A Self-Help Guide to Living with Bipolar

Woman looking out windowThere is a paradox when it comes to bipolar mood episodes in terms of the treatment versus the prevention of episodes. On the one hand, the treatment of mood episodes can be rigorous, prolonged, and unsatisfying for people with bipolar and those around them. However, there are things people with bipolar can do to empower themselves in managing and, in some cases, staving off mood episodes.

Here is a focused outline on three self-guided components for living with bipolar: sleep, self-care, and support.

1. Train Yourself to Sleep

Your body responds to natural circadian rhythms. Based on a 24-hour cycle, a person’s physical and mental processes (e.g., mood) are affected by the changes of light and darkness. Setting the same wake and sleep schedule can dramatically improve your mood. Try to go to bed around the same time each night (even weekends) and get up around the same time in the morning. To do this, utilize these sleep hygiene tips.

Establish a routine to wind down in the evening. Pay attention to what time it is, so there is room to slowly navigate the dental routine, preparing for tomorrow’s workday, and the contact lens storage process. Avoid projects and other mentally taxing activities. Instead, read a novel, take a shower, or do some light stretching in the evening. Using alcohol, nicotine, or other drugs can disrupt nighttime habits, which consequently leads to increased stress and less capacity to manage it. Finish eating at least two to three hours before you go to bed, and abstain from caffeinated beverages in the evening. It takes approximately six hours for caffeine to leave the body, so a reasonable rule would be switching to decaf by 4 or 5 p.m.

When you are ready to hit the sack, use your bed for two things: sleep and sex. This means not binging on Netflix or writing a dissertation from the confines of the bed. Train the body to know that when you are getting into and lying in bed, it is time to fall asleep. You do not want to be alert in front of a screen or stimulated by a task you are doing while in bed. Consistent, alert activity in bed teaches us to be awake; when we do want to go to bed, the brain is confused as to whether dreamland is approaching or to perk up for Breaking Bad.

Similarly, do not submit to long periods of insomnia (no more than 10 or 15 minutes at a time). Although seemingly counterintuitive, this goes back to the idea of training the body. After 10 to 15 minutes of not being able to fall asleep, do not continue counting sheep; go to another room and get a glass of water, read a brief article or part of a book, and wait until you are a little sleepy before returning to bed. This reminds the body that the bed is for sleeping. Life can get in the way, but aim for seven to eight hours of sleep per night.

2. Practice Regular Self-Care

Recent research shows that exercise is at least as effective for relieving depression as antidepressant medication. It also comes with a lot of less intrusive side effects (i.e., feeling relaxed, improved sleep and energy levels). Exercise regularly and make sure to finish a few hours before bedtime. Our bodies did not evolve to sit in office chairs for 12 hours per day, so getting your heart rate up or simply going for a long walk is a great stress release.

The more one understands about contributing factors to bipolar episodes, the more empowered he or she is to take preventative actions. You can develop a lifestyle management routine around your specific needs for mental health.

In addition, the mind, which regulates the flow of energy in our bodies, needs time to regenerate without stimulation. Develop a mindfulness practice or other type of spiritual process that you really value as necessary for mental well-being.

Prayer or meditation is best practiced in the morning after waking up. This establishes an intention for mindfully approaching daily life. Sit in silence while paying attention to your breathing for 20 to 30 minutes (start in smaller increments). Mindfulness group practices and classes are ever more ubiquitous and offer instruction to guide your work. Practicing these techniques within a community can be especially powerful. Contemplative activities are not rooted in gaining or self-improvement, which drive our identification with productivity. It is a commitment to sustaining a healthy lifestyle for the betterment of your relationships with others. Being curious and actively aware of the present will elicit awareness to subtle symptoms while decreasing impulsive behaviors.

A simple tracking sheet for mood and anxiety levels as well as self-care initiatives is a constructive way of monitoring behavioral and mental changes. Use a spreadsheet and leave it next to the bed or, if applicable, next to your daily supplements and/or medication box. Quickly note on a scale from 1 to 10 (1 being depressed and 10 equaling manic symptoms) what your mood was for the previous day. You can do this for anxiety levels as well. Also, note whether you exercised or practiced other self-care (yoga, meditation, etc.) and any significant events (interpersonal issues, medication changes, etc.) that took place. Over time, you will have a noteworthy amount of data to compare the actions you have been taking with changes in your routines, moods, and levels of stress. Utilize the correlations you find and make predictions about what you need to do—or not do—in order to stay on top of emerging problems.

The more one understands about contributing factors to bipolar episodes, the more empowered he or she is to take preventative actions. You can develop a lifestyle management routine around your specific needs for mental health. This includes clues to early warning signs and possible factors you have identified that get you into psychological trouble.

3. Lean on Others for Support

The effects of bipolar rarely occur within a vacuum. When a person tries to manage it alone, it can consume the person. Like any stressor or bothersome life event, the symptoms of bipolar pull on relationships. This becomes a systems issue that requires the support of others. Wright et al. (2009) state that “family members and friends are generally good observers and may be able to recognize the subtle changes in behavior, emotions, and thought processes that signal the onset of mania.”

Having individuals in your life who are aware of your historical battles raises the likelihood that mood changes will be identified before complete manifestation. Talk to people who are close to you when you have medication or drug-use changes, feelings of depression, or energy changes, and allow space for them to discuss your routines or behaviors. Appreciate their information and knowledge while assuming they love and want the best for you. Transparency will alleviate the concerns of others and lessen the burden you feel for managing the prevention of mood episodes.

