Bipolar relapse prevention formulation
Map how vulnerability, stress and lost sleep, early warning signs and your response to them can build into a mood episode, drawing on Lam et al.'s cognitive therapy for bipolar disorder.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Bipolar relapse prevention formulation
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How mood swings build and keep going
Some people are more vulnerable to big changes in mood, energy and sleep. Stress, and lost sleep or routine, can set off early warning signs, and how you respond to them can turn a wobble into an episode, which brings new stresses of its own. Build this map with your therapist.
Your mood swings, from past to present
Work down from the top: what made you vulnerable, what sets a swing off, its first signs, and how your response can build it.
If you notice early warning signs, follow your early warning signs action plan and contact your care team or GP.
Based on Lam et al. (1999): drawn from the book’s account of the model, as a relapse-prevention map.
Vulnerability factors
Core beliefs about self & mood
Episode triggers
Stress, and lost sleep or routine
Early warning signs and course
Thoughts
Emotions
Physical / sleep
Behaviours
How the boxes connect
- Vulnerability factors: leads to Core beliefs about self & mood.
- Vulnerability factors: leads to Early warning signs and course.
- Core beliefs about self & mood: can drive overwork, to Episode triggers.
- Episode triggers: leads to Early warning signs and course.
- Early warning signs and course: leads to Thoughts.
- Thoughts: leads to Behaviours.
- Emotions: leads to Thoughts.
- Physical / sleep: leads to Emotions.
- Behaviours: leads to Physical / sleep.
- Behaviours: Keeps going, to Episode triggers.
Protective factors & strengths
What resources, strengths, and supports might help in recovery?
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When to use the Bipolar relapse prevention formulation
The Bipolar relapse prevention formulation is an interactive cognitive behavioural therapy (CBT) formulation model, most often used in CBT for bipolar disorder.
It is designed to be used within therapy rather than as a standalone self-help tool: a therapist and client complete the model together and make sense of what it surfaces. You can preview the full formulation above, then assign it digitally for clients to revisit between sessions on any device or download it as a print-ready PDF.
How it works
The Bipolar relapse prevention formulation is a guided formulation canvas: you trace a difficulty over time, from early experiences, through the core beliefs and assumptions that developed, to the situations that trigger it today, to build a developmental picture.
Completed on the Formulate platform, your client's answers are saved automatically and shared straight back to you, so you can review them before the next session rather than waiting for a paper copy to come back.
The CBT approach behind it
In common with other CBT methods, the Bipolar relapse prevention formulation works by mapping how the parts of a problem connect and keep it going (formulation). The aim is not positive thinking but a clearer, shared understanding of what keeps a difficulty going and practical, testable ways to change it.
Because it is a CBT tool it stays focused on the here-and-now links between thoughts, feelings, the body and behaviour, and it works best as one part of a wider course of therapy rather than as advice or a diagnosis.
Evidence & sources
This formulation is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Lam, D.H., Jones, S.H., Hayward, P., & Bright, J.A. (1999). Cognitive Therapy for Bipolar Disorder: A Therapist's Guide to Concepts, Methods and Practice. Chichester: John Wiley & Sons.
For use alongside professional support
Formulate provides educational CBT resources for use with a qualified therapist. They are not a substitute for professional assessment, diagnosis, or crisis care.
If you need urgent help now:
- Emergency services: 999 — if you or someone else is in immediate danger
- NHS 111 (NHS 24 in Scotland): 111 — choose the mental health option for urgent help, in England, Scotland and Wales (in Wales, press 2)
- Lifeline: 0808 808 8000 — for urgent help in Northern Ireland, free, day or night
- Samaritans: 116 123 — free, day or night, 365 days a year
- Shout: 85258 — text SHOUT, free, day or night
- SANEline: 0300 304 7000 — 4pm–10pm, every day
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