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Coping Skills for those diagnosed with Bipolar Disorder and the loving people who care for them

2010-04-29T14:58:00Z

I’m often asked how do I cope with bipolar disorder? The truth is, sometimes I cope successfully, and sometimes I do not. I will be the first to admit that my manifestation of bipolar disorder is not the same as the next person’s and their level of functionality may be far different from mine. I've R.A.P.P.E.D. together 6 basic principles that help me find and maintain balance. Routine, Activities, Passion, Purpose, Exercise and Devotion = R.A.P.P.E.D.

Routine: Maintaining a solid routine is a huge part of life with bipolar disorder. When someone gets pulled out of their routine, they can quickly run into problems. A simple change could send someone into a downward spiral, but don't despair, you do learn how to incorporate new activities without shaking up you whole routine.

Activities: Two key factors towards success are doing activities you enjoy and activities that also keep you motivated. The goal is to have a long list of activities some more adventurous that others. When moving feels impossible having a lists helps you find something to do even if it's as simple as going outside to get a breath of fresh air.

Passion: Having passion towards anything gives you a natural rush of excitement. When you're passionate about the activities you choose you'll be more satisfied while doing them. What is it that you’re really passionate about? Music, creativity, reading, being a good mom / dad ? Let your passion empower you to move forward.

Purpose: Stop searching for your "grand" purpose and understand that you're living purposely everyday. The decisions you make have a purpose and that purpose usually becomes increasingly clear as you move through life. In my opinion your number one purpose is to love yourself, once you achieve self love you positively impact all that surrounds you.

Exercise: I can’t stress enough how important an exercise program is to healthy mind and body. We all know the benefits of exercise, but the vast majority of us just don’t do it. You can stabilize your swings, improve your memory, lengthen your life, and boost your self-esteem.

Devotion: It does help me to be devoted to a form of spirituality. I’d never tell anyone what to practice or believe, what is right for me is not necessarily right for you. But when things get bad, having hope and embracing my beliefs has had a definite impact on my strength to hold on.

Before I move on to specific coping skills I'd like to address ways to care for the caregivers. We all know caring for someone with bipolar disorder is often a labor of love. And honestly I believe a lot of what the caregiver does on a daily basis goes overlooked and unnoticed. For this reason it is important to remember you too need TLC. The best example I was given to share was to think of it in this way. On an airplane, you're instructed to put the oxygen mask on yourself first. That's because if you pass out, how can you possibly be of help? The same case can be made when taking care of a bipolar loved one. Since you're the support provider, you have to stay strong both mentally and physically. The following tips may seem simple, but when you spend too much time doing for someone else remembering the little things you can do for yourself can be forgotten.

1. Get adequate rest and sleep. Sounds like a no-brainer right? But it happens all the time. Don't forget getting enough sleep is essential for the healthy function throughout your entire body. Without it you'll sure to hit burnout.

2. Exercise. OK we all know the benefits of exercise, remember something as simple as a 10 minute walk will make a huge difference in reducing your stress. If you can't find the time to do it on your own, incorporate it into your care-giving routine.

3. Eat healthy foods. Give your body the nourishment it needs and deserves. Too much caffeine, processed and sugary foods will only increase your own mood swings. Being mindful is the key to a healthy diet.

4. Time for yourself. Don't just carve out a few minutes each day to relax, plan to participate in outside activities (book clubs, yoga class, coffee with a friend) anything giving you an opportunity to concentrate on things you enjoy will be highly affective in maintaining your health. Remember you need your private time too.

5. Except you will have negative emotions. We know a person with bipolar disorder can at times be irritable, moody or irrational and typically the caregiver becomes the target of these emotions. The truth is guilt, resentment, and anger are all normal feelings for a caregiver to have. Sometimes it's best to take a step back, regroup and try to figure out what's really going on. Except you have the right to your negative feelings and understand they are a natural part of the process.

6. Validate your efforts. Your loved one with bipolar disorder may not always be in the position to express their gratitude for all you do, give yourself a pat on the back from time to time. Taking a moment to appreciate your efforts may sound superficial but the reality is acknowledging your own hard work is healthy and reminds you of your accomplishments.

7. Have your own support. It is very important to surround yourself with people who can understand and support you. Difficult situations are much worse when you have to do it alone. Connect with people in similar circumstances, join a support group, work with your own therapist or doctors, speak with your spiritual mentor, have people who can take over when you need a break, don't go without setting up a support system that works best for you.

8. Laugh. While this may sometimes be difficult, lightening up a tough situation with laughter is one of the world's oldest and best coping mechanisms. Finding humor in your circumstances can potentially defuse a tense moment into a happier less stressful direction.

