Cognitive therapy of postmanic and postdepressive dysphoria in bipolar illness

This paper describes a common dysphoric syndrome occurring during the remission from manic-depressive episodes. Its affective, cognitive and behavioral aspects represent a significant vulnerability to further relapses. It does not respond to pharmacotherapy and requires individual psychotherapy over a period of two to four years. Such therapy usually has three phases. Initially erroneous assumptions concerning bipolar illness and magic expectations regarding treatment are identified and corrected to resolve a negative transference. The main therapeutic focus then shifts to the patient's sense of emptiness. To foster a continuous and integrated sense of self, the patient is advised to write a diary, cultivate memories of competence and recognition, remember previous sessions, develop realistic goals, and read relevant problem-related novels. Finally, improvement in tolerance for ambiguity and accuracy in perceiving self and others, move the patient from the despair of "everydayness" to more serenity and a sense of mastery over his destiny.