10 Aug 2022

POSITIVE PSYCHOLOGY: The ups and downs of bipolar disorder


Bipolar disorder can be treated

IT is not uncommon for people to use the word 'manic' when they want to convey a state of extreme activity or agitation.

Traditionally in psychiatry, the diagnosis of 'manic depression' was made when a patient presented with a mood of two extremes: mania, which described a state of high mood, over-activity, sleeplessness, impaired judgment and agitation; and depression where the mood was low, sad, often hopeless and everything was slowed down.

More recently 'manic depression' has been replaced by the term 'bipolar disorder'. The condition can vary in severity and indeed the psychiatric diagnostic system subdivides the disorder accordingly.

In practice, some people with bipolar have severe mood swings that may result in hospitalisation, whereas for others the mood swing is not as pronounced.

Episodes of mood swings may occur rarely or multiple times a year. Bipolar disorder seems to develop most frequently in the early twenties but it can occur at any age.

We do not know what causes it but it does seem that genetic factors are at play, as having a close relative with bipolar is a risk factor. With the advance of MRI techniques there has been progress in evaluation of the neurological and physical changes in the brain.

A diagnosis of bipolar disorder is only made after at least one depressive and one manic episode. It is a long-term, chronic diagnosis which often has to be managed over a lifetime.

Effective treatment needs to address biological, psychological and social factors. Medication is usually an important part of the picture and people are often on medication for the long-term.

Hence medical monitoring of people’s response to and tolerance of side-effects is crucial.

Psychological treatment is essential in order to both deal with the highs and lows of this condition but also in order to prevent an escalation of symptoms.

In our experience, evidence-based treatments such as cognitive behaviour therapy and mindfulness, are probably the most effective.

Compassion-focussed therapy, which is a newer addition to the psychotherapy field, can also be very helpful, particularly for clients who are self-critical or carry a sense of shame because of their symptoms or diagnosis.

Keeping psychological and social stressors to a minimum is really important.

We find that working with the client so that they develop a good understanding of their stress triggers, is often a useful first step.

For example, a big family occasion such as an upcoming wedding, a change in job or moving house – all typically positive life events – can sometimes trigger an episode.

Learning to identify what maintains their stress (once it has started) is equally necessary. For example, if the client is not sleeping or eating properly they may be more at risk.

We often get people to keep a daily diary which details their mood, for example, is it ‘average’, ‘below average’, ‘well below average’ or is it ‘better than average’, ‘much better than average’. This way the client may learn to spot patterns in their mood fluctuations. The diary can also include factors such as number of hours sleep, energy levels, medication.

We find that it is crucial to help clients identify their protective factors, the factors that keep them well, that help keep the mood stable. For example, practical issues such as getting enough sleep at night, taking exercise (possibly to work off excess energy during a high or to stimulate energy during a low period), taking prescribed medication and avoiding alcohol or drug use.

Social support is also crucial, so having a friend or family member who knows you well, who understands the disorder and who can be available to you during difficult periods, is important.

In therapy, we try to address the above issues with clients. We find that encouraging clients to practise mindfulness skills such as regular meditation can work really well.

Meditation helps to slow down the mind, so it works well when we get agitated. It gets us out of our heads (the monkey mind) and focuses our attention elsewhere, for example, on an internal anchor such as our breathing, or an external one such as looking at the flame of a candle.

The attitudes of mindfulness are hugely important. These are - staying in the present moment when the temptation is to race ahead into the future or to rehash old issues from the past; being aware of moods and accepting them with patience and without judgement; being kind and compassionate to yourself - you did not choose this diagnosis and you are doing your best to manage it.

Figures suggest that the prevalence of bipolar disorder is around 1%, but this figure can be further broken down depending on subtype and so on. Effective treatments usually incorporating medication, psychological treatments and self-help techniques can limit the impact of bipolar disorder and greatly improve quality of life so that this diagnosis does not significantly affect functioning in daily life, pursuit of personal values or achievement of one’s life goals.

Julie O'Flaherty and Imelda Ferguson are chartered clinical psychologists, both based in private practice in Tullamore. Through Mind Your Self Midlands, they run courses on Positive Psychology and Mindfulness through the year. They can be contacted through the Psychological Society of Ireland (Find a Psychologist section) or on their Facebook page, Mind Your Self Midlands.

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