9. Conserve your energy. If you've spent your day dealing with stressful issues around your loved one's moods adjust your expectations accordingly. Going to bed on time and getting a restful sleep will be more useful than doing laundry and having the kitchen picked up perfectly every night.

10. Have your own goals. What do you want from your life? Taking care of a loved one with bipolar disorder might be a really important part of your life, but keep in perspective everything you aim to achieve. When you have a clear idea of your own goals, desires and needs, you'll be better able to prioritize all the demands on your time and know when to say no.

Now that I've listed the benefits of some basic coping principles you can use them to incorporate other techniques and create your personal "wellness tool box.." The goal is for both the person diagnosed with bipolar disorder and all the people who lovingly care for them to be able to remain proactive. Keep in mind no two situations are ever exactly the same. What works once may not work a second time so don't get discouraged. Overtime you'll build a "wellness tool box" filled with numerous coping mechanisms to help you through.

WELLNESS CONTRACTS:
In my opinion one of the most important coping mechanisms you can have place is a "Wellness Contract". A wellness contract is a written document with detailed information concerning your loved ones illness and their wishes. By taking the time to write down key details you eliminate some of the stress associated with caring for someone with bipolar disorder. More importantly the person with the illness knows they have a say in the care they will receive.

1. Make a list of people you both trust ( family members, friends in the area, etc.) who know about your situation with bipolar disorder and are willing to help when needed. Have their names an phone numbers together on a "crisis alert list"

2. List the names and contact information of all the professionals who help manage the care for your bipolar illness. (doctors. psychiatrist, case worker etc.)

3. Work together to write out the particular signs that indicate a manic or a depressive episode. This will help others recognize symptoms letting them know when you need help.

4. Make a list of all your medications, what dosages you take, any side effects you experience and what time of the day you take them. Don't forget to update this list as medication adjustments are made. Make sure to note any medications you are allergic to or DO NOT want to take under any circumstances. Remember you have the right to choose what medications you take.

5. Have directions for the care of your house, your pets, your plants, etc. in case you are hospitalized, planning these details ahead will help eliminate unnecessary stress.

6. Write out your insurance plan information,

7. Include a list of names and numbers of family members and / or employers that need to be contacted in case of an emergency or extended hospital stay.

8. Keep a list of community resources and hot-lines

9. Create positive affirmations you can use to help you get through a stressful situation

10. Mark down volunteering options you'd like to participate in.

Make sure to include any other information that will help you. Remember taking the time to share detailed instructions of what kind of care you do and do not want to receive is a legal way to speak up when you are unable to make decisions on your own. If you need help there is a legal document for this called a Psychiatric Advanced Directive.

THE RELAXATION RESPONSE:
You can't avoid all stress, but you can counteract its negative affects by learning how to evoke the "relaxation response" a state of deep rest that is the polar opposite of the stress response. The stress response floods your body with chemicals that prepare you for fight or flight. But while the stress response is helpful in true emergency situations where you must be alert, it wears your body down when constantly activated. The relaxation response brings your system back into balance: deepening your breathing, reducing stress hormones, slowing down your heart rate and blood pressure, and relaxing your muscles. In addition to its calming physical effects, research shows that the relaxation response also increases energy and focus, combats illness, relieves aches and pains, heightens problem-solving abilities, and boosts motivation and productivity. Best of all, with a little practice, anyone can reap these benefits.

The relaxation response isn't being lazy, laying on the couch or sleeping. The relaxation response is a mentally active process that leaves the body relaxed, best done in an awake state, and becomes more profound with practice. A variety of relaxation techniques help you achieve the relaxation response. Those whose stress-busting benefits have been widely studied include deep breathing, progressive muscle relaxation, meditation, visualization, yoga, and tai chi. Learning the basics of these relaxation techniques isn't difficult. But it takes practice to truly harness their stress-relieving power.

To get the most out of your relaxation practice set aside time in your daily schedule, don't practice when you're sleepy and choose a technique that appeals to you, your specific needs, preferences, life style and fitness levels. Also take into consideration if you need alone time or social stimulation.

1. Deep breathing for stress relief: With its focus on full, cleansing breaths, deep breathing is a simple, yet powerful, relaxation technique. It's easy to learn, can be practiced almost anywhere, and provides a quick way to get your stress levels in check.

The key to deep breathing is to breathe deeply from the abdomen, getting as much fresh air as possible in your lungs. When you take deep breaths from the abdomen, rather than shallow breath from your upper chest, you inhale more oxygen. The more oxygen you get, the less tense, short of breath, and anxious you feel.

