Episode #175

Bipolar II/2 Disorder & CBT

The symptoms of Bipolar I/1 Disorder are typically better known and more commonly diagnosed than Bipolar II/2 Disorder.

What are the symptoms of Bipolar 2?

How is it typically diagnosed?

How can CBT tools support someone struggling with Bipolar 2 Disorder?

Join me, Dr Julie, as we talk about the lesser-known Bipolar II/2 Disorder.

Click to listen now!

 
 

Full Episode Transcript

Hi, and welcome to My CBT Podcast. This is Dr. Julie. I'm a Doctor of Psychology and a licensed clinical social worker specializing in cognitive-behavioral therapy. I'm here to help you bring the power of CBT into your own life.

Thanks for being with me, and I wish everybody a happy and healthy New Year. It's my first podcast for 2026, and I'm going to talk about a topic I had a request that someone sent to me on my Instagram page. It's been a bit of a while ago, so I apologize for being so late, but it's a good topic. And they reached out and asked me to talk about Bipolar 2 diagnosis. I have a couple of podcasts that I interviewed a colleague, Mike, on Bipolar 1 and his experience with his sister-in-law. It's a really interesting story if you haven't listened to that, to those two podcasts. But Bipolar 2 is not as spoken about as much, very, very common, and is really misunderstood, I think. I think most people know more about Bipolar I and know about mania or what they think they know, but there's a lot of misconceptions out there. But Bipolar II, I thought, would be a really good topic to talk about, educate you guys a little bit and then tell you how CBT can help.

So to just give you a couple of quick statistics, Bipolar II disorder affects about one % of the population, though it's often underdiagnosed, I should say. And it's really common that people get diagnosed with depression instead. And that leads to decades long of getting the proper diagnosis, which can really make all the difference regarding medication and treatment. So that's why it's good to understand what it is. And a lot of times why people get misdiagnosed with major depression is because they primarily seek help during depressive episodes. And when someone has hypomanic episodes where it's a short episode of mania, they're often missed or underreported. And so that's the problem. I'm not a medical doctor, I'm not a psychiatrist. They could answer a lot more questions than I can. But again, Bipolar, too, is common but often overlooked. And that ends up leading to significant patient suffering and under treatment. And again, it highlights the need for people to really have a good, really thorough psychosocial assessment when they meet with their doctors and their therapists. So if it's for you or a loved one, make sure someone's getting a really thorough history and talking to family as well, because a lot of times family can see things that the client might not see or they don't want to report.

And there's a lot of things that go along with that. So I just wanted to give you a little bit of statistics about how common is this. And so first I'm going to just talk about what are the symptoms? And then again, I'm going to talk more about how CBT tools can actually help. I want to say that there's a clear and accurate breakdown of symptoms for Bipolar 2 disorder. And we focus both on the hypomania, which again is the small episodes of mania and depressive episodes. Bipolar 2 can be really subtle, and that's why, again, it's often misdiagnosed, because a lot of times when people feel this hypomania because it doesn't last too long most of the time, they And they feel functional or even positive. So they're not going to report it and they're not going to think that they have any issue to go see a doctor for it, right? So that's why it's in that gray area. And also, I'm not going to get into it now, but there's not just bipolar I, bipolar II, there's many subcategories. So that's why you really need someone who's really highly skilled and trained in diagnosing to really be able to identify what's going on.

So let me educate you guys first on what's a hypomanic episode. So hypomania last at least four days, and it's noticeably different from your usual mood. But it does not cause severe impairment, hospitalization or psychosis. That's where it gets tricky. So what are some common symptoms? One is having an elevated or an irritable mood. So that's feeling unusually like upbeat, excited or wired, and also increase irritability or impatience. So the increased energy and activity, you might not need to sleep as much. You might wake up and feel really refreshed after only sleeping three or five hours. And then you also might feel really restless. You might be pacing. You might be starting a lot of projects. And I wanted to say that because most of us, which is okay, there's no reason why you would know how to diagnose somebody, but the ways that people are portrayed in movies that I've seen and all that with the bipolar one, the mania is always this positive mania. People are happy and loving, everything's great, and But I've met many, many people that the mania is very disturbing to their moods. They feel very restless. They become suicidal, lots of different things.

