Your Whole Life Well
Bipolar DisordersPonte Vedra Psychologists
Cognitive-behavioral therapy (CBT) for stress, anxiety, & depression.
Bipolar Disorders
Introduction: When Moods Take Over
Bipolar disorders involve dramatic shifts in mood, energy, and activity levels. Periods of depression may alternate with episodes of hypomania or mania—marked by racing thoughts, impulsivity, elevated or irritable mood, and a decreased need for sleep. These changes can unfold suddenly or gradually, often leaving individuals and their loved ones feeling disoriented and overwhelmed.
At Ponte Vedra Psychologists, we offer a stabilizing, evidence-based approach. We work collaboratively with your medical prescriber to create a comprehensive plan: medications help regulate biological rhythms, while CBT builds the skills needed to manage symptoms and support steady progress.
Why Choose Ponte Vedra Psychologists for Individual Therapy for Bipolar Disorder
Living with bipolar disorder can feel like riding an emotional roller coaster. But you are not powerless. At Ponte Vedra Psychologists, we offer a structured, compassionate environment where you can gain clarity, build resilience, and reclaim a sense of balance.
Dr. Greg Garamoni has practiced Cognitive Therapy (CT) for over 30 years. He trained at the University of Pittsburgh School of Medicine’s Cognitive Therapy Clinic, served as Project Manager for a landmark study, and co-authored ten peer-reviewed articles on cognitive therapy and mood disorders.
Dr. Aaron Beck personally invited Dr. Garamoni to present his “States of Mind Model” at the University of Pennsylvania. Though illness prevented the lecture, the opportunity to discuss theory over lunch with Dr. Beck remains a meaningful moment in his career.
We tailor CBT to your life—helping you anticipate mood shifts, manage stress, and build a confident sense of self.
How CBT Supports Bipolar Stability
CBT helps you:
- Monitor early warning signs
- Anchor routines around sleep, meals, and exercise
- Challenge unhelpful beliefs
- Manage stress and impulses
- Create relapse prevention plans
Treatment begins with a thorough assessment and builds a personalized toolkit for long-term stability.
What the Research Says About CBT for Bipolar Disorders
Meta-analyses show CBT:
- Reduces manic and depressive symptoms
- Improves medication adherence
- Lowers relapse rates
- Enhances coping and functioning
Bottom line: Medication addresses biology; CBT helps you master the habits and choices that keep you well.
Ready to Take the Next Step?
Call, email, or use our secure contact form to schedule a confidential consultation today.
Individual TherapyBipolar I Disorder
Overview
“Stability isn’t the absence of energy—it’s learning to steer it.” — Ponte Vedra Psychologists
What it’s like to live with Bipolar I
When Bipolar I is active, life can feel like it’s swinging between gears you didn’t choose. In the “up” gear, ideas come faster than you can act on them; sleep feels optional; goals multiply; spending, risk-taking, or arguments escalate. In the crash that can follow, momentum drains away—work piles up, self-doubt grows, and even simple tasks feel heavy. None of this means you’re broken. It means your mood system needs structure, support, and a practical playbook.
At Ponte Vedra Psychologists, we bring a steady, evidence-based approach: collaborative assessment, clear goals, CBT skills you can use between sessions, and close coordination with your medical prescriber.
Individual TherapyBipolar I Disorder
Symptoms
In Bipolar ! Disorder, there is at least one manic episode, often preceded or followed by depressive episodes.
Manic episodes are periods of abnormally elevated or irritable mood with increased energy and activity. People often notice a sharply reduced need for sleep, racing thoughts, rapid speech, intensified goal pursuit, increased confidence or grandiosity, and riskier choices; judgment may be impaired and, at the most severe end, psychosis can occur.
Depressive episodes usually include low mood or loss of interest, slowed thinking, fatigue, sleep and appetite changes, self-criticism or guilt, and, at times, thoughts of death. Many individuals spend far more time in depression than in mania, which is why treatment must target both poles and the transitions between them.
Individual TherapyBipolar I Disorder
Impairment
Left untreated, bipolar disorders can disrupt every area of life—relationships, work, finances, and health.
