Today, you’re going to learn all about DBT for bipolar and how to self-manage your bipolar symptoms using dialectical behavior therapy (DBT) skills that you can start using immediately to gain more control over your emotions and your behavior.
Winston Churchill, Lord Byron, Virginia Woolf, Napoleon Bonaparte, Ernest Hemingway and Vincent van Gogh are only a few of the politicians, writers, and artists who, despite having bipolar disorder, have reach great success.
2.8% of U.S. adults have bipolar disorder according to a diagnostic interview data from National Comorbidity Survey Replication (NCS-R).
Having bipolar disorder can often feel like being at the mercy of your emotional states.
But this doesn’t have to be the case.
- What Is Bipolar Disorder?
- What Is Dialectical Behavior Therapy?
- DBT For Bipolar
- 1. DBT Mindfulness Exercises
- 2. Distress Tolerance Skills
- 3. Emotion Regulation Skills
- 4. Interpersonal Effectiveness Skills
- More Tips: How To Manage Your Bipolar Disorder Without Medication?
- I. Managing Mania
- II. Dealing with Depression
What Is Bipolar Disorder?
Bipolar disorder, known before as manic depression, is characterized by extreme highs and lows in mood.
People with bipolar disorder go through cycles when their mood is either elevated (manic) or depressed.
While only a medical professional can accurately give a diagnosis, the internet has made it easy to take online screenings that can help give you a better idea of whether or not you have a bipolar disorder. (*)
What Is Dialectical Behavior Therapy?
Dialectical behavior therapy is a treatment originally created to treat borderline personality disorder. But since then it has proved to be very effective in treating a range of other illnesses as well. (*) (*)
DBT offers effective ways to help you manage your overwhelming emotions without losing control.
4 Categories of DBT Skills
Mindfulness helps you live more in the present moment and as a result reduces your experience of painful emotions that come from overthinking about the past or worrying about the future.
2. Distress Tolerance Skills
These skills can help you cope with depressive or manic episodes in a healthier ways, rather than engage in the old, self-destructive behaviors that would likely make things worse for you.
3. Emotion Regulation Skills
These skills helps you better understand and manage your emotions or learn how to tolerate them when you can’t change them or reduce their intensity.
4. Interpersonal Effectiveness Skills
These skills relate to the relationships in your life. They will help you act effectively in your relationships and stop your intense emotions from hindering these relationships.
DBT For Bipolar
1. DBT Mindfulness Exercises
Why Be Mindful of Your Emotions?
Mindfulness helps you pay attention to your emotions and become aware of any upcoming episodes.
You might find yourself purposely avoiding noticing these emotions, hoping that they’ll go away. But avoidance has the opposite effect.
It is only by noticing them early on and making better choices that you can effectively manage these emotions.
What Is Mindfulness?
Mindfulness is the act of purposely paying attention, in the present moment and without judgment (Kabat-Zinn 1994).
For example, you might have driven or walked the same route to work and when you reached your destination, you realized you have no memory of the last fifteen or twenty minutes of the drive or walk. You were physically engaged in driving or walking, but mentally, you were engaged in something else.
Much of our lives is lived this way.
Mindfulness is about training your mind to tune in to the present moment (within yourself or in the environment) with an attitude of curiosity, acceptance, and openness toward the experience.
Each time your mind wondered, you bring your attention back to the moment.
Why Pay Attention to The Present Moment?
According to a research conducted by the National Science Foundation, we have around 12,000 – 50,000 thoughts daily 80% of which are negative.
When you pay attention to the present moment without judging it, you reduce the time you spend dwelling on negative thoughts.
Mindfulness has other benefits (Harvard Medical International 2004):
- It improves the functioning of your immune system.
- It decreases medical symptoms, including chronic pain, fibromyalgia, psoriasis, and high blood pressure.
- It reduces anxiety and stress.
- It improves sleep.
- It helps to prevent depression from returning.
- It improves your ability to tolerate upsetting thoughts.
- It activates a part of your brain that is connected to experiencing happiness and optimism.
How to Practice Mindfulness?
The idea of intentionally focusing on the present moment without judgment may sound simple, but putting it into practice can be extremely difficult.
Your minds would wonder as soon as you start noticing what’s happening within you and around you.
Rather than seeing that as a failure to practice correctly, it can be helpful to think of mindfulness as returning to the present moment – it is the practice of noticing when your attention goes astray, and without judging yourself, returning your attention to whatever is happening in this moment.
#1. Instructions for Mindfulness Practice
1. Choose something to focus on, such as choosing as object to look at, or listening to music and focusing on the different sounds you hear.
2. Bring your attention to the object—start examining it as though you’ve never seen it before, using all of your senses.
3. Notice when your mind wanders and gently bring your attention back to your object of focus.
4. Repeat steps 2 and 3 over and over and over again.
You can start implementing the same process while doing daily activities.
Start by choosing simple activities you already do with a lot of focus and that easily hold your attention and then buildup from there.
These activities may include:
- Watching an engrossing movie or television show
- Watching the sun rise or set
- Playing with a pet
- Reading a good book
- Playing a sport
- Playing a musical instrument
- Having a discussion about a topic you find very interesting
#3. Use Mindfulness to Distance Yourself From Negative Thoughts
Putting a distance between yourself and your thoughts can lessen their effect on you.
Rather than saying, “I look foolish,” try saying, “I’m having thoughts about looking foolish because I don’t know many people there.”
The following exercises will help you practice putting a distance between yourself and your thoughts.
Practical Exercise 1 – Floating Clouds Exercise
Imagine yourself lying in a field of grass, looking up at the clouds.
Imagine your thoughts resting on these clouds.