So when I see movies and I'm like, That's not really what bipolar disorder is. And I get bothered because, again, lay people are watching going, Oh, I guess that's what it is. And it's always this positive, and it really isn't. So again, it's really in a lot of shades of gray, a lot of different symptoms. It's very personal to that person and what they're going through. So I just want you to keep that in mind that it's not a real good feeling all the time. Some other symptoms are feeling this heightened goal-directed behavior. So you might overwork, you might over-exercise, you might go cleaning sprees, you might start organizing excessively, somebody might start thinking or talking faster. So then you end up having these racing thoughts. You might be talking more than usual, and you may feel this pressure to keep talking. It's this energy that they may feel. You also might have an increased confidence or productivity. So you might feel more capable than you usually feel and feeling unusually social or charismatic when maybe that's not your normal behavior. There's also some risk-taking and impulsivity that can go along with it. As I mentioned just a second ago, it could be spending sprees, increased sexuality or risk-taking, impulsive decisions regarding travel, quitting a job, making big purchases.

So hypomania, which is what we're talking about in bipolar II, does not escalate to full mania. That's what distinguishes it from bipolar I. So that's why It's like, Oh, I feel good. I got some energy. Wow, I got some stuff done. I cleaned the house. This is good, but it isn't always good. And again, that's why people are... They're not going to go for help because sometimes people are like, Oh, I like this energy, especially if I feel depressed often. So what does the major depressive episode look like? This is often the most impairing part of bipolar II, and it tends to occur far more frequently than the hypomania. And the symptoms last at least two weeks, so they can include mood and emotional symptoms, so you can have persistent sadness, emptyness, or hopelessness. You can also have loss of interest or pleasure in things that you used to like to do. You can have changes in your sleep, so you might have more insomnia, trouble staying in the sleep. You might be oversleeping and have excessive sleep where you're sleeping 15, 16, 17 hours a day. You can also have changes in your energy, so you can have really low energy and feel fatigued, feeling slowed down.

Your appetite Your body can change. So some people can have significant weight loss or gain. Some people are like, I have no appetite, and other people are like, I can't get enough food. You might have, again, that increase or decrease in your appetite. And then there's cognitive symptoms. So that means you're having trouble concentrating or making decisions. You might have some memory issues. You might be feeling overwhelmed really easily. And then self-esteem and thoughts connected to that. You may have feelings of worthlessness or excessive guilt. You can also have thoughts of death or suicide. That is not required to get diagnosed with bipolar II, but it can occur. And of course, if you're having these thoughts, please, please, please reach out and let somebody know. And if someone is in your life that you're concerned about. I always tell everybody, if you think somebody may have any thoughts of hurting themselves, suicidal thoughts, don't beat around the bush. Just come out and say, Do you have any thoughts of killing yourself? Just be very blunt. You're not going to put any ideas in anybody's heads, trust me. You got to be really clear about it because if that's true, you want to get help, of course, right?

But that doesn't always happen with Bipolar 2 in the depressive episode. So you got this hypomania, and then you got the depression, right? That's the Bipolar, bi is two. So Bipolar 2 is more depression, a little bit of hypomania. And then you can also have, with this diagnosis, cycling patterns. So a lot of times, if you have Bipolar 2, you might experience long depressive episodes, but then it cycles with the hypomania. Again, that might be subtle or just might be mistaken for good days. And mood instability, which can be triggered by stress, sleep changes, or seasonal shifts. So there's lots of different things that could be triggering this. And again, as I was saying, the hypomania might be subtle or mistaken for good days. Think about if it's one thing to have a good day, it's another thing to not need to sleep, have no appetite, clean, clean, clean, spend, breathe, buy, make, big It's not within the norm. And then some other features that sometimes are present, not always. You can have some symptoms of depression and the hypomania at the same time. You might feel agitated, but also feeling hopeless still. That would be an example.

