Thought Broadcasting is a psychotic symptom in which the patient has the experience that his or her thoughts are being broadcast aloud so that people around can hear the thoughts. This symptom is most common in bipolar disorder, schizoaffective disorder, and schizophrenia. The experience can be extremely upsetting and sort of like being “mentally naked.” Suppose that when a young man standing in line at the local coffeehouse notices a cute girl, he believes that she can hear all of his private thoughts about her. Also imagine that he thinks the guy he is standing behind in line also might go after this girl. He is jealous of him, but he also thinks the other man can hear everything he is thinking. He is afraid the man in front of him can hear his every thought, and as a result is going to turn around and smack him in the face, and the girl is going to laugh at him. He gets very upset, leaves the coffee shop without getting his coffee, and goes home embarrassed, frightened, and discouraged. The patient who is having the experience of thought broadcasting believes that all of this is really happening. It can be a devastating and crippling condition.

Consequences of Thought Broadcasting

Patients with Thought Broadcasting rarely volunteer that they are having this symptom. They can go years without family, friends, or treating professionals becoming aware of the presence or severity of this symptom. It is always a good idea to ask a patient who might be at risk for Thought Broadcasting whether they are experiencing these symptoms.  Patients with Thought Broadcasting often withdraw from social interactions. They frequently stay at home and become socially isolated so as to avoid having others hear their thoughts. In extreme cases they believe that people on the street or in the house next door can hear their thoughts. These symptoms often wax and wane in response to stress, and may be less severe around people whom they are familiar with.

Treatment for Thought Broadcasting

Antipsychotic medication is the first line treatment for Thought Broadcasting. Medications such as Abilify, Zyprexa, Risperdal, and Clozaril can reduce or eliminate Thought Broadcasting. Psychotherapy can help the patient manage symptoms of Thought Broadcasting. Avoiding alcohol and street drugs also is very important. Social support networks such as 12 Step meetings are often difficult for these patients because they believe that everyone in the meeting can hear what they are thinking. As a result, meeting attendance drops off and then discouragement sets in. Helping the patient find a sober plan that they can adhere to if they have an addiction is another key predictor of success when helping to overcome this sometimes debilitating symptom.

 

Cyclothymic disorder is a type of bipolar disorder defined by long periods of fluctuating mood. Individuals with cyclothymia will experience persistent cycling between feelings of elevated or expansive mood and more depressive “down” states. Untreated, these ups and downs can go on for years. Cyclothymic symptoms are less severe than bipolar symptoms: the “highs” are not as high and the “lows” are not as low. Cyclothymic mood episodes do not meet full criteria for manic episodes, hypomanic episodes, or major depressive episodes. However, the cycling between mood episodes is chronic, pervasive, and clinically significant.

An individual with cyclothymia never goes more than two months without experiencing symptoms, and spends at least half the time feeling either too “up” or too “down.” There are rarely periods of wellness, and when they occur, they are short. And though less acute in nature than bipolar disorder, cyclothymic disorder presents with many of the same symptoms.  When in a depressive state, individuals with cyclothymia experience some of the following symptoms:

Depressed mood most of the day, nearly every day
Diminished interest or pleasure in usually pleasurable things
Significant weight loss
Insomnia or hypersomnia
Physical agitation
Fatigue or loss of energy
Feelings of worthlessness or inappropriate guilt
Diminished ability to concentrate
Recurrent thoughts of death or suicide

In an “up” (also called “hypomanic”) state, cyclothymic patients can experience some of the following symptoms:

Inflated self-esteem or grandiosity
Decreased need for sleep
Pressured speech (pressure to keep talking)
Racing thoughts
Distractibility
Increase in goal-oriented activity
Engagement in risky behavior (buying sprees, sexual indiscretions)

Unlike more severe forms of bipolar disorder, cyclothymic disorder rarely results in impairment severe enough to require hospitalization. However, it still leaves the individual in a state of virtually constant emotional instability. Cyclothymic Disorder can be confused with other psychiatric and medical conditions and intoxication by drugs.  It is important to have a mental health expert evaluate the patient in order to make an accurate diagnosis.

References

American Psychiatric Association. and American Psychiatric Association. DSM-5 Task Force. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C., American Psychiatric Association.

 

If you are considering psychotherapy for yourself or a loved one for the treatment of bipolar disorder, it may be helpful to get information about available treatments. Psychotherapy is an effective treatment for bipolar disorder.

Psychotherapy is Effective

Many different types of psychotherapy are available to help patients with psychological problems. Research has shown that mainstream forms of psychotherapy work well when treating depression, anxiety, and most other psychological, psychiatric, and mental disorders. These different types of psychotherapy are all generally effective when compared against one another in large research studies.

Bipolar Psychotherapies

Three types of therapy have been developed for the treatment of bipolar disorder. These therapies have been specifically shown to be effective in treating bipolar disorder in research studies.

All three types of psychotherapy include psychoeducation, which involves helping the patient (and at times his or her family) understand the causes, symptoms, and course of illness. All therapies also emphasize the importance of taking bipolar medications as an important keystone of recovery and maintenance.

Cognitive Behavioral Therapy for Bipolar Disorder
Cognitive Behavioral Therapy (CBT) for bipolar disorder is designed to change negative thoughts, behaviors, and emotions associated with the disorder. CBT identifies irrational negative beliefs and helps the patient to challenge them and replace them with healthier thoughts. Changing destructive thoughts can lead to changes in destructive emotions and behaviors.

Interpersonal and Social Rhythm Therapy for Bipolar Disorder
Interpersonal and Social Rhythm Therapy (IPSRT) for bipolar disorder is designed to reduce current interpersonal stress and stabilize circadian rhythms (24 hour cycles). IPSRT identifies one or more areas of interpersonal conflict and helps the patient develop healthy ways of coping with the conflict. IPSRT also actively focuses on helping the patient to stabilize daily sleep and wake patterns and daily routines.

Family Focused Therapy for Bipolar Disorder
Family Focused Therapy (FFT) for bipolar disorder is a type of family therapy in which families and the patient meet with the therapist to cope with the effect of an ill family member on the family. Families are helped to develop an early response strategy for relapses. The patient and families also learn better communication and problem-solving skills when interacting with one another.

Combining Therapies

Any qualified mental health professional should be trained to provide effective forms of psychotherapy. However, most mental health professionals are not trained in bipolar-specific forms of psychotherapy listed here. For bipolar patients, it may be helpful to combine more traditional forms of psychotherapy with these more targeted treatments. This may involve seeing two different therapists who are communicating with one another and providing coordinated treatment. Or, it may involve getting brief specialty treatment in a bipolar disorder treatment center or setting followed by aftercare with traditional psychotherapy.