   How practice deep breathing:
   1. Sit comfortably with your back straight. Put one hand on your chest and
        the other on your stomach
   2. Breath in through your nose. The hand on your stomach should rise.
        The hand on your chest should move very little
   3. Exhale through your mouth, pushing out as much air as you can while contracting
        your abdominal muscles. The hand on your stomach should move in as you exhale.
        Your other hand should move very little.
   4. Continue to breathe in through your nose and out through your mouth.
        Try to inhale enough so that your lower abdomen rises and falls.
        Count slowly as you exhale.

* If you have a hard time breathing from your abdomen while sitting up, try lying on the floor. Put a small book on your stomach, and try to breath so that the book rises as you inhale and falls as you exhale.

2. Progress muscle relaxation for stress relief: Is a widely used strategy for stress relief. It involves a two-step process in which you systematically tense and relax different muscle groups in the body. With regular practice, progressive muscle relaxation gives you an intimate familiarity with what tensions, as well as complete relaxation, feels like in different parts of the body. This awareness helps you spot and counteract the first signs of the muscular tension that accompanies stress. And as your body relaxes, so will your mind.

   How to practice muscle relaxation:
   Most progressive muscle relaxation practitioners start at the feet and work their way up to the face.
   1. Loosen your clothing, take off your shoes, and get comfortable
   2. Take a few minutes to relax, breathing in and out in slow, deep breaths.
   3. When you're relaxed and ready to start, shift your attention to your right foot
        Focus on the way it feels.
   4. Slowly tense the muscles in your right foot, squeezing as tightly as you can.
        Hold for the count of 10.
   5. Relax your right foot. Focus on the tension flowing away and the way your foot feels as it becomes limp and loose
   6. Stay in this relaxed state for a moment, breathing deeply and slowly
   7. When you're ready, shift your attention to your left foot.
        Follow the same sequence of muscle tension and release.
   8. Move slowly up through your body, legs, abdomen, back, neck, and face
       Contracting and relaxing the muscle groups as you go

3. Mindfulness meditation for stress relief. Meditation that cultivates mindfulness is particularly effective at reducing stress, anxiety, depression and other negative emotions. Mindfulness is the quality of being fully engaged in the present moment, without analyzing or over thinking the experience. Rather than worrying about the future or dwelling on the past, mindfulness meditation switches the focus to what's happening right now. For stress relief you can try any of the following mindfulness meditation techniques.

   Body scan: Body scanning cultivates mindfulness by focusing your attention on various parts of your body. Like progressive muscle relaxation, you start with your feet and work your way up. However instead of tensing and relaxing your muscles, you simply focus on the way each part of your body feels without labeling the sensations as either good or bad.

   Walking meditation: You don't have to be seated or still to meditate. In walking meditation, mindfulness involves being focused on the physicality of each step, the sensation of your feet touching the ground, the rhythm of your breath while moving and feeling the wind against your face.

Mindful eating: If you reach for food when you're under stress or gulp your meals down in a rush, try eating mindfully. Sit down at the table and focus your full attention on the meal (no TV, newspapers, or eating on the run) Eat slowly, taking the time to fully enjoy and concentrate on each bite.

4. Guided imagery for stress relief: Visualization, or guided imagery, is a variation on traditional meditation that can help relieve stress. When used as a relaxation technique, guided imagery involves imagining a scene in which you feel at peace, free to let go of all tension and anxiety. Choose whatever setting is most calming to you, whether a tropical beach, favorite childhood spot or a quiet wooded area.

   How to do practice guided imagery:
   Close your eyes and let your worries drift away. Imagine your restful place. picture it as vividly as you can. Everything you can see, hear, smell and feel. Guided imagery works best if you incorporate as many sensory details as possible.Try to capture your image through seeing, hearing, smelling, feeling and tasting.

5 Yoga for stress relief. Yoga is an excellent stress relief technique. It involves a series of both moving and stationary poses, combined with deep breathing. The physical and mental benefits of yoga provide a natural counterbalance to stress, and strengthen the relaxation response in your daily life.

Although almost all yoga classes end in a relaxation pose, classes that emphasize slow, steady movement and gentle stretching are best for beginners. Tai chi is a safe, low impact option for people of all ages and levels of fitness. Tai Chi is a self-paced, non-competitive series of slow, flowing body movements that emphasize concentration, relaxation and conscious circulation of vital energy throughout the body.

MEMORY AIDS: Using a memory aid to remind us how we can help ourselves during distressing time is a great technique to help reduce stress. There are common and often used word associations that have been incorporated into the therapeutic process. two examples are ass follows.