You might have symptoms of anxiety. You may have irritability during both depression and the hypomania. And again, you might have some seasonal patterns. So meaning that based on the season, your mood changes. That's different than seasonal affective disorder, which I have a podcast on that if you want to learn about what that can be. But these are all just some things to be aware of and understand. Just, again, this is very simple what I'm sharing with you guys today, but what does bipolar II look like. But it's really common and it's, again, misunderstood, underdiagnosed. And if it's not yourself, maybe there's somebody in your life, maybe that's what's been going on, and I haven't been able to figure it out. Because let's say we have a friend or family member that's depressed a lot, and then all of a sudden they're like, I'm having a good day. We're going to be like, Great. Oh, my God, I hope it continues. You're not going to stop and say, Oh, maybe they got bipolar, too. I can see someone saying, Oh, my God, I'm so glad they're up. Wow, they cleaned the house. That's unbelievable. They did the laundry.

They haven't done that in two weeks, right? So you can see why it's really hard to pinpoint, but it's seeing a pattern over and over again. So now let me talk about how CBT can be really effective for bipolar II disorder. But it works best when you combine it with medication and some strategies to help with stabilizing someone's mood. So I'm going to talk about a breakdown of how you can use CBT to fit into treatment and what to focus on specifically for bipolar II. There are some mental health diagnosis. This is one of them, that medication is really important as well as the therapy. You want to get both together. So that's something I just want to share. So let's talk about how CBT can help with bipolar II disorder. So first, we want to manage your depressive episodes. So if you experience the major depression, More often hypomania, that's with the bipolar, too. Your cognitive behavioral therapy can help by obviously challenging your negative thoughts, right? Your hot thoughts. Maybe some might be like, I'm never going to get better. You may have a hot thought that I'm a bird in. Cbt can also help reduce ruminating.

A lot of people ruminate when they're depressed, right? I also know I have a podcast on rumination. People think if I ruminate, and I think, I think, I think about the problem, I'm going to be able to fix it, but it actually just makes you more depressed. So the CBT tools can help reduce rumination. Also, a CBT can increase changing behaviors, right? To help start re-engaging in activities, even when your mood is low. So that goes to my mantra. You want to make decisions based on what's best for you, not how you feel. So when your mood is low, what can I do instead? What is best for me? To get up and take a shower, to get up and walk around the block, to do something different, just even stretch, right? Walking around your house, maybe, if you haven't been moving, anything, just start doing something different based on what's best for you, not how you feel. A lot of times when people are depressed, they're in bed, they're not doing too much. You want to get moving again. And also the CBT can help you start building some structure and routine to reduce the mood dips, right?

When we have structure and routine in our lives, this is important for everybody, not just with bipolar, too. I know people resist structure. Oh, I'm like, to just go on how I feel that day and da, da, da, which is good sometimes, especially maybe on vacation, right? But in general, having structure, tons of research on this, It really helps with your mood. Having routines as well, right? Planning when you're going to do things, working out, going to work, if that's what you do, meeting up with friends, whatever it is that's important to you. Having a structured routine in your day versus waking up and saying, Well, I'm going to see how I feel, and then I'll make a decision. That ain't going to work, right? That's not making decisions based on what's best for you. And you want to remember, with depression, a lot of times you lose your motivation. I have a lot of times people say, Well, I'm going to do that when I feel motivated again, or I'm waiting to feel motivated, and I'm like, Don't hold your breath, right? Motivation comes from acting first. That's why it's tough, right? You need that behavior activation, like I was just talking about.

And then the motivation comes like, Oh, you know what? I felt better after taking that walk. I'm going to go do that again later today or tomorrow. That's where the motivation comes. Most of us, we don't know this. We don't hear about this stuff. I I understand. So I just want to let you know, don't wait to feel motivated because it's not going to just show up. It just isn't. It's after you do something that you enjoy, it makes you feel better, you see the benefits, that's going to motivate you. So keep that in mind. Also with CBT, it's going to help you recognize and regulate the hypomanic patterns. So as I was saying, the hypomania is often missed or minimized because it feels good and productive. That makes sense, right? But with your cognitive behavioral therapy tools, you can identify those early warning signs such as impulsive spending, the decreased need for sleep, the increased goal-driven activity, right? To say, Okay, this isn't my norm, even when I'm feeling pretty good, right? You can create personalized early intervention plans. I'll talk about that in just a minute. You can avoid triggers just as substances, the sleep loss, high stress situations, and you can also reduce risky behaviors before they escalate.

