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.
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 as 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
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
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