Don’t judge the thought. Simply observe each thought on each cloud float by.
When you notice your attention straying from the exercise, gently bring it back to observing the thoughts.
Practical Exercise 2 – Falling Leaves Exercise
Visualize yourself standing in a forest enjoying the sights around you.
Imagine seeing leaves falling from the trees.
Whenever a thought enters your mind, imagine it resting on a leaf and watch it as it falls to the ground.
Without judging the thought as negative or positive, pick up its leaf and put it in a pile of similar thoughts.
For example, if you’re worried about an upcoming meeting, take the leaf and put it in “worry thoughts.”
Continue to notice the thoughts and placing its leaves in piles.
Find more techniques to distance yourself from negative thoughts in this article: 10 Powerful Techniques To Control Your Negative Thoughts
#4. Use Mindfulness to Control Your Urges
Everyone experiences urges. These urges might include using drugs or alcohol, overeating, undereating, self-harm, driving dangerously, overspending, lashing out when you’re angry, etc.
Some people learn ways to control their behavior and not act on these urges. But for other people, these urges can take control and become habits.
Increasing your awareness can help you not engage in these behaviors and find healthier ways to manage your difficult emotions.
Practical Exercise 3 – Breathing Space
This is a quick exercise that will help you increase awareness and access your wiser mind more often.
1. Begin by paying attention to what you are feeling, physically and emotionally. Don’t judge. Simply pay attention to what’s going on in your body and mind.
2. Now, bring your attention to your breathing. You don’t have to change your breathing pattern. Simply focus on the physical sensations of the air as you inhale and exhale.
3. Slowly expand your awareness to include a sense of your whole body. Notice any physical sensations, emotions, and thought that might be present.
By putting some distance between yourself and your emotions, these emotions won’t control your behavior.
#5. Use Mindfulness to Make Effective Decisions
Three Different Ways of Thinking: Emotion Mind, Reasoning Mind, And Wise Mind
Emotion mind is a style of thinking that causes you to react from your emotions, to the point that it feels like your emotions are controlling you and your behavior.
For example, you feel depressed and you withdraw and isolate yourself or you feel angry and you lash out at someone.
Emotion mind can get you in trouble, but it is not entirely a bad thing. It also encompasses positive emotions such as love and joy – and you want to feel these positive emotions.
The goal here is not to get rid of emotion mind, but to balance it with the other styles of thinking.
Reasonable mind (also known as reasoning mind) is the balancing counterpart to emotion mind. It is a thinking style that you use to do logical thinking, where little or no emotion is involved.
Examples include writing your to-do list, or following direction to get somewhere you’ve never been before.
Reasoning mind is obviously important but spending so much time in reasoning mind can throw you out of balance and lead to losing touch with your emotions.
Wise mind is when you are able to think from both emotion mind and reasoning mind together (Linehan 1993b).
When you are in wise mind, you can feel your emotions (emotion mind), but you are also able to think straight (reasoning mind).
This helps you make healthy choices that that fit with your morals and values and are in your best interest.
For example, you might wake up in the morning feeling awful and depressed.
Your emotion mind says, “I feel lousy, I’m not getting out of bed.” Here your emotions are controlling your behavior.
Your reasoning mind would say, “If I don’t go to work today, I won’t meet the deadline on this project and it may put my job in jeopardy.”
In wise mind, you would combine these two styles of thinking, “I need to meet the deadline on this project, so it’s in my best interest to go even though I don’t feel up to it.”
The wise mind here will make a decision that takes into consideration both how you feel and what you think about the situation.
Practical Exercise 4 – Being In Wise Mind
Think of a situation in which you could practice being in wise mind and making effective decisions. Answer the questions below to determine what will be most helpful for you in this situation:
1. Describe the situation
2. What emotions are you experiencing about this situation?
3. What is your urge in this situation? (What is emotion mind telling you to do?)
4. What are your long-term goals in this situation?
5. What would be an effective decision for you to make in this situation? (A decision that will help you meet your long-term goals?)
2. Distress Tolerance Skills
The urge to act self-destructively when painful emotions emerge occurs especially when you are experiencing depression, mania, or mixed episodes. But it can also occur outside of these mood-related episodes.
In an attempt to reduce the intensity of your emotions and make them somewhat more tolerable, you might find yourself engaging in behaviors that actually make the situation worse.
DBT teaches you healthy coping skills (along with mindfulness) to help you tolerate distress.
These skills will not get rid of your emotions, or solve your problems. But they will help you to survive the crisis without making things worse.
#1. Identify Self-Destructive Behaviors
The first step is to identify typical self-destructive behaviors in order to replace them with healthier alternatives.
These may include:
- Drinking alcohol
- Using drugs
- Engaging in disordered eating (e.g., purging)
- Engaging in dangerous sexual practices (for instance, having unprotected sex or having sex with someone you just met)
- Avoiding other people or isolating yourself
- Using sleep to escape
- Becoming violent toward others
- Cutting yourself
- Attempting suicide
Self-harming behaviors, such as cutting yourself, may provide physical pain that distracts you from your emotional pain for a short period. But the long-term consequences outweigh any short-term benefit they may provide.
#2. Cost and Benefit Analysis
This skill helps you act from wise mind and do a better job sticking to your decision, even in the midst of a crisis.
You can also score each positive and negative consequence on a scale from 1 to 5 so that you can evaluate how destructive the behavior really is.