Let me go back to the second saying, Create personalized early intervention plans. There's a couple of things here you can do. One thing we talk about is symptom management. What are your symptoms when that hypomania is getting started? What are the symptoms maybe you notice in a friend or a loved one when they maybe had these episodes before? And write them down. I started spending too much money. I only sleep a few hours and I feel fantastic. I want to go conquer the world, or I'm cleaning my house for days, or I'm scrubbing and scrubbing. I don't want everything to be perfect. I'm never getting tired. Or maybe I am eating and I feel like a bottomless pit. I just can't get full and I'm just craving certain food. So what is it where you can identify your warning signs and then create an early intervention plan? So if that starts happening, I'm reaching out to my psychiatrist, I'm reaching out my therapist, I'm sharing with someone I trust in my life to help me maybe get to an appointment or help me talk through what's going on and get back to some good behaviors.

Having that community, that social network is really important. Again, avoiding triggers. If you go to substances, if you start drinking more, if you start smoking more pot, whatever it is that you might do that feels good, you don't want that around. And you want to pay attention. If you start thinking boy, a beer would taste really good right now, or I want to go have a bottle of wine, or whatever it is that I do. But I know this is really not good for me, and these are some red flags. If I'm not sleeping much, don't minimize that. And if there's high stress situations, we want to use our action plan, which I've talked to you guys about. There's a whole part of that in Mind Over Mood, poor book that I use all the time, that we can create an action plan that when something's happening, what are my possible problems? And then what are my strategies? So I don't need to think about it right then and there. I already have a plan. That's why it's called an action plan. And if there's going to be high stress situations, how can I prepare to deal with those?

And is that something I actually have to be involved with? Or how can I know, you know what, I think it's time for me to leave, or I'm going to have to agree to disagree in this high stress conversation maybe that all of a sudden showed up. I wasn't even planning for this. I need to pause. I need to take a time out. So having a plan of action for when things could come up that I know I might get triggered, you're going to be in a much better place. And then reducing the risky behaviors before they escalate. So with your cognitive behavioral therapy, you can write down, what are these red flags? We can make a plan. What are the thoughts that I have? What are these hot thoughts, these grandiose thoughts, possibly, that I have when I start getting that hypomania? And be like, Okay, this is something I need to check. Also in the Mind Over Mood workbook, in chapters 13 and 14, one's on depression, one's on anxiety. They both have a mind over mood depression inventory and mind over mood anxiety inventory. This is a tool I have my clients fill out every single week on the same day, and you're assessing your week.

This is a great tool. So when it talks about avoiding triggers or creating that intervention, It's like when you're doing the inventory and you get stable, your numbers are going to be within a range on a weekly basis. It's like, Okay, we're stable. We're doing good. When those numbers start creeping up, that can be a red flag for you. So that can be a great tool as well. I've had people come back for a booster session that they said they didn't really recognize their signs, but the numbers started to go up and they thought, Oh, something's going on. Let me go meet with Dr. Julie. So that's a great tool also where it's a rating scale for your moods for a week. So that's another great tool that's in the Mind Over Mood workbook. Another thing that the CBT can help with is stabilizing your daily rhythms. So what do I mean by that? Is getting the regular wake and sleep time. Every night, you go to bed at 10: 00, and every morning, you wake up at 7: 00 or whatever time you want to make. So keeping regular sleep time is really excellent.

Having consistent meals, exercise, and social contact, like I talked earlier about having that community. This is that routine stuff, right? Having the predictable routines to protect your biological clock. This is really sensitive and bipolar disorders, one and two. So having those predictable routines. I'm not talking about perfection, progress, not perfection. But in general, I go to bed at the same time, I wake up at the same time, this is my routine, and I'm going to stick to it as much as I can. That can make a really big difference. Also, again, this is not my scope of practice, but if you're on medication, you want to see a psychiatrist, that's something else I talk to my clients about all the time. I know a lot of people go to primary doctors and they get started on medication. That's okay. But then you have to find a psychiatrist. Psychiatry is so specialized. I can't tell you, it's just so specialized. And a primary doctor is not going to be able to treat your medication long term. So with CBT, you also want explore so you can improve your adherence to taking medicine, because that's another issue right there, right?

