How to Self-Manage Bipolar Disorder Using Dialectical Behavior Therapy (DBT)?

Having bipolar disorder can often feel like being at the mercy of your emotional states.

But this doesn’t have to be the case.

This article contains practical DBT skills that you can begin using immediately to gain more control over your emotions and your behavior.

Ready? Let’s get started!

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.

If you want to learn more about Bipolar Disorder, check out this article Living With Bipolar Disorder: 15 Self-Help Tips For Managing Bipolar Disorder

Bipolar disorder symptoms

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

1. Mindfulness

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.

1. Mindfulness Practice

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.

#2. How to Use Mindfulness In Your Everyday Life?

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.

Read More: 15 Easy Mindfulness Activities to Help You Deal With Anxiety, Depression, and Trauma

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
  • Dancing
  • Playing a sport
  • Playing a musical instrument
  • Walking
  • 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

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#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

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

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

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
  • Overeating
  • 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)
Distracting (2)
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: 13Total: 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: 16Total: 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

Grounding Techniques

  1. Put your hands in water
  2. Breathe deeply
  3. Savor a food or drink
  4. Take a short walk
  5. Hold an ice cube
  6. Recite something
  7. Describe what’s around you
  8. Picture the voice or face of someone you love
  9. Touch something comforting
  10. 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).

Get Your Free Calming Your Intense Emotions Worksheet

3. Emotion Regulation Skills

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
  • Gardening
  • Donating old clothes or items to charity
  • Doing art and craft projects


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
  • Dancing
  • Photography

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
  • Etc

Related: Resolving Marital Conflict: How to Repair Your Marriage

#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?

Start Making Healthier Choices

1. Improve Your Sleep Habits

Sleep can significantly impact your mood and trigger a manic or hypomanic episode.

Not enough sleep can cause you to feel irritable. Too much sleep can cause a lack of energy and motivation.

Read more on how to improve your sleep: 18 Proven, Healthy Ways to Sleep Better at Night and Wake Up Rested

2. Improve Your Eating Habits

Skipping meals or undereating can cause irritability and trigger symptoms of low blood sugar (dizziness, lightheadedness, and nausea).

Overeating can also be problematic, especially during depressive episodes. Using comfort food can trigger feelings of .guilt, shame, anger, and other emotions toward yourself.

Eating a healthy, balanced diet can help to reduce the likelihood of emotion mind taking over.

Cut down on caffeine – including coffee, tea, soda, chocolate, and anything else you ingest that contains caffeine.

Discover food that affect your mood – this may include

  • Fermented foods (some examples include yogurt, bread, wine, cheese, pickled foods, vinegar, olives, chocolate, vanilla, Tabasco sauce, beer)
  • Eggs and dairy products
  • Meat

You may want to experiment by removing these foods from your diet, one at a time, for a trial period of two weeks.

Read more: How Can Food Affect Your Mood?

3. Avoid Substance Use

Mood-altering drugs will make you more vulnerable to manic and depressive episodes.

Cocaine and other stimulants, can trigger a “substance-induced psychotic disorder” (APA 2000, 338) even in people without bipolar disorder.

Alcohol is a depressant, so if you’re already feeling depressed, avoid drinking alcohol. In addition, alcohol impacts the quality of your sleep due to what is called a rebound effect (Roehrs and Roth 2001).

4. Take Care of Physical Illness and Pain

Pain or physical illnesses can increase irritability and cause you to sink into self-pitying thoughts.

If you are experiencing some type of physical illness, taking care of it can prevent your emotions from taking over.

Consider seeing a doctor and resting (especially if you’re dealing with chronic pain)

5. Exercise

Exercising can be hard to do, especially when your mood is low. But keep in mind that exercise is known to be a natural antidepressant.

So don’t wait for motivation to come to start exercising.

Remember that anything more than what you’re doing now will help.

6. Maintain Healthy Relationships

Surrounding yourself with supportive people gives you a feeling of stability in your life.

Make sure you also end unhealthy relationship (e.g. people with a negative attitude that is affecting your mood, emotionally and verbally abusive people, etc).


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.

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.

Bipolar disorder coping strategies
Ways to calm manic episode (bipolar disorder)

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How to Self-Manage Bipolar Disorder Using Dialectical Behavior Therapy (DBT) (3)


  • 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.

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.

Bipolar Free Resources

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