It is essential to develop close relationships with your health providers so they have a longitudinal vista into your mental health. If you wanted to see how your face aged over time, you could take a selfie on a daily or weekly basis and run the images through a video program. Similarly, regular meetings with a psychotherapist will foster insight, but also enable the psychotherapist to notice subtle changes in your mental health presentation. A psychotherapist typically takes a “snapshot” of you each week—or two—and, akin to a series of selfies, compares and contrasts the “images.” This clinical timeline is examined with you in order to make correlations and inferences about mood episodes as well as behavioral changes. A disciplined regimen of psychotherapy is necessary to understand our habitual processes. You become aware of the holes you continuously fall into despite seeing warning signs.

If you can regulate your sleep, monitor internal changes, and stay physically active—while also training your mind—you and your therapist might not have much to talk about.

References:

  1. Archer, A.J. (2013). Pleading Insanity. Bloomington, IN: Archway Publishing.
  2. American Psychiatric Association. (2013). Diagnostic & Statistical Manual of Mental Disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
  3. Kirsch, I. (2010). The Emperor’s New Drugs: Exploding the Antidepressant Myth. New York: Basic Books.
  4. Kirsch, I., Deacon, B.J., Huedo-Medina, T.B., Scoboria, A., Moore, T.J., & Johnson, B.T. (2008). Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. Public Library of Science Medicine 5 (2): 260-268.
  5. Miklowitz, D.J. (2014). Bipolar Disorder. In: D.H. Barlow (ed.) Clinical Handbook of Psychological Disorders: A Step-by-Step Treatment Manual. (5th ed.). New York: The Guildford Press. 462-501.
  6. Murray-Swank, A., & Dixon, L. (2005). Evidence-Based Practices for Families of Individuals with Severe Mental Illness. In: R.E. Drake, M.R. Merrens, & D.W. Lynde (eds.). Evidence Based Mental Health Practice. A Textbook. New York: W. W. Norton & Co., pp. 425-452.
  7. National Institute of General medical sciences: basic discoveries for better health. Circadian Rhythms Fact Sheet. Content reviewed November 2012. Retrieved from: http://www.nigms.nih.gov/Education/Pages/Factsheet_CircadianRhythms.aspx
  8. Siegel, D.J. (2010). The Mindful Therapist: A Clinician’s Guide to Mindsight and Neural Integration. New York: WW Norton & Company.
  9. Wright, J.H., Turkington, D., Kingdon, D.G. & Basco, M.R. (2009). Ch. 8 Mania. In: Cognitive-Behavior Therapy for Severe Mental Illness. An Illustrated Guide. Washington, D.C.: American Psychiatric Publishing, Inc. pp. 181-209.

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Andrew Archer, LICSW, therapist in Mankato, Minnesota

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • erika

    erika

    June 29th, 2015 at 8:19 AM

    Fundamentally you have to learn to put yourself first and take care of yourself, for it is this type of self care that will help keep you aware of your moods and will help you to refocus and stabilize if it feels like things are getting out of control
    I think that the ability to come far more self aware can be crucial to winning this fight against bi polar.

  • cholas

    cholas

    June 29th, 2015 at 4:47 PM

    Having some sort of routine, for me, is the key to me getting through the day. Without that, like when I am on vacation or something , that is when I start to feel a bit lost and don’t do very well with coping with everyday things,, not in the way I do when I stick to some sort of normalcy in my day. It’s tough when going on vacation isn’t all that much fun because I know that it just gets me all out of whack.

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    June 30th, 2015 at 9:30 AM

    Erika-
    I think you are absolutely right about taking care of yourself and I would add having others around to support or cultivate that self-awareness is crucial.
    Cholas-
    If you can predict in advance that you will have breaks from routines, it might give the option of preparing more for them. That way you could work in some structure to an otherwise structure-less activity (i.e., vacation).

  • TIA

    TIA

    June 30th, 2015 at 9:34 AM

    Does this generally get better with medication? Does it help to also implement these other strategies along with that?

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    July 1st, 2015 at 1:42 PM

    TIA- Medication can help contain and or prevent symptoms from occurring. Individuals often need a sense of stability coming out of a mood episode (i.e., with medication). Seeking out strategies to prevent mood episodes via psychotherapy and these at-home skills will have longer lasting results. One has to come to an understanding about how their moods tend to shift and develop ways to manage the contributing stress.

  • Shirley

    Shirley

    July 1st, 2015 at 3:22 PM

    This article offends me to the core, sir being a LCSW does NOT make you a psychiatrist, your article is fine if directed towards people with anxiety disorders or mental health issues that are indeed behavioural but completely irrelevant to those with chemical imbalances! Telling us to deal with the issues in the way you mention in your article is complete and utter nonsense, when our brain chemistry is scrambled the advice given (for example regarding sleep issues) is as helpful as telling us not to breath! What about the times when we suffer a depressive episode and struggle to stay awake or indeed drag ourselves from bed? How will your suggested bedtime routine help there? On the other side of this during a manic episode ANY form of exercise can prove problematic as it can be difficult to know when to stop, increasing the abundance of energy and feelings of invincibility that we already experience during such episodes. Therefore not only leaving you over stimulated but also increasing the risks of injury. I urge that goodtherapy.org consider are fully the qualifications and credentials of any contributors of articles that deal with psychiatric conditions that are so severe that people suffering these conditions can suffer enough to take their own lives!

  • Andrew Archer, LCSW

    Andrew Archer, LCSW

    July 2nd, 2015 at 3:40 PM

    Shirley, thank you for bringing up some crucial points. This article is not meant to be a treatment manual for acute bipolar episodes. These are self-help suggestions for lifestyle management that positively contribute to stable moods, stress reduction and the prevention of episode onset. From my personal and clinical experience, fundamental progress in these domains–over time–can dramatically improve one’s life. For example, meditation and exercise will not ensure a person never goes through depression, but developing these routines makes a person more ready to face mental health challenges.

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