult anyone.
Goals: increase outings, resume hobbies, and talk to colleagues. | Meg was depressed about the fact that the inside of the house is scattered, and the nonfunctional belief, “I am lazy and useless,” is activated. Meg drives purpose-oriented activities to regain self-confidence; therefore, she always postpones annoying routines.
Goals: cleaning up her house, managing money, and keeping on living comfortably without bipolar disorder. | Hank’s mood is uplifting; he overdoes his work, makes mistakes, and activates the nonfunctional belief, “I am a bad person.” To get away from it though, he was immersed in work.
Goals: determine the amount of work, manage money, and join the community. | | C. Monitoring activation and mood | Hypomanic: decreased sleep time, increased activity, talkativeness, and extravagance.
Depression: loss of appetite, self-responsibility, worthlessness, loss of interest, abdominal pain, and headache. | Hypomanic: decreased sleep time, increased purpose-oriented activities, increased sociability, increased optimistic thinking, and talkativeness.
Depression: decreased interest and activity, sad mood, reduced motivation, reduced self-esteem, and pessimistic thinking. | Hypomanic: reduced sleep time, increased activity, talkativeness, frustration, increased money, increased work, and approaching women.
Depression: abdominal pain, decreased interest and activity, sad mood, reduced motivation, pessimistic thinking, and increased sleep. | | D. Mastering coping behaviors with prodromes | Hypomanic precursors: taking a break, calling a family member, and consulting a physician.
Depression precursor: meeting friends and family and watching favorite pictures. | Hypomanic precursors: doing daily routines such as housekeeping and cleaning and performing unscheduled actions (delayed) in the 24-hour transition.
Depression precursor: exercising and meeting friends. | Hypomanic precursor: when shopping, do not buy immediately. Wait for a week, before deciding to buy things added to an online shopping basket.
Depression precursor: walking, meeting an older brother, not falling asleep, and not reflecting alone. | | E. Establishing sleep and daily routine | Schedule activities during the day, wake up on time, and consume meals regularly. | Meg’s daytime activity has improved her sleep quality at night. She refrained from taking a nap and excessive caffeine. | Hank decides to go to work on weekdays, even if he does not feel good. Overtime is restricted to 19:00, even if there is work left. Hank managed bathing, muscle training, and game time. | | F. Rescripting dysfunctional beliefs | Kim identified the beliefs “I am worthless” and “Everything will fail” and rewrote it as “The future is unpredictable, let us act first.” | Meg identified the belief “I am useless and worthless” and rewrote it as “I am loved by friends and family.” | Hank identified the belief “I am a bad person and I will lonely for life” and rewrote it as “I am single now; I do not know what will happen in the future. I have brothers and friends.” |
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