During manic phases, individuals may take risks that lead to lasting consequences. Mania may lead to legal, occupational, or medical crises.
In depressive phases, functioning may become severely impaired. Depression can cost opportunity, strain relationships, and erode confidence.
Even when episodes resolve, fear of the next swing can make life smaller than it needs to be.
Proper diagnosis and treatment are key to stability.
Individual TherapyBipolar I Disorder
Diagnosis & Epidemiology
Diagnosis
A diagnosis is made when at least one manic episode has occurred—often alongside major depressive episodes—and these mood shifts represent a clear change from baseline that cause clinically significant distress and impairment in social, occupational, and other vital areas of functioning (see “Symptoms” and “Impairment” sections). Clinicians confirm that mania involves a distinct period of markedly elevated or irritable mood with increased energy, reduced need for sleep, and impaired judgment or functioning; psychotic features or hospitalization immediately establish mania regardless of duration.
Prevalence
Bipolar I is relatively uncommon in the general population—often described as around one person in a hundred over a lifetime. In specialty settings, the proportion is higher because people with severe mood swings are more likely to be referred.
Onset
Onset typically occurs in the late teens or twenties, though first episodes can appear earlier or later. Stress, sleep loss, and substances are common precipitating factors around the first episode.
Course & Progression
Bipolar I is usually recurrent. The risk of additional episodes decreases with steady routines, careful sleep protection, and combined care (medication plus CBT). At Ponte Vedra Psychologists, we map personal early-warning signs and create written action plans so you can intervene before a full swing develops.
Comorbidity & Family History
Anxiety disorders, ADHD traits, and substance use are frequently comorbid and may complicate treatment if unaddressed. Family history of bipolar I or II is more common than in the general population, reflecting strong heritability; that history helps guide monitoring, not destiny.
Individual TherapyBipolar I Disorder
Causes
Bipolar disorders have a strong biological and genetic basis, often involving irregularities in mood-regulating systems in the brain.
Bipolar I reflects an interaction of biology, rhythm, and context. There is strong heritability; the brain’s reward and arousal systems are more reactive; and circadian clocks are unusually sensitive to disruptions (late nights, travel, shift work). Stress, substances, and sleep loss can precipitate episodes. Beliefs and habits—“I don’t need sleep,” “This opportunity can’t wait,” pushing past limits—can unintentionally accelerate escalation, while demoralizing beliefs prolong the lows. The good news is that routines and skills meaningfully buffer these vulnerabilities.
At Ponte Vedra Psychologists, we focus on accurate diagnosis and stabilization, while helping clients understand their unique mood cycle patterns.
Individual TherapyBipolar I Disorder
Treatment
Lasting stability comes from combined care: effective medication management plus the day-to-day skills that keep mood swings from gathering momentum.
At Ponte Vedra Psychologists, we coordinate closely with your prescriber while CBT provides the playbook you use between visits.
Together we map your personal early-warning signs—sleep shrinking, ideas racing, spending spikes, irritability—and build a response plan that starts before things tip into mania.
We’ll protect circadian rhythms (sleep/wake, meals, activity), practice decisions that slow impulsive chains, and develop strategies for high-risk beliefs (“I don’t need sleep,” “This opportunity can’t wait”).
Because depressive episodes often follow mania, we also address the crash: re-establishing routines, challenging hopelessness and self-criticism, and rebuilding momentum through small, visible wins. With your consent, a partner or family member can learn how to support sleep, spot prodromes, and collaborate on a written relapse-prevention plan you both trust.
The goal isn’t a smaller life; it’s a steadier one—so your energy and talents are steered, not sidelined.
Moving Forward
Stability isn’t the absence of drive; it’s the skill of directing it. We’ll help you build those skills and keep them sharp.
Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Individual TherapyBipolar I Disorder
Individual TherapyBipolar II Disorder
Overview
“You don’t have to choose between your drive and your stability—you can have both.” — Ponte Vedra Psychologists
What it’s like to live with Bipolar II
Bipolar II often feels like two very different versions of you. In hypomania, you’re quicker, more social, more confident; projects leap forward, sleep shrinks, and it can seem like you’ve finally hit your stride—until frayed sleep, friction with others, or questionable decisions start to show the cost. The depressions that follow are typically longer and more frequent than the highs, bringing fatigue, self-doubt, and a sense of losing ground. The pattern is real—and workable.
