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A longitudinal formulation for bipolar disorder — mapping life events, episode patterns, and maintaining factors across time.
This formulation maps your bipolar journey over time: vulnerability factors, life events that triggered episodes, the pattern of your episodes, and the factors that maintain mood instability. It helps you and your therapist see the bigger picture.
Use in the early phases of therapy to develop a longitudinal understanding of the client's bipolar disorder, mapping episodes across the lifespan in relation to life events, stressors, medication changes, and psychosocial factors.
Frame as creating a timeline together that helps both of you understand the pattern of mood episodes over time. Explain that identifying patterns and triggers helps with early detection and prevention of future episodes. Start with the most recent episode and work backwards.
For clients with many episodes, focus on the most significant or representative episodes rather than attempting an exhaustive history. For those with memory difficulties (common after multiple episodes), supplement with collateral information from family or medical records where available and consented.
If detailed recollection of past episodes triggers significant mood instability, pace the formulation across multiple sessions. Avoid formulating during an acute episode — wait for relative mood stability. Be cautious about exploring traumatic life events without adequate containment.
Pay particular attention to prodromal patterns — most clients have individualised early warning signs that precede both manic and depressive episodes. The longitudinal formulation should reveal these patterns. Also map medication adherence and its relationship to episodes, as non-adherence is a major predictor of relapse.
Suitable for clients working with bipolar, formulation, longitudinal, cbt, mood episodes, vulnerability. This tool can be used as a standalone worksheet or as part of a structured homework plan.
Create a free account to access 10 worksheets per month.
Identify personal early warning signs for both depression and mania/hypomania, and create a stepped action plan for each mood polarity.
Track daily routine stability — wake time, meals, activity, social contact, and bedtime — as routine disruption is a key trigger for mood episodes.
Track daily mood on a depression-euthymia-hypomania/mania scale alongside sleep, medication, and key events.
Identify and challenge positive beliefs about mania/hypomania that reduce motivation for relapse prevention — e.g. "I'm more creative when high."