Overview

Mania is the presence of noticeable episodes of extreme elevation in mood and is often the main symptom in several mental health conditions, like bipolar disorder. Manic episodes impair an individual’s ability to function in day-to-day life and can leave people feeling ashamed about the sudden changes in their behaviour.

Psychotherapy, commonly referred to as ‘talking’ therapy, provides the tools needed for an individual to understand their disorder and helps to plan for the onset of manic episodes. Whilst psychotherapy isn’t normally offered as a treatment option for singular episodes of mania, it has been proven to have great benefits for those who experience mania as part of wider mental health disorders

This article underlines the key symptoms and causes of mania and its presence in some mental health disorders, as well as aims to highlight the benefits of psychotherapy for its treatment. 

Symptoms

There is a wide range of symptoms associated with mania, but the key defining features related to a manic episode are:¹

• Heightened mood, or feelings of euphoria
• Inflated sense of self-importance
• Rapid and continuous speech
• Reduced need for sleep
• Impulsive behaviour i.e, gambling
• Easily distracted
• Driven to complete unfinished projects and tasks
• Increased risk-taking, or reduced sense of risk

In extreme cases, some individuals may also experience psychotic symptoms during a manic episode.² This is the presence of delusions or hallucinations, where the line between reality and fantasy becomes blurred. Some examples of delusions and hallucinations are:^3,4

• Delusions of paranoia/persecution e.g., the belief that someone is trying to hurt you 
• Delusions of grandeur e.g., the belief that you have special powers
• Bizarre delusions, e.g., the belief that aliens have cloned you  
• Auditory hallucinations, e.g., hearing sounds that are not there 
• Visual hallucinations, e.g., seeing objects or people that are not there

Mania vs hypomania

A manic episode is a combination of the symptoms mentioned above, which typically lasts at least one week but can go on for months. The symptoms are often so severe that they result in hospitalisation due to the social and work-related impairments that they can cause. 

Similar symptoms define Hypomania, but these episodes are markedly less intense with shorter episodes that average at around four days.

Importantly, the state of elevated mood and other associated symptoms in both mania and hypomania must not be initially induced through substance use, e.g. drugs or alcohol, or other unrelated medical conditions, but rather triggered from a natural state. However, previous substance abuse can contribute to a manic episode further down the line.¹

Causes

As with most other mental health conditions, there is not one sole reason for why someone may experience mania, but rather a combination of factors that contribute to its onset. Both biological and environmental risk factors play a part in triggering manic episodes.

Biological causes

Biology is often the first port of call for the reasoning behind mental health conditions like mania, with factors such as genetics and chemical imbalances contributing to its onset.

Genetics

Genetics play a role in a wide range of both physical and health-related conditions. However, there is an ongoing debate on whether mania is purely a symptom of other mental health conditions, or if it is a disorder in itself. This makes it difficult to assess the role of genetics in mania alone.⁵

The vast majority of mania cases occur in the context of bipolar disorder; a mental health condition that is characterised by extreme shifts in an individual’s mood, often cycling between manic and depressive episodes. Bipolar disorder has a strong genetic makeup, with scientific research suggesting that approximately 80% of cases are caused by genetics.⁶

Chemical imbalances

The cells in the brain communicate through the rapid firing of chemical signals, otherwise known as neurotransmitters.⁷ Concerning behaviour, the release of each type of neurotransmitter results in different outcomes depending on the brain regions involved. 

The elevated moods and high energy seen in people with mania and bipolar disorder are in part due to the high levels of the neurotransmitter noradrenaline. Another signalling molecule involved in mania is dopamine, a neurotransmitter associated with the reward pathway. People experiencing mania participate in greater risks and impulsive behaviour, as these behaviours have increased dopamine release when compared to lower risks.⁸

Environmental triggers

Environmental and lifestyle factors also have a big role to play in manic episodes and other associated disorders. Some of these include:⁹

• Stress
• Brain injury
• Physical/sexual abuse
• Bereavement
• Substance abuse
• Childhood trauma

Heightened stress through traumatic events may reduce the ability of the brain to adapt and mould to the surrounding environment, which is thought to increase susceptibility to mental health conditions, like mania and bipolar disorder.¹⁰ Exposure to traumatic events may also heighten the stress response to both positive and negative life events when compared to those who haven’t experienced trauma.^9,11

Psychotherapy

Many individuals lean towards medication as a form of treatment for disorders where mania is a key symptom. Whilst medication can improve quality of life by relieving symptoms, it offers no cure for the condition. 

Alternative methods like therapy are often used alongside medication, in an attempt to delve into the root cause of the disorder. By exploring the different options under the umbrella term of psychotherapy, individuals can implement a variety of techniques in their day-to-day lives to reduce the onset of manic episodes.

Cognitive behavioural therapy 

Cognitive behavioural therapy (CBT) is the main form of psychotherapy that is widely used in the treatment of mental health disorders. It is based on the assumption that the way you think has a direct effect on the way you feel.¹² Therefore, shifting outlooks from negative to positive will improve your state of mind to help you function better during day-to-day life. 

CBT requires multiple sessions over a few months, in which the therapist will guide individuals through the 4 different stages:¹³

Assessment and psychoeducation

Therapists will initially assess the individual based on the severity of symptoms to create a plan with specific treatment goals to ensure you get the most out of your time in therapy. Psychoeducation involves educating the individual about the nature of their disorder, which is commonly bipolar when experiencing mania. This involves exploring the potential causing factors and how they can be addressed.¹³ It can also promote adherence to medication, to prevent relapse of manic episodes in the future.¹⁴

Intervention and relapse prevention 

Interventions for bipolar disorder and mania involve mood monitoring to increase self-awareness before the implementation of any other techniques. This can be as simple as scoring moods throughout the day and making particular note of days with any significant changes, e.g., lack of sleep or missed medication.¹³

Interventions directed towards mania aim to reduce the negative behaviours that are seen as rewarding during an episode by confronting them head-on. This could include things like:¹³ 

• Slowing down impulsivity on important decisions, by asking the opinion of trusted friends beforehand
• Setting monthly budgets or financial restraints to prevent overspending/gambling
• Creating a strict routine to limit participation in over-stimulating activities

Therapists also aim to redirect the individual’s thinking towards more appropriate thought processes, which is known as ‘cognitive restructuring’. This can also be used to prevent the recurrence of episodes, by helping individuals identify the early signs and develop coping strategies to tackle them.¹⁵ 

Summary

Largely occurring as a result of bipolar disorder, manic episodes can create great challenges for those who experience them. Periods of extremely heightened mood and reduced need for sleep may sound appealing to the neurotypical, yet in reality these uncontrolled episodes often result in destructive behaviours that can leave individuals feeling ashamed. 

The behavioural and cognitive interventions offered as a part of psychotherapy aim to help the individual restructure the unrealistic thought processes seen during manic episodes. When implemented alongside the use of medication, psychotherapeutic techniques can enable individuals with mania to make conscious decisions about their behaviour that will hopefully improve their daily lives.