At Ponte Vedra Psychologists, our approach is compassionate and structured. We help you keep what’s best about your drive while smoothing the peaks and lifting the lows with day-to-day skills you can rely on.
Individual TherapyBipolar II Disorder
Symptoms
A diagnosis is made when there has been at least one hypomanic episode and at least one major depressive episode, with no history of full mania, and these mood shifts represent a clear change from baseline that cause clinically significant distress and impairment in social, occupational, and other vital areas of functioning (see "Symptoms" and "Impairment" sections).
Hypomanic episodes are distinct periods of elevated or irritable mood with increased energy and activity that last at least four days and are clearly observable to others, but do not require hospitalization or include psychosis. People notice reduced need for sleep, faster speech and thoughts, increased productivity, social expansion, and more risk-taking than usual.
Major depressive episodes include low mood or loss of interest, decreased energy, sleep and appetite changes, slowed thinking, self-criticism, and sometimes thoughts of death. Because depression dominates time in Bipolar II, treatment must directly address both prevention and recovery from the lows.
Core features & course
The combination of hypomania and major depression defines bipolar II:
At least one hypomanic episode (a milder form of mania, without psychosis)
At least one major depressive episode
Hypomania is noticeable but not severe enough to require hospitalization
Onset often occurs in early adulthood, and misdiagnosis as unipolar depression is common, delaying optimal care.
Individual TherapyBipolar II Disorder
Impairment
Left untreated, bipolar disorders can disrupt every area of life—relationships, work, finances, and health.
Hypomania may appear “functional,” yet it can still harm relationships, finances, and judgment. During hypomanic phases, individuals may take risks that lead to lasting consequences.
Depression disrupts work, strains families, reduces social connections, and narrows ambition. In depressive phases, functioning may become severely impaired.
Over the years, the stop-and-go rhythm can wear down confidence—exactly what treatment aims to restore.
Proper diagnosis and treatment are key to stability.
Individual TherapyBipolar II Disorder
Diagnosis & Epidemiology
Diagnosis
A diagnosis is made when there has been at least one hypomanic episode and at least one major depressive episode, with no history of full mania, and these mood shifts represent a clear change from baseline that cause clinically significant distress and impairment in social, occupational, and other vital areas of functioning (see “Symptoms” and “Impairment” sections). Hypomania lasts at least four days, is clearly observable to others, and changes functioning, but does not require hospitalization or include psychosis; depression accounts for most disability over time.
Prevalence
Bipolar II is also uncommon in the general population—often cited in the about one-percent range—yet appears more often in mood clinics because people seek help for recurrent depressions and fluctuating energy.
Onset
The pattern typically emerges in early adulthood. Many people have a history of repeated depressions before anyone recognizes the hypomanic stretches, which is why careful history-taking matters.
Course & Progression
Time is often spent more in depression than in hypomania, which is why plans must emphasize prevention and recovery from the lows. With the right mix of medication and CBT, people achieve steadier functioning and faster recovery after dips. At Ponte Vedra Psychologists, we help you protect sleep like a vital sign and design a simple, color-coded action plan for early-warning signs.
Comorbidity & Family History
Anxiety disorders and substance use are common co-travelers; thyroid and sleep problems can aggravate mood variability. A family history of bipolar spectrum disorders is frequently reported and informs monitoring and education.
Individual TherapyBipolar II Disorder
Causes
As with Bipolar I, risk reflects genetic loading, circadian sensitivity, and context. Sleep loss, high goal pursuit, and major stressors can tip hypomania forward; perfectionism and avoidance can deepen depressions. The cycle is reinforced when “up-state” overcommitment creates “down-state” overwhelm. Stable routines and cognitive/behavioral tools weaken this cycle.
At Ponte Vedra Psychologists, we focus on accurate diagnosis and stabilization, while helping clients understand their unique mood cycle patterns.
