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Stress and bipolar episodes

G

Ginger Kitten

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Stress triggers my illness. It's that simple. As soon as I have something worrying or difficult to deal with, it overpowers me. I get caught in the feeling of panic and can't stop overthinking. So I get no relief from the problem. Very quickly, within a day or two, I am starting to show symptoms: tension, irritablity, forgetfulness, tearfulness, reduced sleep.

A mh professional has recommended that my support worker works with me on stress-reduction techniques. Does anyone know what these are? The mh professional only mentioned self-soothing and mindfulness in passing. I know about the latter, because I've done a lot of it, but it's not something I keep up. I used to meditate for an hour a day and mindfulness is similar, so I know the benefits, I just don't bother. When I'm stable, I consider myself non-bipolar (odd maybe, but I never give the illness a second thought).

Has anyone else got some tips for stress reduction please - because that's where almost every one of my episodes starts. Thanks in advance to anyone who answers this. 💜💙💚
 
Tawny

Tawny

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Hello Ginger Kitten,

You must feel like a passenger to your illness, i know how this feels. I find that i don't always know what has caused me so much stress until days later when i feel the repercussions. Some stressful events have a big impact and some much smaller.

I find dealing with stress is not helpful, but avoiding it in the first place. Once 'it' has happened, it is too late. Do you mean dealing with that exact moment such as when an argument is imminent, or when you have a deadline you cannot meet? I have to go a step further back and not take on that project that has a deadline and not spend too much time what that person who likes to argue, or not see them unless they are on good form.

It is difficult but you will notice what causes you the biggest relapses. Can you identify any in particular right now?

If i have a very busy day, week away, people staying over at mine, they can all cause relapses small or large.

A death or diagnosis or something life threatening in a loved one is a major trigger. I feel a passenger at these times.
 
Tawny

Tawny

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I cannot find a good website for this course but have done it in the past. Interpersonal and social rhythm therapy, it is very well known and there used to be courses on it for those with bipolar disorder. There was a website to do it online but i cannot find it, hopefully you are able to or your nurse can point you in the right direction.

I hope it is helpful
Please keep writing and we will try and help

Tawny
 
K

keith74

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I find dealing with stress is not helpful, but avoiding it in the first place. Once 'it' has happened, it is too late. Do you mean dealing with that exact moment such as when an argument is imminent, or when you have a deadline you cannot meet? I have to go a step further back and not take on that project that has a deadline and not spend too much time what that person who likes to argue, or not see them unless they are on good form.
I completely agree with this. The best strategy is to try to minimize your exposure to stressful situations. With my wife, the stress can trigger her mood swing so quickly that there can be little time to react. And once she falls in the proverbial hole, it gets very difficult to climb out of it using conventional methods like mindfulness and CBT/DBT.
 
Tawny

Tawny

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I completely agree with this. The best strategy is to try to minimize your exposure to stressful situations. With my wife, the stress can trigger her mood swing so quickly that there can be little time to react. And once she falls in the proverbial hole, it gets very difficult to climb out of it using conventional methods like mindfulness and CBT/DBT.
That's it, minimize exposure, i couldn't think of the words, thank you.

I try to remember, run! If i start crying, arguing, anything inappropriate or mis-matched to the situation in any way, leave with an excuse, or if on the phone i will hang-up and pretend my battery died and not call back for a while. I dig a deeper hole. I think when something is collapsing, get out and go back and deal with it when you are more able or have had time to prepare for the situation. Maybe it is that frozen brain situation, the brain jolting, something has happened, be careful now.
 
G

Ginger Kitten

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No, it's not a question of avoidance, Tawny. Life if full of stressors and there are many different ones that can set me off. Currently I'm off work due to the pandemic, but I'm going back in 2 weeks and my line manager bullies me. (I work in a garden centre.) I was just putting up with it and biting my tongue before, but I'm going to report it to centre manager if it continues when I return. Last weekend, I had to deal with a financial matter, and worrying about that then set off the worry about work that I had been suppressing.
As I said, stress is a part of modern life, it can't be avoided because it can't be predicted and you don't know what the stressor might be or when it might arise - life is too unpredictable for that. The fact that my colleague is a bully is nothing to do with me, but it doesn't stop it impacting me weeks before my return.
It turned out that the financial concern was nothing - I had just spiralled into a frenzy of worry about it. It turned out just to be a courtesy call to remind me of something, but the official paperwork didn't look that way, so I guess a bit of worry was normal - the way I worry just isn't. I just can't think or talk about anything else once I'm in the grip of it. I now see it as part of my illness. I never obsessed like this before I got BP - which wasn't until I was nearly 30. I'm 60 now, so I've had it half my life, though it was only diagnosed 8 years ago.
To me, it makes sense to try to use self-help measures to lessen the worry and overthinking once they hit. To try to avoid stress isn't possible, because it could come at you from any quarter. Avoidance works for you, but we're all different I guess. Thank you for taking the time to respond.
 