What are your beliefs about medication? A lot of people are afraid of possible side effects. They worry about the stigma. A lot of people don't want to take medicine because it's a reminder every day that they're treating something that they're not happy about. The hot thoughts that I'm different, I'm not good enough. Just the thought that there's something wrong with me will stop people from taking in their medicine. A lot of times with bipolar disorder, I've noticed that people will get on medication, do therapy, they're doing great. And then because they're doing great, feeling well, they're like, Oh, I don't need my medicine, and they don't make the connection that I'm feeling well because I'm on my medicine and doing everything else. When I worked in psychiatric hospitals, the number one reason people got readmitted is because they stopped their medicine. And I'm like, Why did you do that? And they say, Because I was feeling good. So you want to understand. But you also want to address within yourself, with your therapist using your CBT tools, what are my beliefs about medicine? Because I think that's probably one of the number one issues why people are hesitant to go on meds.

Again, the stigma around mental health, which is unfortunate. I also have an older podcast on that. I talk about the stigma of mental health and how we have to eliminate that. I tell everybody, Yeah, there might be side effects, but they're possible. I know some people on psychiatric medicines that have never had a side effect. I know other people have had some. They change medicines. They're like, This is great. So that's why you're working with someone who specializes in this, meeting with a psychiatrist. So assess your beliefs about medicine because that can get in the way. We can also with CBT, Any motivational barriers. We can talk about just what I was saying. What are the barriers to you sticking with your medicine and making that easier for you? Creating a way for you to remember to take your If this is new to you, it's a new routine in your life, it's important to remember to take it. So what does that look like for you? And working with your prescriber collaboratively between your psychiatrist, your therapist, and I usually have my clients give me permission to speak with their psychiatrist so that we can work together.

Because especially as a therapist, I got to tell you, psychiatrists, because they're just focused on the medicine overall, most psychiatrists, they're just dealing with medicine. They're not doing the therapy. They don't really learn about the daily routines of their clients. And so when I talk to the psychiatrist, I can tell them, This is going on, or these are some family dynamics, or this happened, and they're like, Wow, I had no idea. Thank you for letting me know. So having that collaboration with your team can make a huge difference. Huge difference. And I'm telling you, when you get the right medicine and you can stay on it for this diagnosis and use your tools, you can really get to a really, really good place. Another thing where the CBT can help is addressing those cognitive distortions related to the mood cycling. So there's certain thought patterns that are particularly common in bipolar, too. So one of them is the cognitive distortion of all or nothing thinking. An example would be that if I'm not super productive, I'm worthless, all or nothing. It's got to be perfect. I got to get everything done or that means that I'm not good enough.

Another cognitive distortion to address can be what we call mood-dependent reasoning. So this is believing thoughts that arise during depression or hypomania states. So you're believing your thoughts, basically. It's what I talk about is we have to realize that I'm really feeling depressed. I have some hypomania maybe going on. I really have to be mindful and identifying my hot thoughts. It's more important than ever right now because I can really get sucked into what I'm thinking with the depression that I'm not good enough or the hypomania of that I can do anything. I'm going to go spend all this money. It's all going to work out. I'm going to make this big purchase I always wanted. It's like, Okay, slow down. Pause and breathe, right? Pause and breathe. So this reasoning that we can go through in, Oh, of course this is true. This is how I'm feeling. It's probably not true, and it's probably a hot thought. So we want to be able to identify that using our CBT tools. And the other thing that is related more with the Bipolar, too, is what we call goal-driven of imperfectionism during hypomania. So your cognitive behavioral therapy can teach you how to do some reality testing to address these thoughts when you're depressed or manic dealing with bipolar, too.

So we can come up with lots of tools, not just identifying your hot thought, but there's lots of CBT tools I've talked to you guys about in how to test your reality. What is really true? Is this my norm? When I am feeling stable and well? Am I trying to be perfect? Am I doing a million things? Am I not sleeping much? Is what I'm telling myself really true? That as I was saying earlier, If I'm not super productive, then I'm worthless. So your CBT tools can help you hone into that and start realizing like something's not right and I need to go get some help to get stable again and not to make decisions based on what I'm thinking or feeling. This one, not thinking or feeling, okay? And then the last thing I want to talk about with CBT, as always, is relapse prevention planning. So with your CBT, you can build a personalized plan, right, regarding relapse prevention. That includes your unique mood triggers, again, your early warning signs for both depression and the hypomania. What's some tools to increase your sleep, to relax, to ground yourself, and for reaching out for support.