Individual TherapyBipolar II Disorder
Treatment
Bipolar II often feels like two very different lives: productive, quick, connected during hypomania—and slowed, doubtful, withdrawn during depression.
Treatment integrates careful medication decisions with CBT that evens out the ride.
At Ponte Vedra Psychologists, we help you protect sleep like a vital sign, since even small erosions can nudge hypomania forward.
We’ll identify the thoughts and habits that accelerate “up” phases (“I work better on four hours,” “This has to be perfect”) and the patterns that deepen the lows (“I’ve blown it,” “Why try?”), replacing both with steadier routines and choices.
We’ll create a simple color-coded action plan—green (daily maintenance), yellow (early-warning steps), red (safety measures and urgent contacts)—so you and your supports know exactly what to do, when.
Between sessions, you’ll practice skills that preserve gains: consistent wake times, planned breaks from overwork, values-based goals that continue whether mood is high or low, and gentle re-entry strategies after a dip.
The result is fewer surprises, faster recovery from swings, and a life guided by your priorities—not by the peaks and valleys.
Moving Forward
You don’t have to choose between your drive and your stability. With the right structure, you can have both.
Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Individual TherapyBipolar II Disorder
Individual TherapyCyclothymic Disorder
Overview
“When your inner weather changes too often, you need a steadier climate—not a different personality.” — Ponte Vedra Psychologists
What it’s like to live with Cyclothymia
Mood and energy pulse up and down—more than the average person’s—without reaching full mania or major depression.
Others may describe you as mercurial: inspired and social one month, subdued and avoidant the next. The unpredictability can strain confidence, goals, and relationships.
Individual TherapyCyclothymic Disorder
Symptoms
Cyclothymia involves numerous periods of elevated mood with hypomanic-like symptoms and low moods with depressive-like symptoms that do not meet full criteria for hypomania or major depression.
The pattern is present for at least two years in adults (one year in youth), with symptoms occurring at least half the time and no symptom-free period longer than two months.
Even though the individual highs and lows are “subthreshold,” the accumulated effect is real.
Individual TherapyCyclothymic Disorder
Impairment
Left untreated, cyclothymia, like other bipolar disorders, can disrupt every area of life—relationships, work, finances, and health.
Plans start strong and then stall; inboxes fill, projects lag, and relationships ride the rhythm. The long-term impact is inconsistent performance, missed opportunities, and a creeping uncertainty about reliability—yours in yourself, and others in you. This instability takes a toll on self-esteem.
Proper diagnosis and treatment are key to stability.
Individual TherapyCyclothymic Disorder
Diagnosis
A diagnosis is made when there have been at least two years (one year in youth) of fluctuating hypomanic and depressive symptoms that never meet full episode criteria yet are present at least half the time with no symptom-free interval over two months, and the pattern causes clinically significant distress and impairment in social, occupational, and other vital areas of functioning (see "Symptoms" and "Impairment" sections).
Prevalence
Cyclothymic disorder is uncommon but not rare. Most large references place lifetime prevalence in the 0.4–1% range in the general population. In specialty mood clinics, observed rates are higher—often 3–5%—because people with cycling symptoms are more likely to be referred for evaluation.
Onset
The pattern typically begins in adolescence or early adulthood. Many adults, in retrospect, can trace shorter, milder “ups and downs” back to their teens. In youth cohorts, very early symptom emergence is sometimes observed, which can complicate school performance and peer relationships before the condition is formally recognized.
Course & Progression
Cyclothymia is a long-standing pattern on the bipolar spectrum. Without structure, some individuals later experience full hypomanic, manic, or major depressive episodes; with structure, functioning and confidence improve substantially.
By definition, cyclothymia follows a chronic, fluctuating course (≥2 years in adults; ≥1 year in youth), with symptoms present at least half the time and few long symptom-free intervals. It is frequently underdiagnosed or misdiagnosed as recurrent unipolar depression or a personality issue, which partly explains variability in prevalence estimates. Longitudinal studies suggest a meaningful progression risk along the bipolar spectrum for some individuals—roughly two in five converting to bipolar II and a smaller minority to bipolar I in certain cohorts. These figures vary by sample (age, setting, follow-up length) but capture the direction clinicians monitor.