     IMPROVE the moment
    I      Imagery - safe place visualization
    M    find Meaning in the situation
P    Prayer - meditation, spirituality
R    Relaxation
    O    One thing at a time
    V    Vacation - take some time out of the situation
    E    Encouragement - positive and calming self talk

     Distraction: ACCEPTS
     A    Activities
     C   Contributing - helping others
   C   Comparisons - with others
     E    Opposite Emotions - watch movie / tv, listen to music that will trigger positive emotions
     P    Pushing a way - thinking about or putting our attention onto something else
     T    Thoughts
     S    Sensations - use seeing, hearing, smelling, tasting and touching senses

COGITATIVE BEHAVIORAL THERAPY
One of the most effective coping skills to master is CBT or Cogitative Behavioral Therapy. CBT helps us make sense of our current situation. With CBT you learn that it's not the event which causes our emotions, but how we interpret that event, what we think or what meaning we give that event or situation. CBT teaches us when we become aware of our attitude and beliefs against what we are thinking and feeling, we can create new brain pathways by consciously choosing and developing new thoughts and behaviors.

For example maybe someone who's depressed might wake up in the morning and think: "This is going to be another awful day", "I'm going to mess up again", or "What's the point of anything?" which will make them feel even more depressed(feelings), and may prompt them to pull the covers over their head and stay in bed (behaviors). It's very likely that this will increase their negative thoughts, which in turn will increase the feelings of depression, and make them even less likely to get out of bed. A vicious cycle is the result -continuing to think and act the same way will help maintain our depression.

CBT can help you to break these vicious cycles of negative thinking, feelings and behavior. When you see the parts of the vicious cycle clearly, you can change them and therefore change the way you feel. It can also be helpful to look at the way our thoughts and feelings affect our bodies, and the physical sensations we can experience. CBT is definitely a skill worth practicing.

All change begins with awareness. Awareness allows you to notice your thoughts, feeling words and actions. With awareness you identify your attitude and beliefs. You can practice awareness by focusing your attention on the present moment. What do you see, hear, smell, taste and feel. What thoughts are you thinking, what is your "self-talk"

Once you become aware you then can make a conscious choice using thoughts and feelings that support a healthy attitude, goals and your dreams. Awareness partnered with choice allows you to accept responsibility for your thoughts and become empowered to make conscious choices that support your desired result.

Change happens when you put into practice taking the choices you have made and transforming your thoughts and feelings regarding your attitude and goals. You begin making change by practicing the technique of taking a new thought and change your thinking whenever you notice you are sabotaging your desired result.

Dialectical Behavioral Therapy (DBT) combines cognitive and behavioral therapy, incorporating methodologies from various practices including Eastern mindfulness techniques.

RECAP
Start the day with a relaxing ritual, meditate, write in your journal, do some gentle stretches or read something that inspires you. Adopt healthy eating, exercising and sleeping habits. A combination of these gives you the energy and resilience to deal with life's hassles and demands. Remember it's important to set boundaries. Remind yourself that when you say "no" you are giving yourself the opportunity to say "yes" to the things that you truly want to do. Make sure to take a daily break from technology, put away your laptop, turn off your phone, stop checking email and use this time to completely disconnect.. And finally nourish your creative side. Creativity is a powerful antidote. Try something new, start a fun project, work on your favorite hobby, choose activities you are passionate about and be inspired. Your options are limitless

Surround yourself with positive and supportive people
Isolate yourself from triggers
Call your doctor or therapist
Take time for yourself to relax and unwind
Get some form of recreation outside of the house
Ask for extra help
Increase your exposure to light
Increase or decrease the stimulation in your environment
Shower to keep your appearance up
Organize morning and afternoon activities
Keep mood charts / monitor your symptoms
Positive self-talk "I can get through this, I've managed before and I can manage now"
Positive affirmations
Gardening
Cooking or baking something pleasurable
Work on crossword puzzles
Use aromatherapy or reflexology
Watch a movie
Go to the hairdresser
Read, Go for a walk, Dance
Sit at the beach or a park
Visit church, library, museum, zoo or see concert
Practice CBT skills
Learn something new take a class
Listen to or create calming or uplifting music
Look through old pictures or take new ones
Eat something your haven't tried before
Massage your hands or feet / Paint your nails
Write a list of things you can be thankful for
Write a letter to yourself
Call someone you haven't spoken to for a while
Do some voluntary work
Express yourself physically, bang a drum, scream, shout or sing loudly
Kick a ball against a wall, Punch a pillow, have a good Cry
After a manic or depressive episode go back and review the activities and be aware of events that occurred during the episode
Practice being mindful
Smile, Pray

When bipolar disorder is present coping skills are needed in all areas of life. Your ultimate goal is to develop a "wellness tool box" filled with coping skills and activities you can use to maintain stability. Creating even a basic wellness toolbox will make all the difference. It takes experimentation and time to find winning strategies use what reels right.