Example – Cost-Benefit Analysis of Drinking alcohol
Self-Destructive Coping Behavior: Drinking Alcohol
|Helps relax and calm me (4)|
Helps me forget about my problems (4)
Helps numb my emotions (3)
|Putting myself at risk for depressive episode (5)|
It’s an avoidance technique that intensify painful emotions (4)
Feel guilty afterwards (5)
Bad for my health (2)
My partner doesn’t like it, it causes relationship conflict (4)
|Total: 13||Total: 20|
Healthy Coping: Not Drinking Alcohol
|Pushes me to face my problems (4)|
Makes me feel better about myself (5)
Not risking my physical and mental health (3)
Better sleep quality (4)
|Harder to relax (4)|
Having to face problems and emotions (4)
Having to find other ways to cope (3)
|Total: 16||Total: 11|
In cost-benefit analysis, you can usually see that the benefits of coping in a healthy way outweigh the benefits of coping in a self-destructive way.
But you may find yourself unable to think of reasons to learn new ways of coping. When this happens, try asking safe people for help to think of additional reasons to try to stop the problem behavior.
#3. Put Some Time Between The Urge and The Action
They key here is to notice the urge as it builds up. Mindfulness can help you here.
Notice your urge and rate its intensity on a scale from 0 to 10 (0 meaning absence of the urge and 10 meaning the urge is highly intense).
The goal here is not to avoid acting on the urge, but to try to put some time between when you notice the urge and engaging in any behavior.
Deciding that you’re done with the behavior probably won’t be effective for very long and might make you feel worse when you relapse.
Instead, decide that you will not act on the urge for just fifteen minutes. This is much more doable and can give you a chance to use healthy skills instead of automatically acting on the urge.
During your waiting time, you’d want to use the following distress tolerance skills:
#4. Use Distracting Skills
In general, the harder you try to stop thinking about something, the more you’ll think about it.
Distracting skills give you something else to think about so you can stop thinking about your urge. These skills include:
- Mindfully engaging in an activity (go for a walk, play with your pet, watch a comedy on television, read an engaging book, play an instrument, play a sport, dance, clean and organize your space, etc)
- Thinking neutral thoughts (Counting, singing the alphabet song, saying the names of objects out loud as you look around the room, praying, repeating a neutral mantra to yourself)
- Doing something for someone else
- Grounding techniques
- Put your hands in water
- Breathe deeply
- Savor a food or drink
- Take a short walk
- Hold an ice cube
- Recite something
- Describe what’s around you
- Picture the voice or face of someone you love
- Touch something comforting
- Listen to music
These skills can provide a distraction in crises, but you can also incorporate them into your life on a regular basis to care for yourself and reduce your overall stress level, reducing the number of future crisis.
#5. Shut Out The Situation, Physically And Mentally
When your overwhelming emotions are triggered by the environment you are in, leaving the situation physically and going somewhere calm and quiet can reduce your distress.
However, sometimes your emotions don’t come down even after physically leaving the situation. This is when you want to use the pushing away (Linehan 1993b) skill.
This skill helps you use your imagination to convince your mind that this is not a problem that can be worked on in the present moment.
Practical Exercise 5 – Pushing Away Skill
1. Write down the problems that are triggering painful emotions.
2. For each problem on your list, ask yourself: “Is this a problem that can be solved right now?” or “Is now a good time for me to try to work on this problem?”
3. If the answer is yes, then these are problems that you need to solve rather than pushing away. The skill of pushing away is only effective when the problem is not solvable.
4. For the remaining problems that can’t be solved now, close your eyes and try to imagine an image that represents the problem (this could be a person you’re having a difficulty with, or words that represent the problem).
5. Next, visualize a box and see yourself putting that image into the box. Put a lid on the box and tie the lid on with string. You can go further by visualizing yourself putting the box on a high shelf in a closet and shutting the closet door – whatever you need to in order to send the message to your brain that this problem is not solvable right now (Linehan 2003a).
Why We Need Emotions?
Emotions are neither good nor bad. They are there to serve a purpose.
Anger, for example, motivates you to do something about a situation that involves injustice.
Fear helps you survive by activating the flee, fight, freeze, or faint response when you’re being threatened
Guilt informs you that you’ve done something that doesn’t align with your morals and values and encourages you to reflect on it and fix it.
So the goal here is not to get rid of emotions but rather to learn how to manage them effectively.
How to Manage Your Emotions?
#1. Validation (Radical Acceptance)
Validating your emotions might sound counterintuitive. After all, you when you’re experiencing an uncomfortable emotion, you don’t want it to stick around.
However, invalidating yourself and fighting these unpleasant emotions can cause the emotion to stick around and even become more intense.
How are you invalidating yourself?
You invalidate yourself when you judge the emotion or judge yourself for having it, which triggers other unpleasant secondary emotions (emotional reactions we have to other emotions).
For example, when you feel anxious and you judge yourself for having that emotion, you might become angry at yourself and end up dealing with both anxiety (the primary emotion) and anger (the secondary emotion).
Anxiety (primary emotion) + Invalidation = Anxiety (primary emotion) + Anger (secondary emotions)
How you validate your emotions?
By giving yourself permission to have them!
Validating your emotions doesn’t mean you like having them or that you don’t want them to change. It simply means acknowledging the presence of the emotion without judgment.
For example, if you’re feeling anxious, you validate your emotions by saying “I feel anxious,” and leaving it at that.
Anxiety (primary emotion) + Validation = Anxiety (no secondary emotions)
When you validate your emotions, it becomes much easier for the wise mind to figure out what you can do to change them.
Practical Exercise 6 – Learning to Validate
1. Start by looking at the ways you invalidate yourself.
In your journal, write down some of the judgments you have about your feelings.
For example, you might find yourself saying, “Why do I feel sad. What’s wrong with me?” or, “This is stupid! I shouldn’t feel so angry?”
2. Challenge these judgments.
“Sadness is a natural human emotion. There are going to be time when I feel sad that doesn’t mean there’s anything wrong with me for feeling that way.”
