The Bipolar Workbook, Second Edition: Tools for Controlling Your Mood Swings - Softcover

Basco, Monica Ramirez

Softcover

ISBN 10: 1462520235 ISBN 13: 9781462520237

Publisher: Guilford Press, 2015

Synopsis

Bipolar disorder is a lifelong challenge, but it doesn't have to rule your life. Join the many tens of thousands of readers who have used the science-based tools in this book to achieve greater balance and get the most out of treatment. Leading expert Dr. Monica Ramirez Basco helps you understand the nature of bipolar illness and recognize the early warning signs of mood swings. Step-by-step exercises (you can download and print additional copies of the forms as needed) give you greater insight into your own triggers, vulnerabilities, and strengths. Dr. Basco guides you to build the particular skills you need to withstand the seductive pull of manic episodes and escape the paralysis of depression. You'll also learn key strategies for managing stress, making healthy decisions, and solving problems. Vivid stories and examples illustrate how to put the techniques into action. Significantly revised, the second edition features a new structure, more succinct chapters, and streamlined exercises.

About this title

About the Author

Monica Ramirez Basco, PhD, a clinical psychologist, is Associate Director for Science Policy, Planning, and Analysis at the Office of Research on Women’s Health at the National Institutes of Health. She served as Assistant Director for Neuroscience, Mental Health, and Broadening Participation at the White House Office of Science and Technology Policy from 2014 to 2015. Dr. Basco is an internationally recognized expert in cognitive-behavioral therapy and a founding fellow of the Academy of Cognitive and Behavioral Therapies. She was formerly on the faculty of the University of Texas at Arlington, where she was awarded the University of Texas Regents’ Outstanding Teaching Award.

Excerpt. © Reprinted by permission. All rights reserved.

The Bipolar Workbook

Tools for Controlling Your Mood Swings

By Monica Ramirez Basco

The Guilford Press

Copyright © 2015 The Guilford Press
All rights reserved.

ISBN: 978-1-4625-2023-7

Contents

Preface, xi, 
Step 1 Get the Big Picture, 
1 Understand How You can control Your Mood Swings, 3, 
2 Learn about the Symptoms of Bipolar disorder, 11, 
3 Distinguish Symptoms from the Real You, 30, 
Step 2 See it coming, 
4 Recognize and Label Your Moods, 47, 
5 Identify Triggers and Improve Coping, 58, 
Step 3 Don't Make it Worse, 
6 Avoid Things That Make You Feel Worse, 73, 
7 Don't Let Your Emotions control Your Thoughts, 87, 
8 Stop Avoidance and Procrastination, 104, 
Step 4 Reduce Your Symptoms, 
9 Regain Control When You Feel Overwhelmed, 121, 
10 Change Your Negative Outlook, 134, 
11 Analyze Your Thoughts, 147, 
12 Work through Denial about Needing Medication, 157, 
13 Improve Medication Consistency, 166, 
Step 5 Strengthen Your Coping Skills, 
14 Effectively Solve Problems, 181, 
15 Strengthen Stress Management Skills and Healthy Habits, 194, 
16 Make Better Decisions, 207, 
17 Maintain Your Gains, 216, 
Resources, 227, 
Index, 229, 
About the Author, 237, 

CHAPTER 1

Understand How You can control Your Mood Swings

In this chapter you will:

[check] Find out what you can do to control your mood swings.

[check] Read about the five steps toward better control of your symptoms.

[check] Learn why medication may not be enough.

[check] Discover how this workbook can help.

Feeling Bipolar?

The word bipolar is usually used to describe a specific type of mood disorder in which people have severe mood swings called major depressive episodes and manic episodes. However, many people use the term bipolar to describe sudden or extreme shifts in mood, attitude, outlook, or behavior that cause problems in relationships or at work, lead to poor coping behaviors such as substance abuse, or result in poor decision making that leads to negative life consequences.

Mood shifts are normal human experiences. They can be reactions to positive or negative events such as successes or losses. They can occur in response to the words and actions of others. They can be driven by biological changes such as alterations in brain chemistry for people with psychiatric disorders, changes in blood sugar for those with diabetes, fluctuation in hormone levels, and physical illness or injury. Mood swings can also be the result of a combination of these forces acting at the same time.