And also, you can even create scripts for talking to loved ones about your episodes. I think that's really important. And to be able to educate those around you what's going on. Because most people, again, they don't know and they're going to maybe have a distorted belief or information, based on what they see in the media or even movies that don't really talk about this. It's really, again, all this good mania. I've heard people say, I like to be manic for a couple of days because you're thinking they're going to get all their tasks done and go work out and do all this stuff. But it's a real struggle. It's a real struggle when you have bipolar disorder, one or two. Having scripts to talk to your loved ones about your episodes so others can understand and give you the support you need can be really important. I'd want that. If I have someone in my life that has any mental health issues and any diagnosis, please tell me how you're feeling. Tell me what's going on. I want to know. So maybe we can build a trusting relationship. And if I notice something, I can say, Hey, Sue, I'm I'm noticing, you got a lot of packages showing up at the house.

What's going on? Are you doing that overspending is one of your triggers? And for Sue to be open and be like, Yeah, I know. I was thinking that. I really didn't want to address it because I was feeling good, but this is what I talk to you about so you can help me stay on track. And again, for yourself, if you're dealing with this diagnosis, to come up with a relapse prevention plan regarding, if I do start to relapse, what is my plan? I always tell you, hope is not a plan. We need a plan to know I'm going to call my doctors. If I'm maybe not even in therapy right now, maybe I'm going to go back to, I'm going to look over my CBT tools, I'm going to reach out to a friend, I'm going to get back on my routine and my schedule, whatever it might be. All the things that I talked about today. There's so much that your CBT can help you with, which is fabulous. And that's why you want to be connected to your psychiatrist and be connected to your CBT therapist. And remember, with your psychiatrist or your therapist, if you're not feeling like you're getting what you need, if you don't feel connected, if you don't think they're listening, if they're not available to you, it doesn't mean they're going to be there right when you call all the time.

But it needs to be reasonable, right? I've heard of people calling their psychiatrist. They don't hear back from them, and now they're getting even worse and worse and worse because they're waiting to hear from their doctor. You need someone that you know is available enough, especially when you start getting maybe into a crisis mode or start relapsing. So that's a conversation also have with all your doctors, psychiatrists, therapists. What's your availability outside of the office? What should I do if I start noticing that I'm relapsing, that I want to get this nipping in the bud as soon as possible? So what's your protocol? People know what my protocol is. If they need to contact me, you need to know your therapist and your psychiatrist. Psychiatrist. So that's really important. And don't put it off. If you can't get through to anybody and you need to even go to the emergency room, go to the emergency room. I want you guys to get better and back to being stable as quick as possible. And again, if you're someone that has someone in their life to develop that trust in relationship so they'll listen to you and they won't get defensive when you might notice before they even do.

So I'm really grateful that one of my listeners reached out to me on Instagram to We talk about this because, again, it's very common. 1% is a lot of people in the whole world. It's a lot of people. And again, there's probably maybe even more because there's so many people that are undiagnosed. And a lot of times, one last thing I want to say that bipolar disorder definitely runs in a family tree. So you want to ask family history. Does anybody know? More people now are aware of some family history. But one or two generations ago, people weren't getting diagnosed much. People did not go to therapy. The stigma was just even worse, I think, than it is probably now. And so it's more like the last couple of generations, there's more people getting diagnosed correctly and getting treated. So ask those questions and just being aware of that and generations after you, letting them know what you went through so they can be mindful of that and be able to say, oh, maybe this is what's going on because I had my mom, my dad, my grandpa, my aunt, uncle, my cousin also went through this.

So I just wanted to share that little side note. So as always, I hope this was helpful. Please share with anyone you think might benefit from the information.

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So again, I just wanted to first say happy and healthy New Year. Let's make this a year of good mental health and learning CBT and sharing CBT and using your tools on a daily basis.

And as always, make decisions based on what's best for you, not how you feel.