Remember to incorporate your core principles, relaxation techniques, a wellness contract, mixture of various activities, solid and open communicative relationships, healthy habits that empower you both mentally, physically, and spiritually. Doing this plus taking the time to educate yourself and others on bipolar disorder gives you the opportunity to grow and move forward consistently while improving your quality of life

Bipolar 101: What to do after Diagnosis

2010-02-04T00:35:00Z

You hear it all the time, a person is given a diagnosis of bipolar disorder, the doctor writes a prescription, tells them to book a follow up appointment and that person leaves the doctors office with a lot of unanswered questions. Often their first reaction is denial, confusion, frustration and for some possibly relief that they’re not crazy.

Bipolar is an illness were those diagnosed and the people caring for them will both need understanding and emotional support. The best place to fulfill these needs is through education. When you take time to learn about the disorder you begin to find a much needed balance. Gaining knowledge empowers you to move forward and puts you on a path towards “recovery.”

In this article I’ll be covering basic information to get you started. To begin you should know it is possible for someone to go years before being diagnosed. Statistically nearly 7 out of 10 people with bipolar are misdiagnosed as least once, and that average length or time from the first symptoms to correct diagnosis is 10 years. Therefore it’s completely understandable why denial, confusion or frustrations are all common reactions to the diagnosis.

Current beliefs/findings are that bipolar disorder is primarily brought about by abnormal biological changes in brain chemistry. These changes involve mood swings from mania to depression. There are symptoms in addition to mania and depression but in general all forms of bipolar include obvious changes in moods. It’s important to note with bipolar these mood changes are episodic, meaning they’re not continuous but come in separate and distinct bouts.

Researchers are looking into a possible gene as a contributing factor, but so far no gene has been linked to bipolar disorder. Although studies are showing that bipolar tends to run in families. Statistically a child whose parent has bipolar is15-30 % more likely to develop the illness and when both parents have the disorder that number rockets to 50-75%.

To help you get a better picture of the illness the following categories are used to describe bipolar disorder. These include bipolar I, bipolar II, Cyclothymia, Rapid Cycling and NOS.

· Bipolar I; Is diagnosed when a person experiences severe depressive and full-blown manic episodes. It is estimated that about 1% of the general populations has bipolar I

· Bipolar II; Is diagnosed when a person has frequent major depressive episodes and more episodes of hypomania instead of full blown mania. Bipolar II is the more common form to be diagnosed.

· Cyclothymia; A person diagnosed with cyclothymia is usually perceived as extremely moody and very emotionally reactive. This is considered to be a milder version of bipolar II. Still if left untreated cyclothymia usually will develop into bipolar I or II.

· Rapid Cycling; You’ll hear this term to describe when a person has more than four manic / depressive episodes within a twelve month period. Statistically 10-20% of people with bipolar will develop rapid cycling. Rapid cycling is also more common in women and those diagnosed with bipolar II.

· Not Otherwise Specified (NOS); basically this term describes a variation of bipolar disorder that doesn’t follow any particular pattern.

As I mention there are shared symptoms aside from the depression and mania. These may include delusions, hallucinations, paranoia, intense anger or irritability, anxiety, feeling overwhelmed, lack of focus, suicidal thoughts or impulses, self-harm and also hypochondria. It is the combination, length and severity of the symptoms that can lead to a proper diagnosis.

Once you receive a bipolar diagnosis it becomes important to track your moods, medications, and life style choices (food, exercise & environments). By doing this you learn to spot warning signs, see patterns, or possibly avoid triggers. To put this in perspective I’ve listed some common symptoms of depression, signs of mania and possible triggers.

Starting with depression the obvious signs include prolonged sadness, feeling of hopelessness or suicide. But restlessness, irritability, increased worry, anxiety and inability to concentrate or make decisions can be signs. Also when tracking your moods pay attention to changes in your appetite (eating more or less), changes in your sleep (sleeping more or less) and if you notice you’re less interested in activities that you normally would enjoy make note of this. These are all signs of depression.

The other side of bipolar is manic or hypomania. Both are evident when your mood is abnormally energetic or irritable. Noticing hypomania can sometimes be difficult because a person feels good, continues to be productive and is functionally well but unlike a full blown manic episode hypomania shouldn’t require emergency care. What you’re looking to spot is when those abnormally increased energy levels last more than a week.