“The anger serves a purpose; something triggered this emotion and I have every right to feel it.”
3. Validate your emotions.
Choose statements you can repeat to yourself to help you feel more accepting of your emotions.
“I give myself permission to feel this emotion.”
“It is okay for me to feel this way.”
#2. Increase Positive Emotions
The goal here is to improve your mood and help make the depression a little bit more tolerable.
A. Pleasurable Activities
Doing pleasurable activities can help lift your mood, but they can also be extremely difficult to do. When you’re depressed, it’s hard to find the motivation or energy to do much of anything.
The thing is, it’s very unlikely that your mood will improve until you start to do some of these enjoyable activities.
For example, you might not feel like going outside, but once you do, it’s not so bad. So it helps to do them even when you don’t feel like it.
What can you do that will be enjoyable?
Think of activities that help calm or soothe you.
Think about activities you’ve tried in the past that have improved your mood.
Here are some examples:
- Sitting outside in the sunshine
- Playing with your pet
- Watching a funny movie
- Spending more time with people you care about
- Cooking a special meal
- Donating old clothes or items to charity
- Doing art and craft projects
LIST OF PLEASURABLE ACTIVITIES
Try doing at least one activity every day to increase your contentment and satisfaction and reduce the frequency of potential depressive episodes.
B. Setting Goals
Setting goals for yourself increases your overall satisfaction.
These goals involve big changes you want to make in your life, but also the smaller goals that you can achieve everyday.
Start by asking yourself, “If I could do absolutely anything I wanted, what would it be?”
Then work your way from there.
Practical Exercise 7 – Setting Goals
1. Write down your any interests you have, even the ones never acted on. These could include:
- Playing sports
- Playing music instruments
- Learning new languages
- Reading books
2. Choose one interest you’d like to start with
3. Do some research to come up with a plan on how you can pursue that interest.
For example, if you want to learn photography, find out if you can take a class or follow free tutorials online.
4. Take a step to work toward your goal.
#3. Act Opposite to Your Urge
Emotions serve a purpose (for example, anger alerts you that an injustice happened).
However, emotions can get in the way of you being able to act effectively.
For example, If someone close to you harshly criticizes you, it will probably make you feel angry and trigger an urge to lash out.
Anger here is alerting you that you don’t want to be treated in this way, but acting on your urge won’t help you effectively communicate that message to that person.
By acting opposite to your urge, you manage your anger and communicate your message more effectively.
The goal here is to reduce the intensity of your emotions.
It is important to keep in mind that your emotions won’t get resolved until the problem gets resolved.
In the example above, calming yourself down and not acting on the urge to lash out will reduce your anger. But eventually, you’ll need to do something to resolve the problem, like speaking with that person and letting them know that: you don’t accept that kind of treatment. Otherwise, you may have to end the relationship.
4. Interpersonal Effectiveness Skills
This skill involves techniques that will help you change the way you interact with others in order to improve your relationships.
How Can You Take Care of Your Relationships?
Taking care of your relationships involve two things:
The first is maintaining the relationship and preventing it from breaking down. So you call your friend regularly and invite them to things together.
The second is keeping the relationship healthy. As soon as a conflict arises, you become aware of it and address it.
If you don’t address these conflicts, overtime, they will fester and build resentment.
#1. Assess Your Relationships
Before working on improving your relationships, start with assessing your current relationships:
“If I experience a crisis, do I have someone I can call for help? If so, who?”
“Do I often find myself in conflict with friends or family members?”
“I am satisfied with the way I’m spending time with others, or do I feel that there are things I’m missing out on things that I need to do more of?”
“Do I find it easy to apologize to someone when I know that I hurt them in some way?”
“Do I find it hard to ask people for help when I need it?”
“Do I find it hard to say no to others when they make requests I can’t or don’t want to comply with?”
“Do I have any difficulties expressing my opinions or feelings?”
“Are there any unhealthy relationships in my life that I want to end but have been unable to?”
The next step is to think of the goals you have in terms of relationships. These goals may include:
- Improving your relationship with some people and in certain ways
- Having more close friends
- Working on improving communication with others
#2. End Unhealthy Relationships
Some people you’re having relationships with are just not healthy people for you.
Maybe you have relationships with people who abuse you emotionally or verbally. Maybe some of your friends are drug addicts who insist on offering you drugs.
Ending a relationship can be very difficult, but you need to keep in mind that you must do what is healthiest and most effective for yourself.
#3. Practice Assertiveness
1. Know What You Want
It’s very difficult to get what you want when you don’t know what it is.
For example, a coworker harshly criticized you. You felt disrespected and hurt.
When interacting with that person, you want to decide what you need:
- Do you have a goal that person can help you reach?
- Do you want to improve your relationship with them?
- Do you want to be able to say no to a request they made of you?
- Do you want to feel good about how you handle the interaction?
Sometimes you have to prioritize one of these areas over the other ones.
2. Asking for What You Want in an Effective Way
Here are the steps for assertiveness:
A. Nonjudgmentally describe the situation, sticking to the facts.
For example, you could repeat what someone said that you found hurtful.
“Earlier this morning you said something critical about the way I dress.”
B. Describe what you think and feel about the situation.
“I didn’t like what you said, and I’m feeling hurt.”
C. Clearly asking for what you want.
“I would appreciate it if you wouldn’t make such comments in the future.”
Want to learn more communication skills? Read this post: The Art of Validation: How to Comfort and Support Someone Without Giving Advice?
More Tips: How To Manage Your Bipolar Disorder Without Medication?
Although medical treatments such as medicines and psychological treatment are the primary treatment of bipolar disorder, self-help techniques are also important, perhaps indispensable to improve your life quality.