G

Ginger Kitten

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I just lost a long reply. That's annoying.
 
K

keith74

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To me, it makes sense to try to use self-help measures to lessen the worry and overthinking once they hit. To try to avoid stress isn't possible, because it could come at you from any quarter. Avoidance works for you, but we're all different I guess. Thank you for taking the time to respond.
Yes some stress just can't be avoided. In those cases, things like CBT\DBT can be helpful to prevent falling into a deep mood swing. But by far the best to minimize the stressful situations as much as possible. For example, my wife is figuring out certain work environments cause her more stress than others. Hence she will no longer pursue opportunities that put her in those environments. She is also learning that she has unhealthy boundaries with some of her family members. Hence she is being more firm with boundaries so that she is not triggered by them as much. By doing things like this, she is minimizing her exposure to stress. Again she can never get rid of them all, but for ones she can control she is taking action
 
G

Ginger Kitten

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Thank you Keith and I agree that works for your wife. But I'll give you a recent example: I received a letter from my bank about my mortgage a week ago. It was about my mortgage and turned out to be nothing serious, but the letter sounded official and ominous and it set off the worry cycle. I had no way of knowing that letter was going to arrive. As a result of this worry being triggered, it simultaneously started me worrying about returning to being bullied at work. I could not have forseen that either. I assume that happened because I'd been repressing the work worries, but I don't know. I just spiralled into an obsessional loop about both topics that meant I couldn't think or talk about anything else and it triggered my symptoms, as I mention above:

Very quickly, within a day or two, I am starting to show symptoms: tension, irritablity, forgetfulness, tearfulness, reduced sleep.

As I've also said, you can't avoid stress in life - especially if it comes out of the blue as it did for me. I have been through this multiple times Keith and even my pdoc hasn't found a solution. That's why I've put the question out there, to see if other people know how to reduce stress once it has triggered symptoms and an episode is impending as a result. Someone - or several someones - will be dealing with the same issue.

I don't wish to worry you on your wife's account, but I have foujd my ability to handle stress has got progressively worse due to having bipolar. I've found I can deal with it less and less as time goes on - and I have been working on myself and my own self-help strategies, with help from mh services, since diagnosis nine years ago. It is not as easy as just avoiding stressors, it's more complicated than that for me. And what works for your wife clearly wouldn't for me, or I wouldn't need to seek ways to deal with the stress once it hits. Everyone is different and we are all seeking our own solutions, but thank you for your input.
 
K

keith74

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In your example, I think something like DBT "distress tolerance" can be helpful. My wife is/was taking DBT to help with scenarios like that. The hope is to had the skills to regulate your emotions so that it doesn't trigger an episode (or make it less severe). Yes, you are right, some stress just cannot be avoided so there needs to be other skills to help deal with the situation. My wife had only a bit of CBT/DBT training when her last crisis happened and she hadn't been practicing it long enough for it to prevent an acute depressive episode. But the hope is that over the years, she gets better at it and that it can help. She just started so I can't say how useful it will be. But her psychiatrist feels DBT, once really honed, can can be useful that way. She also affirmed that once you fall into an acute episode, it starts to get really hard to practice those skills and you need to rely more on meds and other typical treatments to get out of it. They are most useful early and best learned when at baseline.
 
G

Ginger Kitten

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Thank you for your thoughtful reply Keith, and I would love to have DBT, but 'protocol' in my mental health trust doesn't allow it. I found out about it on the net and realised it would work for me for me because it was about controlling difficult emotions. I already knew about the benefits of one of its components, mindfulness, because I used to meditate for an hour a day and because mh services everywhere are using it now for its ability to still the mind. But DBT also interested me because of its focus on distress tolerance and emotional regulation skills.

So I asked my psychiatrist to refer me and after two attempts on his part, I got into a group, but everyone else there had emotionally unstable personality disorder. The 'complex needs' department of the trust only offers DBT to people with that personality disorder, not people with bipolar. My pyschiatrist has since put me forward for another such group, but this time it was a point-blank no.

I've looked DBT up again on the net and looked over my notes again, but it's not the same. And DBT is meant to be practised over years - I was only given it for 12 weeks 2 years ago. I also found it frustrating because no one else in the group was even trying to follow the techniques offered. They had such a helpful resource and yet no one ever bothered to do the homework. Honestly, it was helping me most and it's not even supposed to be suitable for me, according to 'protocol'. But there you are, life isn't always fair. I may consider paying for it, or I may suggest it to my support worker, who's very proactive. What would be ideal is if she and I could combine some DBT stuff with stress control - distress tolerance is just another way of saying stress control, after all.

I must say, Keith, you are very kind to keep replying, especially at Easter - I do appreciate it. Kind regards, GK.
 