Although bipolar symptoms are a result of biological changes in brain chemistry it is possible triggers can ignite bipolar episodes. Obviously all trigger may not be avoided yet it’s still important to know what they are. Some common triggers involve stressors such as arguments, certain social or family events and alcohol or drug abuse. Simple everyday tasks like poor sleep habits, unhealthy eating choices, relationship issues or anything that disrupts your balance can trigger an episode.

Taking the time to track your symptoms and triggers helps to make educated decisions on the medications you may be prescribed. Unfortunately not everyone responds to these medications in the same way. Be prepared to try several different combinations and dosages before you find one that works for you. The other problem with bipolar medications is the amount of time that may pass before you see any affects. Because of these extended time periods finding the best combination could reasonably take a month or even over a year. This fact makes it easy to understand the frustration many people feel when seeking medication treatment for bipolar disorder.

Usually, bipolar medications are prescribed by a psychiatrist. But in some cases clinical psychologists, psychiatric nurse practitioners, and advanced psychiatric nurse specialists can also prescribe medications. With mood stabilizers, antipsychotics and antidepressants there are numerous medications available, leaving open an infant number of combinations. When you’re given these prescriptions take a moment to learn the names, what category they fall under and what they are used for. Ask what side affects you should be looking out for, what is normal and what needs immediate attention. From the beginning and as you continue on chart all your medications including the dosages and side affects, this will help determine what combination works best for you over a period of time.

Starting with Mood Stabilizing medications, these are usually the first choice to treat bipolar disorder. Their function is to help even out the highs and lows. Mood stabilizers (or anticonvulsants) are generally used in the long term treatment of bipolar disorder. With mood stabilizers you may notice a variety of side affects including, restlessness, dry mouth, bloating, indigestion, heartburn, acne, drowsiness, dizziness, discomfort to cold temperature, joint or muscle pain, headache, diarrhea, constipation, brittle hair and nails or even mood swings.

To treat the symptoms of mania you may be prescribed an atypical antipsychotic medication. With most atypical antipsychotics the side effects go away after a few days and often can be managed successfully. These include dizziness when changing positions, blurred vision, rapid heartbeat, sensitivity to the sun, skin rashes, menstrual problems, major weight gain and a change in metabolism.

Antidepressants are used to help lift the depressive symptoms of bipolar disorders. People with bipolar disorder who take an antidepressant are often prescribed a mood stabilizer. The reason for taking both is if you’re only on an antidepressant you can increase your risk of developing rapid cycling and hypomania or mania. With antidepressants the side affects do subside after a few days, but it is possible for them to remain consistent. You may notice headaches, nausea, sleeplessness, drowsiness or feeling jittery. And both men and women could experience sexual problems.

When it comes to your meds don’t take anything for granted we know certain medication and supplement combinations may cause unwanted or even dangerous side affects. Tell your doctor about all prescription drugs, over-the-counter medications or supplements you’re using.

Medications are just one part of managing your bipolar disorder. The second treatment includes therapy. A licensed psychiatrist, psychologist, social worker, or counselor can provide therapy for bipolar disorder. Remember you’re looking for a long term partnership. The doctor you choose will be assisting you to put in place your personal treatment plan. Find a doctor, who makes you feel comfortable, listens and understands bipolar disorder. If you don’t feel your needs are being met it’s perfectly OK to switch doctors.

Most therapists use a combination of approaches including cognitive and interpersonal therapies to help manage bipolar symptoms. The purpose of these behavioral therapies is for you to begin changing and gaining control over any unwanted behaviors. For example cognitive behavioral therapy or CBT helps people with bipolar learn to change harmful of negative thought patterns and behaviors into positive thoughts and actions. A method of therapy that works towards managing your daily routine and to improve your relationships is known as interpersonal and social rhythm therapy. And at some point you may work with family-focused therapy. This process is used to enhance family coping strategies. Examples would include recognizing new manic or depression episodes, learning how to avoid triggers, working on improving communication and also become skilled at problem solving.

Other terms you may hear include psycho education which is a therapy group where participants learn to recognize signs of relapse making it easier to get treatment early on. And the other is electroconvulsive therapy (ECT) also known as shock treatment. ETC is controversial but still used to help people who have tried medications and psychotherapy and they don’t work.

With bipolar disorder maintaining stability requires a good strategy incorporating, staying educated, healthy eating, exercise, avoiding stress, therapy, medications, a sleep routine, coping skills, having an emergency plan in place, making sure to surround yourself with positive people and eliminate toxic relationships. The road to “recovery” begins with balance.