I. Managing Mania
Even when someone is responding well to mood stabilizers, it’s still possible that they might find themselves edging toward hypomania or even full-blown mania. The relapse might appear with or without obvious triggers.
The following are some ways to help you reduce the chances of a relapse:
#1. Be Prepared
Protect yourself from real crises by recognizing specific triggering events or patterns that might increase the likelihood of mania. Do your best to avoid these triggers, or learn how to manage them better if they can’t be avoided without a major impact on your life.
#2. Slow Down
There are sometimes challenges that can make you rush, such as meeting a deadline at work, cooking Thanksgiving dinner for your entire family, etc. These situations can’t be avoided. However, there are a lot of things that you can do to make your life more peaceful and less likely to be interrupted by manic episodes:
Avoid highly stressful jobs – Jobs that involve a lot of last-minute deadlines or waiting on many customers, or less-than-enlightened boss or fellow employee, might not be right for you.
If you have a disability due to bipolar disorder, you may be entitled to certain on-the-job considerations thanks to the Americans with Disabilities Act.
Avoid highly stressful situations – Plan your day to avoid unnecessary rushing. Avoid putting things off until last minute. Don’t take on unnecessary work or responsibilities that will burden you and ssk for help when you appropriate.
Take short breaks whenever possible – Pause at times to look around you. Get some fresh air. Meditate. Listen to some music.
#3. Pay Attention to the Calendar
Some dates or events might trigger manic episodes. You need to be aware of mania patterns especially when it’s triggered by the following:
* Cycles – This is when your history of manic or depressive episodes tends to run in cycles. For example, if your mania tends to follow depression, you need to be prepared for the possibility of mania or hypomania if you have recently been feeling down.
* Seasons – This is when seasonal changes cause dramatic mood swings for you. Avoid high-energy behavior during such times.
* Anniversaries – Memories of events, especially ones associates with a loss of some kind such as divorce, death of a loved one, etc, can contribute to an episode.
* Forthcoming events – This could be something stressful (such as a court date) or even a potentially positive event (such as marriage). It’s important to discuss in advance with your therapist how to deal with significant changes and events.
#4. Warning Signals
Becoming mindful of your mania symptoms can help you manage mania better. Make a list of changes that you suspect precede your mania episode. These could be changes in your thinking patterns, feelings, the way you act, etc.
Respond right away by slowing down and getting help from your therapist or doctor.
The following are some marked changes that might indicate a potential manic episode:
- Speech patterns: talking more rapidly than normal, voice louder than usual, feeling compelled to send e-mails, or talk on the phone so you can keep communicating nonstop.
- Eating and sleeping: eating and/or sleeping patterns dramatically changing. (*)
- Busy without productivity: always active, yet accomplishing little, taking on some tasks that have no purpose.
- Irritability: being easily irritated more than usual, getting annoyed more than usual by small things.
- Lavishness: suddenly spending more money, giving more gifts, and/or taking more trips, suddenly living beyond your means.
Other people in your life (coworkers, friends, or family) can give you feedback when they notice that you seem to be edging toward an episode. If they comment that you seem much more agitated or ask you to slow down, then perhaps you should get some extra help.
#5. Protect Your Assets
There many things you can do to minimize damage to your finances, property, or other assets should you have a manic episode.
Consult with an attorney about protecting your assets through co-signature of a spouse – or even a neutral third party – before spending, selling, or giving away money or assets that exceed a predetermined amount.
Consider consulting with an attorney to set up a system that provides you with an allowance – a predetermined amount of cash per week or month or year.
II. Dealing with Depression
Treating a depressive episode before it becomes incapacitating is easier and more ideal than treating it when it hits in full-swing.
However, spotting an oncoming depressive episode is more difficult than anticipating a manic one. This is why it is important to spend time studying how bipolar disorder affects you, in particular to determine if you have a specific pattern of depression warning signs.
#6. Distinguish Between Sadness, Mild Depression, and Chronic Depression
It is important to distinguish between serious chronic depression and mere sadness.
Occasional sadness is part of the balance of a life and they don’t keep people from functioning in other ways. It does not cause you to lose all interest in people and activities, or to withdraw from society. It does not wreak havoc on your eating and sleeping habits. Most important of all, it does not make you suicidal.
If you have bipolar disorder and feel sad for a day or so, you may not be showing a symptom of a disorder. However, if you are not sure, check with your doctor or therapist.
Mild and Chronic Depression
Sometimes minor or mild depression can follow specific events such as a loss of a loved one, a divorce, a loss of a job, etc. Mild depression allows people to function, but half-heartedly.
Mild depression should be treated if it affects a person’s quality of life. Lifestyle changes, therapy, and some medications can relieve symptoms and prevent the condition from getting worse and further affecting the person’s life.
Major, chronic depression goes far beyond sadness. Sufferers might find themselves crying uncontrollably, without an obvious cause. Joy, motivation, and a reason for living seem to be sucked out of them.
“Major depression is not something you can snap out of by remembering an upbeat saying or forcing yourself to smile. It requires medical intervention.”
Antidepressants are not an appropriate treatment if you have bipolar disorder. They can make things much worse by sending you into full-blown mania. This is one more reason it is so important to be under a doctor’s care for bipolar disorder.
#7. Stay Active and Eat well
A healthy diet, combined with exercise can help reduce symptoms of bipolar disorder, particularly the despressive symptoms.
It can also help limit weight gain, which is a common side effect of medical treatments for bipolar disorder.
Running, for example, has been reported to ease the symptoms of depression.
Many people benefit from taking up meditation, yoga or other relaxation techniques. Take charge and fill your time with healthy habits.