If you have self-awareness, you might notice that you feel full of energy on some days and are tired or unmotivated on other days. These fluctuations are considered normal unless they last too long, interfere with your ability to function normally, are accompanied by other physical and mental symptoms, or cause you a great deal of discomfort or distress.

Your mood swings may be noticeable to other people. You might have had the experience of friends or family members telling you that you are "acting bipolar," are "moody" or "unpredictable," have "multiple personalities," or just seem to be a different person depending on the day, the season, or the time of the month. This workbook is intended for people who suffer from these types of mood changes, and the goal is to become more aware of them and to gain as much control over them as possible.

Bipolar Spectrum Disorders

Bipolar I disorder is a psychiatric illness that affects about 1% of Americans. It generally starts in late adolescence or early adulthood and is lifelong once it begins. People who have bipolar I disorder usually experience periods of extreme depression that can last months at a time. They also experience periods of euphoria or extreme irritability that are called manic episodes. During manic episodes a person might have racing thoughts, feel a pressure to keep talking, be unable to sleep, and behave in ways that show poor judgment. Manic episodes can last anywhere from several weeks to several months. During this time, the person's ability to function worsens. Bipolar I disorder is one of the most severe and persistent mental illnesses.

There are other types of mood disorders that resemble bipolar disorder but are not as severe. They may not include experiences with mania, or may seem more like personality characteristics than an illness. Together, these are called bipolar spectrum disorders because they include people with a full range of symptoms on a spectrum from the most severe and chronic to those that share the features of bipolar disorder but occur infrequently and do not impair daily functioning. Chapter 2 will provide more information about these disorders.

While the first edition of this workbook focused specifically on bipolar I disorder, this second edition provides interventions for all types of mood swings on the bipolar spectrum. The exercises address symptoms of major depression and mania, but these strategies can also help to prevent or relieve the symptoms of hypomania, a milder form of mania, as well as mild depression, irritability, and anxiety.

What can You Do about It?

There are many different strategies for controlling your mood swings. If you have a mood disorder such as bipolar I or bipolar II disorder, medication is a key to stabilizing your mood. If you are female and your mood swings are related to your menstrual cycle, your gynecologist may suggest hormones to even out your mood. If you have problems with your thyroid, poorly controlled diabetes, or another type of endocrine problem, your physician can work with you to try to resolve mood symptoms. If medical interventions are not enough or if your mood swings are not the result of a biological problem, you may be able to learn how to control your mood swings by making changes in your reactions, your attitudes, or your life situations.

Take Control of Your Mood

This workbook is designed to guide you through the process of learning what you can do, in addition to taking medication regularly, to control your mood swings. If you make the effort, you can learn to lessen and perhaps avoid severe mood swings as well as symptoms of depression, mania, hypomania, irritability, anger, and anxiety. You can also learn to cope with the many ways your mood symptoms interfere with your life. You can use this workbook on your own, make it part of your individual or group therapy, or work through it with your therapist or doctor. Each chapter offers information, skills, and exercises that can help you learn to cope with your emotions, control negative thinking, minimize physical symptoms, stick with medication treatment, and manage problems of daily life.

If you commit the time to practice and learn each method, this workbook can help you learn more about your mood swings, discover new ways to keep the symptoms from coming back, get more out of treatment, and work toward reaching your goals in life. To accomplish these things, you will need to learn how to do several important things:

1. Understand what is happening to you.

2. Recognize significant mood swings.

3. Not act in ways that make symptoms worse.

4. Reduce your symptoms by adjusting your actions, thoughts, and environment.

5. Strengthen yourself for the future by learning better ways to cope.

The chapters in this book are organized according to these goals. Below is a brief summary of what you can learn at each step. There are many different exercises throughout this workbook. Not all will apply to your unique situation and problems. Pick the ones that seem to suit you best. If they are not helpful, try some of the others.