You now have a basic educational foundation to begin moving forward. As you can see bipolar disorder is an illness that is as individual as the person diagnosed with it. Some sufferers will experience episodes of depression and mania over many years and others become symptom free. Therefore when is comes to the meaning of recovery it’s up to you to determine what “recovery” will look like.

Start by finding out which category of bipolar you’ve been diagnosed with. Then put together a complete charting system. By efficiently tracking your signs, symptoms, medications etc. you make it possible to work with your doctors more effectively putting together your personal treatment plan.

Next month I’ll be addressing bipolar and relationships. With so many dynamics between the people diagnosed with bipolar, those that loving care for them and a variety other outside influences it’s a topic with many perspectives.

About the author:

Marcy Rubin is a Professional Life Coach at Make-Life-Rewarding Coaching Her unique perspective on bipolar comes from the combination of her personal life growing up with undiagnosed bipolar, professional coach training along with client experience, time mentoring and hours spent researching the illness. Marcy is respected among the bipolar community for her passion and drive to speak openly about her illness. She knows her voice can make a difference. Marcy invites you to Be A Voice by joining her at BipolarUnitedWorldwide.com

Bipolar and The Holidays

2009-12-13T03:11:00Z

Most of us approach the holiday season hoping, wishing and pretending that everything will be OK, but what we often fail to do is PLAN & PREPARE. By taking time to revisit past holidays you gather a lot of useful information to help with preparing and planning for the next holiday season. Tonight's goal is help you to stop feeling overwhelmed, avoid being pulled in a 100 different directions, show you how to work with triggers before they happen, use pre-planning to lesson the burdens over the holidays and begin new and happy traditions.

With Bipolar the key to stability during the Holidays is to keep a schedule
Make a list that includes everything you THINK you have to accomplish

Shopping, family parties, work functions, cooking/baking,wrapping gifts, sending cards, preparing the house for company, decorating tree, travel plans, packing, making arrangements for pets and every other task you feel you need to do

Break down your list into two categories, Things you enjoy and the stuff that triggers negativity and stress
Schedule the things you do enjoy
Break your schedule down in to reasonable times
Be realistic and don’t try to do it all at once
If shopping triggers your anxiety schedule multiple trips, ask someone to go for you or shop online
It's OK if you don't get everything done, you do NOT have to do it all
Other people pick and choose what they want to do,why aren't you doing the same?
Ask why you stopped putting your happiness and your safety first?

What do You do with all the other “crap” that’s creating this feeling of dread and despair?

How do You not go to a family event?
How do You decline hosting the annual party?
How do You tells omeone we are not exchanging gifts?

The Answer just say ... NO !

The holidays are a great time to practice saying no. Think about this, what are you gaining if saying Yes creates stress and may trigger an episode? Saying no is an important coping skill to master once you do the end result is priceless

Work together to uncover your loved ones triggers, then say NO to any activity that is on this list
Take the time to weigh all your pros and cons, then say NO to anything that is on the list of cons
If you know facing another holiday with your family is going to make you crazy don’t go, say NO
If you absolutely feel you have no other choice but to attend an event, set a specific amount of time to spend there then stick to your limit and leave, if you're ask you to stay longer, say NO
You don’t have to make excuses when it comes to your health.

The holiday season can cause depression for people regardless of having Bipolar.

When you’re depressed during the holidays remind yourself it’s OK to take it easy
If you find yourself in an episode of deep depression check in with your doctor
Remember each holiday last only for one day
Do NOT isolate, Canceling plans to stay home alone is Not an excepted alternative
Have a safety plan (contact numbers close by)
Pick up the phone and let people know you're looking for something to do
You don't have to feel guilty for backing out of attending parties, your health always comes first
Give yourself a break and go out to eat or order delivery
Depression affects the people you love during the holidays accept their offer to help in any way they can

Bipolar can mean dealing with uncontrollable moods and verbal orsometimes physical abuse. Bipolar may cause these episodes but in NO way makes anyone obligated to stand by and donothing. You MUST SET BOUNDARIES.

The Bipolar Illness can NOT be allowed to dominate a household
Setting good boundaries prevents you from being hurt and allows you tofeel safe in your environment
Know yourself and what you can and cannot live with
Be prepared to enforce consequences
Don’t let “bipolar” divide and conquer
Discuss your needs with other family members. Get their support and have them help
Talk with the psychiatrist and therapist, enlist their help too
Avoiding engaging in the poor behavior
Keep a perspective on what's actually going on
Write out and Sign a Boundary Contract stating what will no longer be accepted
Have your own support system and take time to learn affective coping skills
If your having a hard time enforcing boundaries, you may need to consider alternative care.

