Learning to manage stress is important for everyone, and doubly important for people with bipolar disorder. This stands to reason because when feeling good, many people with bipolar disorder can get a lot done, and may find themselves taking on more and more tasks and responsibilities. But should a depression start to develop, all of those daily activities may suddenly feel burdensome and overwhelming.
If possible, it’s best to develop, build, and practice your relapse prevention strategies or plan when you’re feeling well. The reason is that the more you practice when feeling calm, good, and relaxed the more likely you’ll be able to call up and use your skills effectively when things are going less well. Sitting down to play the piano at Carnegie Hall without having ever taken lessons is not a good idea. More than ever, the adage “practice makes perfect” is crucial in the development of relapse prevention strategies that work.
Here is a short list of techniques, mostly cognitive and/or behavioral approaches, that can help. There are many others, as well.
• Identify specific sources of stress, work, home, finance, etc., and map out specific strategies for diminishing the problem. One helpful cognitive technique is to decide what is in your control in the situation and what isn’t. As they say in twelvestep groups, “change what you can change and learn to accept and let go of those things not in your control.”
• For example, if you’re working a job that requires you to do rotating shifts, or if you can’t stand your supervisor, weigh the pros and cons of staying versus leaving. If the cons come out on top, take active steps to find a less stressful job.
• If you know that when manic or hypomanic you can drain your bank account, take real steps to limit your access to credits cards, ATM machines, and online shopping
• Learn how to say “no” when asked to take on additional chores, responsibilities, and tasks. For some people with bipolar disorder, who may run on the hyper side, people around you may be used to you being a ball of energy that gets a ton accomplished. At times this is fine, but when you’re feeling stressed, it’s important to know how to put the brakes on. To completely misquote Nancy Reagan, when asked to take on a new task or responsibility, “just say no.”
• Learn how to effectively ask for what you want, whether it’s a day off, an urgent visit with your therapist/psychiatrist, or some favor that might lessen your overall sense of feeling burdened. For people with bipolar disorder who are also parents and/or caregivers, this might be getting someone else to look after the kids or Mom/Dad. This could be just for a bit, or it might involve asking for ongoing assistance and on a regular basis.
• Carve out regular times, at least three to four times a week, for exercise. There is good evidence that demonstrates the positive benefits of moderate to strenuous exercise in combating depression, fatigue, and anxiety. Join a gym, buy a treadmill or elliptical machine, go for daily walks, play tennis, swim, you decide, just do it.
• Try yoga, meditation, and mindfulness techniques. On the flip side of strenuous exercise is an equally robust body of evidence that shows the positive benefits of these non-medication methods for decreasing symptoms of depression, anxiety, and stress and promoting an overall sense of health and well-being. If you’re someone who needs others around, sign up for a yoga, meditation, or mindfulness class. If you prefer to exercise alone, buy a couple of tapes or a book on mindfulness such as Full Catastrophe Living by Jon Kabat-Zinn or The Miracle of Mindfulness by Thich Nhat Hanh. The important thing is to set aside the time for this and do it daily. All of these techniques work, but they must be practiced.