GET THE BIG PICTURE

• Understand your mood swings and figure out what you can do to help yourself.

• Learn about the symptoms of bipolar disorder.

• Figure out the difference between a mood swing and the real you.

SEE IT COMING

• See the changes coming — learn to recognize and label your moods.

• Know what triggers your mood swings and improve your coping.

DON'T MAKE IT WORSE

• Avoid things that make your mood worse.

• Don't let emotions control your thinking.

• Stop avoidance and procrastination.

REDUCE YOUR SYMPTOMS

• Regain control when you feel overwhelmed.

• Change your negative outlook.

• Learn to analyze your thoughts.

• Work through denial about needing medication.

• Improve medication consistency.

STRENGTHEN YOUR COPING SKILLS

• Learn to deal effectively with problems.

• Strengthen your stress management skills and healthy habits.

• Make better decisions.

• Maintain your gains.

Why It Might Take More Than Medication

Medications that effectively control symptoms of depression and mania, mood swings, anxiety, irritability, and sleep problems are the cornerstone of managing severe mood swings like those common in bipolar disorder. Mood disorders are biological illnesses that cause changes in the way your brain processes the chemicals your body naturally produces. Medications are designed to correct this problem by providing these chemicals or neurotransmitters when they are lacking or by helping your brain use them more efficiently. Without medication, psychological approaches like those presented in this workbook may be only minimally effective for people who have severe mood swings. But even with medication, you may need more to gain the greatest possible control over your mood swings and to prevent relapses.

• You need backup interventions for those times when you don't take your medications consistently or when they are not working fully. Most people have trouble taking medication on a regular basis, especially when their symptoms have improved or when medication side effects are unpleasant.

• You need ways to minimize stress, cope with changes of season or life circumstances, and avoid sleep loss — all factors that can cause symptoms to return even when you take medication every day.

• You need healthy and effective ways to control your symptoms instead of giving in to the temptation to use alcohol or street drugs to help you sleep, calm your anxiety, or change your mood. Alcohol and street drugs are not safe to use when you are taking psychiatric medications, they can interfere with the potency of some medications, and they can make your mood swings worse.

• You need methods for examining and managing your lifestyle so that it doesn't lead to sleep loss, poor eating habits, or unhealthy behaviors that can increase the risk of relapse.

• You need some strategies for sorting out your feelings about your mood swings and treatment when you feel conflicted about it. You may find yourself going through times when part of you rejects the idea of having to take medications to control your mood or is unwilling to make the modifications to your lifestyle that might help reduce or eliminate symptoms. At the same time another part of you knows what you should do to take care of yourself.

• You need ways to reverse the mental meltdown that makes it hard to think. Mood swings can make it hard to organize your thoughts, make decisions, and solve problems.

• You need ways to resolve the problems that stress you so that you can improve the quality of your life. Medications may remove symptoms, but if you've had financial, legal, or family problems as a result of your symptoms, you'll be left with those problems even when your mood swings have improved.

Fortunately, there are methods you can learn to fill the gaps that medication treatment leaves. Strategies for controlling symptoms, preventing relapse, and solving problems are explained in this workbook. Mastering these strategies will help you come to terms with your illness, give you a reason to stick with medication treatment, and keep the ups and downs from interfering with your life.

How Does It Work?

Many different things can trigger mood swings. They can include reactions to upsetting or exciting events, a stressful interaction with a significant other, important news — either good or bad, lack of sleep, hunger, physical illness, or concern for other people. In people who have mood disorders, shifts into mania or depression can be triggered by taking medications inconsistently or not at all, changes in seasons, illness, or trauma, or they can occur for no obvious reason at all. Once a mood swing starts, however, your reaction to it can make symptoms better or worse. A goal of this workbook is to help you recognize mood shifts, pause long enough to think through your choices of action, and handle the situation in a way that is helpful and not hurtful to you in the long run. Here are some examples, which are composites designed to represent experiences common among those struggling with mood problems.