#8. Break the Cycle of Self-Defeating Thoughts
When negative thoughts become dominant, you increase your chances of having depression. Breaking the cycle of negative thoughts and beliefs can increase your resilience and your ability to cope with stress.
Cognitive behavioral or other therapy may help you with this.
#9. Harness The Power of Spirituality
Spirituality has different meanings. It can refer to a religious belief, or an attitude— a conviction or belief that you have a definite reason for living. Some people feel most spiritual while meditating, or enjoying nature.
Having a spiritual orientation is proven to help you cope with stress and give you the strength to help you deal with everyday challenges.
#10. Dealing with Loss
Experiencing a major loss, such as that of a loved one through death or divorce, or loss of a job can increase the risk of depression and sometimes even mania.
When dealing with a major loss, seek professional support to help you consider whether a different counseling, therapy, or medication would be appropriate.
Loss is a part of life. Make an effort to use any type of personal philosophy or spiritual foundation that you built up during your recovery to cope with crises as they come along.
#11. Keep It Organized and Clean
A cluttered environment will add to your stress and make it harder for you to relax. No one wants to spend hours digging through a mess just to locate something they need or coming home to a depressing mess.
Living in a mess reinforces notions of unworthiness and prevent you from relaxing in your own home or getting the job done in your office.
#12. Write to Alleviate Feelings of Depression
Whether it is simply to vent or to create something of interest to other people, writing your unhappy thoughts down can alleviate feelings of depression.
This can be a journal, a poem, or novel. The insights you discover while writing, may give you a better perspective and sense of satisfaction. It doesn’t have to be publishable material, although the first Harry Potter novel was written with the author in the midst of a depression.
#13. Talk About It
Individuals suffering from bipolar disease might not find it easy to talk about their condition to family members and friends.
This is why many organizations run self-help groups that can help people feel less alone and provide them with helpful ideas to cope with their disorder.
Some useful charities, support groups and associations include:
#14. Avoid drugs and alcohol
Some people suffering from bipolar disorder use alcohol or drugs in an attempt to ease their distress.
However, alcohol and drugs are well-known for their harmful physical and social effects, and can not substitute treatment and good healthcare.
#15. Addess suicidal feelings
Suicidal thoughts are a common depressive symptom of bipolar disorder.
Studies show that the risk of suicide for people with bipolar disorder is 15 to 20 times greater than the general population.
If you’re having suicidal thoughts, go to your nearest A&E department as soon as possible.
Crisis number for your area by visiting the 24-hour Hotline Numbers State Crisis Lines website at http://mentalhealth.samhsa.gov/hotlines/state.asp or http://suicidehotlines.com/national.html.
You can also call 911 and explain that you are feeling dangerously depressed.
Bipolar disorder is a mood disorder caused by an abnormality of brain chemistry.
It has been shown that if there’s an imbalance in the levels of 1 or more neurotransmitters, an individual may develop symptoms of bipolar disorder. (*)
Neurotransmitters are the chemicals responsible for controlling the brain’s functions, and include noradrenaline, serotonin and dopamine.
An individual with bipolar disorder may experience periods of an extremely elevated or irritable mood (manic episodes) as well as episodes of depression.
The depressed phase can be merely gloomy or it can be profoundly despairing.
The manic phase can be an enthusiastic glow or it can be transcendental fervor or delirious psychosis.
Bipolar disorder is often called the chameleon of psychiatric disorders because its symptoms change from one patient to the next and from one episode to the next in the same patient.
The disorder tends to hibernate. Symptoms may spontaneoudly disappear for years. This adds confusion to the diagnostician and makes the person with bipolar disorder wrongly assume he doesn’t need treatment.
Using DBT, you can self-manage your bipolar disorder in a way that helps you lead a fulfilling life.
1. Bipolar Disorder Symptoms: What Bipolar Disorder Looks Like?
Bipolar disorder is a mood disorder whose main symptom is an abnormality of mood.
Persons afflicted with bipolar disorder experience periods of severe depression as well as a period of mania – a mood state that is the opposite of depression to some extent.
While not many individuals with bipolar disorder experience a full-blown manic episode, mania is the most unmistakable of the abnormal mood states which makes it a good place to start when diagnosing bipolar disorder.
Symptoms of mania
- Elated, euphoric mood
- Irritable mood
- Increased energy level
- Decreased need for sleep
- Erratic appetite
- Increased libido
- Grandiose delusions
- Feelings of heightened concentration
- Accelerated thinking (“racing thoughts”)
Stages of Mania
There are three stages of mania that an individual with bipolar disorder may experience.
1. Hypomania (stage I)
During the early stages of manic, individuals with bipolar disorder report thinking more clearly and more rationally than usual. Such mental state is not likely to make the individual suspect that something is wrong.
Mania usually starts gradually and then becomes more extreme and more unpleasant, sometimes taking weeks to develop fully.
In the early stages of mania, the mood states of the individual with bipolar disorder, gradually moves “upward”, and the person finds himself filled with a sense of well-being and confidence that eventually evolves into euphoria.
The feelings of overconfidence that characterize mania can lead to several behavioral patterns, such as spending sprees, sexual promiscuity, and overuse of alcohol and other intoxicating substances.
Other symptoms include:
- Increased rate of speech and increased physical activity,
- Irritability when the individual’s demands are not instantly satisfied,
- Increased interest in religion.
2. Acute Mania (stage II)
Eventually the thinking process increasingly accelerates until it becomes “racing”. This is what psychiatrists call flight of ideas – where thoughts ran with lightning-like speed from one subject to another.
This jumping from one thought to another becomes even more unpleasant as the episode develops.