Comorbidity & Family History
Comorbid conditions are common, especially anxiety disorders and substance use. A family history of bipolar I/II is reported more often than in the general population, consistent with shared heritability across the bipolar spectrum. Recognizing these patterns helps guide treatment planning and early, steadying interventions.
Individual TherapyCyclothymic Disorder
Causes
Bipolar disorders have a strong biological and genetic basis, often involving irregularities in mood-regulating systems in the brain. Contributing factors include:
- Family history – Bipolar disorder is one of the most heritable psychiatric conditions.
- Brain structure and function – Changes in activity and connectivity in specific brain areas are common.
- Neurochemical imbalances – Dysregulation of dopamine and serotonin plays a role in mood shifts.
- Sleep disturbances – Poor sleep may trigger or worsen episodes.
- Life stress or trauma – Can interact with biological vulnerability to trigger onset or relapses.
At Ponte Vedra Psychologists, we focus on accurate diagnosis and stabilization, while helping clients understand their unique mood cycle patterns.
Individual TherapyCyclothymic Disorder
Treatment
Cyclothymia is about rhythm. The mood shifts are real, even if they don’t meet full episode criteria, and the work is to smooth the pattern so you can count on yourself.
At Ponte Vedra Psychologists, CBT begins with clarity: we chart your cycles, triggers, and habits across weeks and months, then design a routine that holds steady through both “up” and “down” stretches. Think of it as building a metronome for your life—regular sleep and wake times, predictable work blocks, balanced social time, and sustainable exercise—so momentum doesn’t spike or stall.
We’ll address the thinking that tends to swing with mood: the overly optimistic plans that overfill your calendar during energized periods, and the overly pessimistic conclusions that make you withdraw during lows.
Together, we’ll practice realistic pacing, boundary setting, and values-based commitments that continue regardless of state.
f symptoms are frequent or particularly disruptive, we’ll coordinate with your physician to consider medication options as part of a broader plan.
Over time, people describe feeling more themselves—not a different personality, just a steadier version that can be counted on.
Moving Forward
When your inner weather changes often, a steadier climate is possible. Small, consistent choices create it—and keep it.
Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
Individual TherapyCyclothymic Disorder
Three Bipolar Disorders, Three Roller Coasters
At Ponte Vedra Psychologists, we often use visual metaphors to make complex ideas easier to understand. Our three-roller-coaster illustration highlights the key differences between Bipolar I, Bipolar II, and Cyclothymia. Seeing these differences clearly is essential for a proper differential diagnosis, because each condition requires its own tailored approach to treatment and support.
Bipolar I: The Extreme Roller Coaster
This is the tallest, most dramatic ride, with incredibly high peaks and deep, steep drops.
- Peaks = Mania: A period of intensely elevated or irritable mood, often with decreased need for sleep, racing thoughts, impulsive behavior, or psychosis. Mania can be exhilarating but also dangerous and disruptive, often requiring medical care or hospitalization.
- Valleys = Major Depression: Severe periods of low mood, energy, and motivation.
Why it matters: Bipolar I is defined by at least one full manic episode. Recognizing mania—not just depression—is critical to prevent misdiagnosis and to guide the right mood-stabilizing treatment.
Bipolar II: The Less Intense Highs
This ride looks similar but the peaks aren’t as high.
- Peaks = Hypomania: Elevated mood that is noticeable but less disruptive than mania. No psychosis, and usually no hospitalization needed.
- Valleys = Major Depression: Still deep and often severe, which is why Bipolar II is frequently mistaken for unipolar depression.
Why it matters: Bipolar II is defined by at least one hypomanic episode and one major depressive episode—but no full mania. Finding the hidden hypomania is key to accurate diagnosis and effective treatment.
Cyclothymia: The Constant, Milder Fluctuations
This is the smaller, winding coaster with many small ups and downs.
- Ups and Downs = Subthreshold Symptoms: Mood swings are persistent but never reach the full criteria for hypomania or major depression.
- Duration: At least two years in adults (one year in children/adolescents), with symptoms present more days than not.