Tommy is a struggling college student. He has had two episodes of mania so far. The first episode was mild and did not last very long. He was diagnosed with bipolar disorder after his second episode because his symptoms were bad enough to require hospitalization. The police took him to the emergency room when he crashed his car into a light pole. It took several hospitalizations before Tommy began to feel like his old self. Throughout the workbook, examples of Tommy's efforts to work through the exercises will be provided.

Like most people who have been newly diagnosed, Tommy knew very little about bipolar disorder, but he was pretty certain that he did not have it. He picked up the book from time to time and read through sections that caught his eye but did not really work through the entire program right away. His psychiatrist encouraged him to read more and learn about what he could do to control his symptoms. Tommy read the first few chapters, about the illness, but was not ready to buy into the idea that he had bipolar disorder. His mom was very worried about Tommy and frustrated by his lack of effort to educate himself. She read through the workbook as well as many other books on bipolar disorder so she would understand what was happening to her son. Eventually, Tommy began to use the workbook like a reference book. Each time he had a new experience that might be related to bipolar disorder, he tried to find an exercise related to it.

Amanda is a good example of someone who has dealt with the many ups and downs of bipolar disorder but does not feel confident that she can control it. She is a 32-year-old nurse who had her first episode of major depression in high school and her first manic episode in nursing school about 6 years ago. She has had other periods of depression, mania, and hypomania and has been under the care of a psychiatrist off and on over many years. In addition, Amanda has had supportive counseling and attends a self-help group to cope with periods of low mood. She knows she has bipolar disorder and wants to do what she can to control it for the sake of her family. She suffers from low-level depression much of the time and often has difficulty keeping her home clean and organized, doing her job at the hospital, and caring for her 5-year-old daughter and 12-year-old son. She has lost jobs for poor attendance when she was depressed and has walked off of jobs because her irritability and impulsiveness during manic spells have gotten the best of her.

Amanda picked up this workbook after a period of depression that really frightened her. She caught herself thinking that life was not worth living and that there was no hope for a better future. This was not Amanda's usual attitude, and when she came out of the depression, it greatly upset her that she had allowed her thinking to get so distorted. She kept thinking, "What if I had acted on those ideas?" Amanda was ready to work diligently through all the exercises in the workbook. She recognized her symptoms from the examples in Chapters 2 and 3 and knew she had coped poorly with them in the past. Amanda was particularly interested in learning to control her distorted thinking, so she slowly and carefully worked through each exercise in Chapters 7, 10, and 11. Amanda's examples are included throughout the workbook. If you think you're like Amanda, pay particular attention to how she completed each exercise.

Paul and Raquel are both good examples of people who have learned a great deal about how to manage bipolar disorder. Both have had bad experiences with depression and did not want to go there again. Paul is 24 years old, but his bipolar disorder started during his elementary school years and he has been through enough treatment to be an expert on the issue. He is a software engineer working for a small start-up company. He spends most of his time building websites for other companies, but he has a number of creative ideas and plans to start his own company before he turns 30. Paul did not go through a period of denial like Tommy had, because his parents explained to him when he was a young child what illness he had and how medication would help. He learned early in life that he felt better with medication than without it and that things went better at school and with his friends when he was more stable. Although Paul knew a great deal about the biology of bipolar disorder and was pretty consistent with taking medications, he did not know much about how his reactions contributed to his symptoms. He wanted to learn what he could do to keep his symptoms from flaring up without always having to take additional medications, which had been his strategy in the past. Paul only skimmed through the first three chapters because he had already read so much about the illness, as had his parents. What he wanted to learn were the methods in Chapters 5 and 6 for making himself less vulnerable to relapse by controlling his actions. Although he knew himself pretty well, he did not always recognize symptoms until they were severe and easily noticeable to others. Examples of how Paul worked through each exercise are provided throughout the workbook.

(Continues...)

Excerpted from The Bipolar Workbook by Monica Ramirez Basco. Copyright © 2015 The Guilford Press. Excerpted by permission of The Guilford Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
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Edition details

• Publisher: Guilford Press
• Publication date: 2015
• Language: English
• ISBN 10: 1462520235
• ISBN 13: 9781462520237
• Binding: Paperback
• Edition number: 2
• Number of pages: 237