K

keith74

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Yes, DBT incorporates much of mindfulness and CBT in it. My wife was already familiar with those two but heard of DBT during her last hospitalization when she was looking for techniques to help avoid panic attacks. DBT was indeed originally intended to help people with BPD (borderline personality disorder). The person who created it had BPD. However, it has also been shown to help people with other issues like bipolar or GAD. The group my wife found (referred to by her psychiatrist) has people in it with all sorts of issues (bipolar, GAD, anger management, eating disorders, trauma, BPD, etc). It sounds like things are more strict in the UK regarding the protocol for who should get DBT therapy. We live in Canada and my wife's psychiatrist supported her trying out DBT and there was no issue staying in the group (as long as you can pay). I should mention that it wasn't covered by government health care (it was partially covered by my insurance from work and we had to pay the rest). The people in the group were passionate about the group and did their homework (maybe because many were paying for it themselves). And yes, you are right - it takes many years of practice to get it right. Many people in my wife's group were repeat attendees - they were taking it for the 2nd or 3rd time as a refresher. You have to practice it over and over so that it gets ingrained in there and so that when some stress event happens, your brain just automatically kicks in DBT without you having to even think about it - like reflex. If you need to think about how to do DBT when the stress event happens, then it will not be as effective because you don't have the time and clarity when it happens. My wife had a little DBT training when she has a panic attack in January. She tried to practice DBT and while dealing with the panic attack, she was trying to refer to some notes on what to do (the "STOP" skill, etc) and go through her checklist. Needless to say, it didn't work. She hopes to eventually get to a point where she does not need to refer to any notes or checklist, but instead when it happens she knows exactly what she needs to do to calm down without even really thinking about it. That is when it seems DBT will really shine.

Best of luck in your pursuit of incorporating DBT into your treatment. I think it is great life skill to have, not just for people with a mental illness but for anyone.
 
Wishbone

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And DBT is meant to be practised over years - I was only given it for 12 weeks 2 years ago. I also found it frustrating because no one else in the group was even trying to follow the techniques offered. They had such a helpful resource and yet no one ever bothered to do the homework.
Ouch! This makes for pretty painful reading. It shows how out of touch MH services are, still, in the UK.
But then you also have some patients not taking the help that is best for them either. The comparison with those paying for it out of their own pocket, as Keith mentioned, tells a lot. Do some people even want to get better or do they just want to keep running services up and down all the time and in doing so making it more difficult for the rest of us to access them when we need them?

GK, I'm different to you in that stress needs to build up in me I think. An isolated incident here and there is completely managable but ongoing stress is kind of like pulling the blocks out of a Jenga tower, but then most people would probably say the same I guess, ill or otherwise. The difference is that continued stress may lead to sleep deprivation/disturbance and that seems to have a bigger impact on me if it goes on for a little too long. But then things still happen seemingly out of the blue and it's those things that I just don't know what to do with because I usually don't even see them coming.
 
G

Ginger Kitten

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Ouch! This makes for pretty painful reading. It shows how out of touch MH services are, still, in the UK.
But then you also have some patients not taking the help that is best for them either. The comparison with those paying for it out of their own pocket, as Keith mentioned, tells a lot. Do some people even want to get better or do they just want to keep running services up and down all the time and in doing so making it more difficult for the rest of us to access them when we need them?

GK, I'm different to you in that stress needs to build up in me I think. An isolated incident here and there is completely managable but ongoing stress is kind of like pulling the blocks out of a Jenga tower, but then most people would probably say the same I guess, ill or otherwise. The difference is that continued stress may lead to sleep deprivation/disturbance and that seems to have a bigger impact on me if it goes on for a little too long. But then things still happen seemingly out of the blue and it's those things that I just don't know what to do with because I usually don't even see them coming.
Hello Wishbone. Have a look at Keith's excellent post above about his wife's experience of DBT. He's very knowledgable. I found it brilliant, but as we've discussed, it's not an option for me here in the UK. I suspect it's because it's more expensive to administer and takes longer than CBT, for instance, but also, because services here are blinkered. Why on earth something that has been devised to calm emotions can't be used for anxiety, panic disorder, ptsd and bipolar disorder, I really can't imagine. The probable answer is that NHS services are free - and in life you get what you pay - or don't pay - for! Thanks for replying.
 
G

Ginger Kitten

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Sorry, Wishbone, I meant to say that I understand the sudden impact of stress on bipolar symptoms - that's exactly what happened to me last weekend when I got a worrying letter from my bank - or what I assumed to be worrying, it turned out it was nothing to worry about at all. There's a lesson there, I think. I literally worried myself sick. This is something DBT could help me with, in terms of distress tolerance, radical acceptance and self-soothing. Would DBT help you too, do you think? If you're in North America, you'd be able to access it, unlike here, though you might have to pay. I could pay for private therapy too (my current treatment is free on the NHS) but I don't have the money, unfortunately - and that is due to the impact of bipolar on my ability to function at work and deal with stress. I've accepted that now, but it's a bitter pill to swallow. Thanks again for your reply.
 
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