As the episode develops, the feelings of grandiosity increase. Fears disappear altogether, and reckless behaviors take over. This is one of the points at which the manic person can begin to lose touch with reality. He might become convinced that he is the president or prime minister or a rock star.
Other symptoms include:
- Pressure of speech and activity increased still further,
- The irritability experiences surig the first stage progresses to open hostility and anger,
- Racing thoughts progress to increasing disorganization,
- Preoccupations became more intense,
- Grandiose becomes delusions.
3. Delirious Mania (stage III)
As the thinking patterns spin even faster, consciousness becomes clouded, hallucinations may develop, and delusions can increase even further.
Other symptoms include:
- A desperate, panic stricken, hopeless state, accompanied by frenzied and frequently even more bizarre activity,
- Thought became incoherent.
During the first stage of mania, individuals with bipolar disorder experience a state of mild euphoria and hyperactivity. The individual experiences increased energy level, rapid thinking and speaking and sometimes a bit of irritability.
Because individuals in the hypomaniac stage do not experience the severe mental disorganization of mania, they’re unlikely to seek treatment and might stop taking their medication to recapture the wonderful feelings that accompany hypomania.
However, hypomania can nevertheless have unpleasant consequences can wreak havoc on individuals’ lives.
* Feelings of overconfidence can lead to foolish investments in real estate or the stock market, and risky business ventures.
* Increased sexual feelings can lead to extramarital affairs or promiscuity.
* The irritability of hypomania can lead to arguments and disagreements with family, friends and colleagues that can sour relationships, sometimes irreparably.
The depression of bipolar disorder is a more familiar set of feelings than mania. Everyone, whether suffering from bipolar disorder or not, has gone through periods of depressed mood.
At the same time, the depression of bipolar disorder is a very different experience from “normal” depression. (*)
Individuals who do not suffer from a mood disorder, experience temporary depressed mood after romatic disappointments, the loss of a job, the loss of a loved one, a period of homesickness, etc.
They’re depressed but they retain the normal reactivity of mood – the ability to dispel the feelings of disappointment or bereavement.
Mourners can relax after the funeral service and reminisce about good memories of the person who has died. They can still enjoy catching up with family and friends.
With individuals suffering from bipolar disorder, the depressive mood is constricted and not reactive.
The mood of the bipolar disorder depression is a relentless, pervasive gloom that continues from one day to the next and from which the afflicted person cannot rouse himself.
Ruminations on themes of guilt, shame, and regret are especially characteristic of depression in individuals with bipolar disorder. Feelings of inadequacy and worthlessness are similarly significant.
Another typical symptom of depression in individuals with bipolar disorder is the loss of interest in usually pleasurable activities and unablity to derive any pleasure from these activities – also called anhedonia.
Just as mania infuses the individual with bipolar disorder with feelings of inexpressible joy, the depressive mood of the disorder brings indescribable anguish.
Hallucinations occur in severe depression, but not as frequently as inmania.
3. Mixed States
Mixed state, or mixed affective state, is another type of abnormal mood can be seen in bipolar disorder. It’s the combination of both the frenzied intensity of mania and the horrors of deep depression.
Symptoms of depression and mania seem to exist almost simultaneously in the individual. The accelerated thinking and hyperactivity, typical of the manic state, are present, but instead of a euphoric mood, the individual experiences a depressed, despairing, desperate mood.
Just as hypomania can be difficult to distinguish from an elevated but normal mood, milder mixed states can be difficult to recognize. Individuals suffering from bipolar disorder might describe having mild mixed states as “anxiety”, although it is not the fearful fretfulness of ordinary anxiety. It’s more total despair made even worse by terrible agitation.
The mixed state can be very dangerous. This negative energy puts the individual at high risk for hurting themselves with suicidal behaviors or a variety of self-destructive behaviors that are not immediately life-threatening, such as cutting themselves, in an attempt to shift the inner pain to “the outside”.
Another type of mood “mixture” called ultra-rapid cycling, occurs when there is rapid alternation between mania and depression, rather than a true mixture of the two states simultaneously.
2. How Bipolar Disorder Is Diagnosed?
Diagnostic classification has two purposes: make predictions about the course of the disorder, and help the clinician in selecting the treatment most likely to be effective.
Classification systems are mostly derived from studying different combinations of symptoms of groups of patients.
1. Bipolar I
Bipolar I is the designation for the classic variety of bipolar disorder. It is characterized by full-blown manic attacks and deep, paralyzing depressions.
The pattern of abnormal mood episodes seems to vary widely. During the course of the illness, its symptoms come and go, which makes it difficult to diagnose and treat. (*)
Features of Bipolar I
* Fully developed manic episodes
* Fully developed depressive episodes
* Untreated episodes average six months
* Hallucinations and delusions are frequently seen
* Three-phased episodes (depression, mania, depression)
* Relapses more frequent as patient ages
2. Bipolar II
Bipolar II is characterized by fully developed depressive episodes and episodes of hypomania.
Individuals suffering from bipolar II don’t have history of fully developed manic episodes. They would have severe depressions, but their “highs” never develops into mania.
Although individuals suffering from bipolar II don’t experience full blown manic episodes, this doesn’t mean that doesn’t make it a milder form of bipolar I.
In fact, individuals suffering from bipolar II tend to be more symptomatic and long periods of depression tend to be even more debilitating than the dramatic, but shorter-lived, depredssive episodes of bipolar I.
Features of Bipolar II
* Hypomanic episodes
* Fully developed depressive episodes
* Increased sleep and appetite during depressions
* More chronic depressions
* Bipolar II history in family members
* Possible increased risk for alcoholism
3. Cyclothymic Disorder
Cyclothymic disorder is characterized by frequent short periods (days to weeks) of hypomania and of depressive symptoms, separated by short periods of fairly normal mood.