Why it matters: The long-term, chronic pattern of cyclothymia can still be exhausting and impairing. Identifying it early allows for steady, supportive care instead of crisis-driven treatment.
Why the roller coasters matter for diagnosis
These three “rides” represent three distinct clinical patterns. Knowing which ride you’re on shapes the entire treatment plan—from therapy style to medication choices to lifestyle adjustments. For example, prescribing only antidepressants to someone with undiagnosed Bipolar I or II can worsen mood instability. Recognizing cyclothymia can help you address patterns before they intensify into full episodes.
At Ponte Vedra Psychologists, we don’t just look at your current mood—we look at your entire pattern over time, your life story, and your medical background. That’s how we make sure you’re on the right track to healing, not the wrong roller coaster.
Use one of the three buttons below to reach out today—call us, send an email, or use our secure contact form to schedule a confidential consultation.
A Whole Life Lived Well is a Work of Art
–Dr. Garamoni
Fast Facts Footnote
WHO we are
At Ponte Vedra Psychologists, we are a compassionate and experienced team led by Dr. Gregory Garamoni, Ph.D., a licensed clinical psychologist with over 30 years of experience. We serve individuals, couples, and families navigating emotional, relational, or psychological challenges—with care that emphasizes clinical excellence, transparency, and personal respect. Based in Ponte Vedra Beach, we also support clients from across Northeast Florida, including Jacksonville Beach, Neptune Beach, Atlantic Beach, Jacksonville, Orange Park, Nocatee, Palm Valley, and St. Augustine.
WHAT we do
We provide therapy for anxiety, depression, relationship difficulties, and other emotional concerns. We also offer life coaching to support personal development, decision-making, and forward momentum, as well as psychological assessments for a wide range of cognitive, emotional, and educational needs—including specialized gifted IQ evaluations. Our approach blends evidence-based methods like cognitive-behavioral therapy with individualized strategies that promote insight, clarity, and lasting change.
WHERE we are
Our office is located in the Sawgrass Village Shopping Center in Ponte Vedra Beach, Florida. We offer a discreet and welcoming environment in the heart of the community, making it easy for clients from throughout the First Coast—including Jacksonville Beach, Neptune Beach, Atlantic Beach, Jacksonville, Orange Park, Nocatee, Palm Valley, and St. Augustine—to access care.
Ponte Vedra Psychologists
2304 Sawgrass Village Drive
Ponte Vedra Beach, FL 32082
(In Sawgrass Village Shopping Center, our office has a private exterior entrance on the 3rd floor of the professional office building, Park Place.)
🧭 Get Directions on Google Maps
WHEN we're open
Appointments are available Monday through Thursday, from 9:00 a.m. to 8:00 p.m. We’re flexible, so you can find a time that works best for your life and schedule—whether you're seeking therapy, life coaching, or psychological evaluation.
WHYchoose us
Choose Ponte Vedra Psychologists for our deep clinical experience, our warm and respectful atmosphere, and our unwavering commitment to your long-term well-being. We value transparency, privacy, and personalized care—offering therapy, life coaching, and expert psychological testing to meet you wherever you are in your journey and help you take confident steps forward.
HOWto connect
We invite you to call us at (904) 285‑4229 to schedule a confidential consultation, or visit our Secure Contact Form page to send a message or request an appointment online.
Our office is located at:
Ponte Vedra Psychologists
2304 Sawgrass Village Drive
Ponte Vedra Beach, FL 32082
(In Sawgrass Village Shopping Center, our office has a private exterior entrance on the 3rd floor of the professional office building, Park Place )
🧭 Get Directions on Google Maps
Availability
We are currently accepting new clients for both in-person and online sessions. Whether you're local to Ponte Vedra Beach or connecting from elsewhere in Florida, we’re here to support you with flexible, confidential care.
Please note that all appointments must be scheduled in advance. We do not accept walk-in visits, as unplanned arrivals may disrupt our scheduled sessions.
Whether you're reaching out for therapy, life coaching, or psychological assessment, we're here to support you with responsive and compassionate guidance every step of the way.
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