Understanding bipolar disorder
Understand mood episodes, daily routines and ways to work with your care team.
Written by Tarun Vermani, Trainee Clinical Psychologist Last reviewed
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Understanding bipolar disorder
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Episodes: high, low and mixed
Bipolar disorder involves episodes of changed mood, energy and activity that affect daily life. There may be periods of feeling well between episodes. Experiences vary; the diagnosis does not describe all of who you are.
High periods: unusually high energy, confidence or irritability, less need for sleep and riskier decisions. Hypomania is a less severe high. Mania can seriously disrupt judgement and safety, sometimes with experiences others do not share. Highs need not feel pleasant.
Low periods: loss of interest, exhaustion, difficulty with tasks, hopelessness or suicidal thoughts. Mixed experiences combine low mood with racing thoughts, agitation or increased energy. These need prompt team attention.
Routines and noticing change early
Regular sleep and daily routines can support stability. Less need for sleep, faster thinking or withdrawal may be early signs for you, not proof of an episode. Agree personal signs and responses with your team while well. Contact them early about changes.
Working with your team and people you trust
Therapy and medication can both be part of care. Make medication decisions with your prescriber. Do not change or stop medication on your own. Discuss planned changes and side effects with them. If you suspect a serious reaction, seek urgent medical help and follow the clinician's advice. With your agreement, someone close can help notice changes or support routines. Choose who is involved and what is shared.
When help is urgent
For suicidal thoughts, risky behaviour, feeling out of control or rapidly worsening sleep or mood, seek urgent help from your team or crisis service now. Use local urgent care if unavailable.
In an emergency, call 999 or go to A&E.
Your question
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When to use ‘Understanding bipolar disorder’
‘Understanding bipolar disorder’ is a psychoeducation handout based on cognitive behavioural therapy (CBT), most often used in CBT for bipolar disorder.
It is designed to be read within therapy rather than as a standalone self-help tool: a therapist introduces it and discusses it with the client. You can preview the full handout above, then assign it for clients to read between sessions on any device or download it as a print-ready PDF. Where a short reflection is included, it offers space to respond to the reading.
How it works
Most people work through it in around 10 minutes. It moves through five short sections to read:
- Episodes: high, low and mixed: Bipolar disorder involves episodes of changed mood, energy and activity that affect daily life. There may be periods of feeling well…
- Routines and noticing change early: Regular sleep and daily routines can support stability. Less need for sleep, faster thinking or withdrawal may be early signs for you, not…
- Working with your team and people you trust: Therapy and medication can both be part of care. Make medication decisions with your prescriber. Do not change or stop medication on your…
- When help is urgent: For suicidal thoughts, risky behaviour, feeling out of control or rapidly worsening sleep or mood, seek urgent help from your team or…
- Your question
The handout can be read on a phone, tablet or computer, or downloaded as a print-ready PDF. If it includes a reflection, answers entered on the Formulate platform are saved automatically and shared back with the therapist for review before the next session.
The CBT approach behind it
‘Understanding bipolar disorder’ introduces a CBT approach that involves putting clear, personalised coping steps in place for difficult moments. 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 handout is grounded in established cognitive behavioural therapy theory and practice. Key sources include:
- Lam, D. H., Jones, S. H. & Hayward, P. (2010). Cognitive Therapy for Bipolar Disorder: A Therapist's Guide to Concepts, Methods and Practice. Wiley-Blackwell.
- National Institute for Health and Care Excellence (2014). Bipolar disorder: assessment and management. NICE guideline CG185.
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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