Individuals with cyclothymic disorder don’t experience fully developed depressive episodes or fully developed manic episodes. They seem to constantly oscillate between the two opposite poles of mood.
Because of the mild, but frequent ups and downs of mood, cyclothymia can be mistaken for a personality problem rather than a disorder caused by an abnormality of brain chemistry.
Features of cyclothymic disorder
* Frequent alternation between mild depression and mild hypomania * Short, irregular cycles (days)
* Short periods of normal mood
* Patients often wake up with mood changes
* Frequently mistaken for problem with “personality”
* Sometimes develops into bipolar I or II
4. Bipolar Spectrum Disorders
Some individuals seem to have symptoms of mania or hypomania that are too few in number or too short in duration to meet the diagnostic criteria for bipolar I or II or cyclothymia.
For this group of individuals, a fourth category exists called “bipolar disorder not elsewhere classified” (also, simply, “bipolar NEC”).
Individuals suffering from bipolar NEC have one of the “soft” bipolar disorders with a baseline mood that is a bit “higher” than that of most people. While they have high energy level and are confident and socialble, they tend to become irritated easily and can be impulsive, even reckless at times.
They usually have a family history of bipolar disorder and suffer from recurrent depressions.
Antidepressant medication alone can make them more irritable and miserable or provoke a manic or hypomanic episode, but mood stabilizers can be very helpful.
Features of bipolar NEC
* Family history of bipolar disorder
* Habitual short sleeper—less than six hours per day
* Cheerful, optimistic personality style
* Extroverted and sociable
* Tendency to become irritable easily
* Recurrent depressions
Schizoaffective disorder is an illness with features both of mood disorders (depression, hypomania, or mania) and of a very different psychiatric illness: schizophrenia (hallucinations, delusions, and other bizarre mental experiences typical of schizophrenia).
Although many individuals with bipolar disorder develop delusions (false beliefs and ideas) or hallucinations (false sensory perceptions such as the hearing of voices), in the mood disorders, these symptoms arise out of the mood state.
For example, an individual in a severe depression might have the delusional belief that he has a terrible illness like AIDS or cancer.
Individuals suffering from schizophrenia, on the other hand, have bizarre delusions and hallucinations that don’t usually seem to bear any relation to a change in mood.
More importantly, Individuals suffering from schizophrenia do not experience episodes of sustained abnormal changes in mood.
When an individual suffering from bipolar disorder has bizarre delusions or hallucinations during times when they do not seem to be in an episode of abnormal mood, the diagnosis of schizoaffective disorder is often made.
3. Do people with bipolar experience normal emotions?
When people with bipolar are excited about something, they can get comment from people around them like “Calm down, you’re getting manic.”
This can be frustrating and you may even find yourself questioning all of your emotions, believing that whatever you feel is caused by your illness.
But this is not true.
People with bipolar experience normal ups and downs like everyone else. They just need to know which ups and downs are regular and which are caused by bipolar.
4. If bipolar disorder is a biological illness and chemicals in the brain are involved, how can I control my emotions?
This question cannot be easily answered. It is sill unknown what the exact causes of mood disorders are or the role that the brain plays in them.
One theory called the kindling theory (Frank and Thase 1999), holds that, the first episodes of bipolar disorder are generally triggered by stressful events. But as the illness progresses it takes less and less stress to trigger new episodes.
In other words, over time it becomes very difficult to determine what the triggering event was, which creates the illusion that mood episodes come out of the blue and are out of your control.
Research focusing on habitual patterns of negative thinking that people fall into, found that such thinking patterns can trigger depression relapse. The low mood leads to more negative thinking, which creates a vicious cycle (Segal, Williams, and Teasdale 2002).
This means that there is a lot that you can do to prevent and reduce the number of these episodes, so you’re not a helpless victim of your brain chemistry.
5. How Can Mindfulness Help With Bipolar Symptoms?
Studies have shown that mindfulness is helpful for people with bipolar disorder.
By practicing mindfulness, you learn how to be present with your bipolar symptoms rather than try to get rid of them.
By doing this, your symptoms become less intense and more manageable.
This might seem counterintuitive, but suppressing our emotions or numbing them tends to make them even more intense.
Being present with your symptoms, doesn’t mean you like them, or you want them to stay. It simply means that you are not wasting any more time or energy judging yourself for having these symptoms, or trying to numb them.
Mindfulness helps you liberate yourself from your habitual thinking patterns and behaviors that keep you stuck.
People with bipolar disorder experience episodes of both depression and mania.
These episodes are often accompanied by anxiety (an excessive or inappropriate fear response), negative thinking and unreasonable beliefs about the self, and irritability.
Mindfulness can help you manage these symptoms.
- Portions of this article were adapted from the book The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life, © 2009 by Sheri Van Dijk. All rights reserved.
- Dialectical Behavior Therapy (DBT): Definition, Techniques, and Efficacy (verywellmind.com)
- Dialectical Behavioral Therapy for Mental Health Problems (webmd.com)
- Dialectical Behavior Therapy (DBT): What It Is & Purpose (clevelandclinic.org)
- What is dialectical behaviour therapy (DBT)? – Mind
- NIMH » Bipolar Disorder (nih.gov)
- Bipolar disorder – Symptoms and causes – Mayo Clinic
- Bipolar disorder – Wikipedia
- Psychiatry.org – What Are Bipolar Disorders?
Additional DBT Resources
DBT Self-Help a website that provides the answers to commonly asked questions about DBT, as well as handouts and articles on DBT and mindfulness.
TrueRecovery A website that provides reading material, questions, and answers about DBT, and a forum to post questions and comments about skills.
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