Let’s be realistic,in order to cope we all need support. Whether you’re the afflicted or affected doesn't matter without strong support managing the holidays becomes a nightmare. Your support system should be a mixture of strong and positive people. Don't let one person become overwhelmed. Anyone you feel comfortable reaching out to can be a person of support.

Spouse
Family
Friends
Therapist / Doctors
Support groups (In person, via the phone and online)
Coaches
Coworkers
Religious Leader
Mentor
Teachers
Volunteer
Hotline caregivers

During the holidays your support people become your biggest allies.

preplan with your ally
Your ally will remind you it's time to leave a party even if you're having a great time.
Your ally will help remember medications
Your ally will help you stay motivated
Your ally can monitor your moods and possibly avoid full blown episodes
Your ally can be your "out" person, someone who steps in when its time to walk away
Your ally will help you stay on a sleeping schedule
Your ally will create calmness for you

Tell your ally if you get agitated don’t take it personally
Tell your ally if it gets to be too much it's OK to walk away and ask for help
Remind your ally their health and safety is just a simportant as yours

NOTE: Create and Sign an emergency care contract, having a contract in place lets others know what your wishes are when you are in a crisis

Triggers around the Holidays that can cause negative symptoms of bipolar

The biggest problem with the holidays is when you change the regular routine
Financial stress: Stick to your budget no exceptions.
Prone to manic spending sprees: Hand over your credit cards, check book and stay off the computer. When the euphoric feeling stops you don’t want to be left with excessive debt

When Travel means switching time zones: Begin changes ahead of time go to bed earlier or later
Flying: use music/book for diversions
Over-stimulation or missing medications can set in to motion mixed episodes
This time of the year the days are shorter and night are longer, your body may not have adjusted
Common triggers around deadlines and Job related stress may not be avoided, ask for help
Relationship Strains: including personality conflicts, past issues and family, keep a perspective
Not taking breaks: This time of the year you have more than usual on your schedule take breaks
Even having too much down time can trigger an episode

Ways to remain calm or avoid stress:

Being around animals
Journal
Deep breathing
Relaxing scents
Enjoy nature
Leave early
Don’t rush
Meditation
Soothing sounds
Be flexible
Drink tea
Dark chocolate
Snooze
Add omega-3s
Laugh
Let other people take control you don't have to do it alone
Exercise
Plan time for yourself

The BEST way to remain calm during the holidays, create your own annual Traditions. This year is perfect to begin special traditions that are best for your health and also resonate with you and your family.

Stay home and cook a new meal
Watch your favorite movie or go to the theater and enjoy a night out
Volunteer there are many other people who will benefit from your time
Host a low key party at your home
Pet sit for a friend (animals are known for uplifting spirits & you're helping a friend)
Take a vacation with activity options, go alone or with a group you'll enjoy spending the time with
Drive or walk around and look at the holiday lights
Have kids gather up old toys and clothes then donate them, keep up the giving spirit of the holiday
Make gifts for each other
Play boardgames, they are fun, make time fly by, are interactive and not the TV
Make plans with your neighbors, sharing with friends close to home means no travel
Alternate who hosts, don't take all the burden every year
Change formal attire to comfy or vice-versa, dress up special even if you're staying home
Go caroling at hospitals, adult care houses, and rehab facilities.
Can't be with with family set a time to call, knowing in advance eases the pressure
Read a book by the fire and candle light, nature yourself
Decorate the tree with new themes each year
Talk about the true meaning of the holiday you are celebrating. How does each family member feel about it and does it inspire you to live life differently in the upcoming year?
Make Christmas day special, leave a written note from Santa to read remembering of all the wonderful & good things that happened over the past year: add a little humor and or some advice
Instead of sending useless gifts pick a charity to donate the money to
Exercise is always beneficial, after dinner take time alone to get away from the crowd and go for a long walk

Recap:

Create a list of everything you think you are obligated to do
Break down tasks into reasonable times
Schedule everything you like and want to do,
Leave off items likely to have triggers or disrupt your enjoyment
Your final schedule is a list about you & your needs
Remind yourself it’s OK if you can’t get it all done
Stick to a time specific schedule
Set Boundaries, do not allow unacceptable behaviors
You have the right to Say NO
Everyone should have their own complete support system
Spot depression and allow for help
Have coping skills or options that will assist in calming you down
If situations becomes escalated both the sufferer and the supporter should have an “out.”
Your past does not have to equal your future, make changes Start New Traditions
Most Importantly remember You deserve to enjoy your holiday !!!

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2009-10-26T07:51:00Z