Do it Yourself Cognitive Behavioral Therapy

Cognitive behavioral therapy is about changing how you think.  I've been trying to work on my thought patterns for quite some time, and recently I found a website that has lots of suggestions. 

The website is about Dialectical behavior therapy, which is a type of cognitive behavioral therapy that was designed for people with Borderline Personality Disorder.

The great thing is that it works for people with mood disorders too. 

If you're interested in how to mentally cope with the mood swings of Bipolar Disorder, you might benefit from these DBT Lessons.  The section on distress tolerance has great suggestions for how to make yourself feel better.  Some of the suggestions are things I've already been doing, and some are new to me. 

The section on Emotion Regulation is also helpful for anyone who experiences the extreme emotions of Bipolar Disorder.

Lots of helpful reading.

Tips on Goal Setting for People with Bipolar Disorder

I read somewhere that we often overestimate what we can accomplish in one day, but underestimate what we can accomplish in a year. With that thought in mind, I started setting monthly goals for myself.

I used to set daily goals, but my lists were always too long. The goals looked achievable, but I just couldn't get them all done in a day. Sometimes I'd try to push myself to do every one of them on the list, but I'd often end up in bad mood... frustrated, anxious, disappointed in myself, etc.

Setting and achieving goals can be difficult, and Bipolar Disorder adds a few twists to the process. The unpredictability of the disorder makes it hard to judge how many normal days you'll have. Furthermore, while the many ideas we have during hypomania or mania can be productive, there can also be some ideas that throw us off course. The trick is to figure out what's important to do, and what's distraction.

Benefits of Monthly Goal Setting

- Completion of Projects. I come up with a lot of ideas, especially when I'm feeling "up." Monthly goal setting means that ideas for new projects have to be put off until the next month, or until the current month's goals have been completed. This encourages completion of current projects before starting new things, which means less unfinished projects. It also means time to think before jumping into a new project. This time for thinking can be used to make better decisions.

- Looking at the big picture. One day is a very small time. The success of a long term project or goal shouldn't be judged on one day. When choosing monthly goals, I reflect on the whole previous month, rather than just one day. Everyone has bad days, and it's best not to put too much weight on them.

How to Set Achievable Monthly Goals

- Set goals that you have complete control over. If you're unemployed, the goal "get a job" isn't a good one. However, a goal of sending out a certain number of resumes, practicing interview techniques, etc, is something you have control over. Likewise, if you're in sales, you can't guarantee a certain dollar amount in sales, but you can write down specific actions that you can take that will make it likely that you will increase your sales.

- Break a big project into small parts. Your goals should be to achieve these small parts of a project. If you're writing a book, a goal could be “Write Chapter 1.”

- Strive for consistency. Look at what you achieved the previous month, and make goals that are equal to or a little big greater. Consistency is a hard thing to achieve, and a goal that keeps your output consistent is a goal that will give you great long term rewards. People often give up too early.

- It is better to underestimate what you can achieve than to overestimate. If you get your monthly goals done early, then you can start on new goals early. Next time you will have a better idea of what can be achieved.

- No task is too small to be a goal. You can set goals for activities that will likely turn into a habit. Your goal could be to brush your teeth two times a day, every day. If you do this all month long, it's unlikely that you will stop doing this once the month ends. You will have developed a habit.

Depression and Monthly Goals

Depression can make you want to give up. It can also make negative events stand out in your mind, and you may have trouble remembering the positive things. When you think about “what point is there to all of this” it's hard to have the willpower to complete a goal.

If you write your goals when you are feeling hopeful, positive, and optimistic, then when you are depressed, you can remember that these goals were written by the positive you, and you can try to talk yourself into working on the goals because that happy you will come back, and you don't want to let her (or him) down.

Sometimes depression makes it hard to do anything, and if that's the case, you can relax and know that you truly do have the whole month to accomplish the goals, so taking off a day won't ruin everything. Sometimes the depression has to be treated first, and you should take steps to treat it. Treating the depression can be a goal in of itself. The goal should be specific though, like: Talk to doctor, find therapist, read a book on depression, etc.

Keeping Track of Sick Days: An Alternative to Mood Charts

I have rapid-cycling bipolar disorder. My moods change throughout the day. I can wake up depressed and go to bed hypomanic. I can feel normal for part of the day, and then anxious for a couple of hours.

I haven't kept a mood chart in years. Every time I try to keep one, I freeze up, because I don't know what to fill out. Should I count that hour of craziness as hypomania? How about that episode of unusual tearfulness - was that depression?

So this month I have tried something different. I only write down my sick days. And by sick, I mean sick enough that I would have stayed home from school/work and/or went to see the doctor. A runny nose or a few sneezes doesn't qualify as sick. That's just normal life.

And guess what? Writing down sick days is really turning out to be helpful! It helps to put a depressed day in perspective. It also will help me to know whether my amount of sick time is normal or not for me.

So I started keeping track at the beginning of May. This is a good month. This is what my sick days list looks like:

5/3/11 - Depression

5/10/11 - Anxiety, took phenibut, then felt good. Not a full sick day, since I solved the problem.

5/21/11 - Depressed, took: Ginseng, Piracetam, 2 Choline & Inositols, Aniracetam (started to feel more normal, but not completely better), Coffee... around 11pm, getting back to normal

5/22/11 - Half sick day, depressed in morning, took 2 Choline & Inositols, and Aniracetam, felt better.

As you can see, I also wrote down if I did anything for the sickness. I was also somewhat hypomanic on 5/24 and 5/25, but not to the point that it interfered with my life, so I didn't write it down. On 5/24, I simply found myself stating “What a wonderful day it is today!” and I then thought, “I don't really have any reason for thinking that...” so I was really positive, but it didn't mess me up. I was also a bit more talkative than usual on 5/25, but again, nothing bad came of it, and I was able to control myself fine.

But looking back over the month, this tells me a lot. I went for about a week with no symptoms, and if you ignore the anxiety episode (which could have been triggered by a specific event), I went for over 2 weeks with no depression. I did have mild PMS a few days, but it wasn't strong enough to qualify as a sick day - I was still able to function as normal.

I'm going to try to keep writing down my sick days. It really is giving me insight!   

Really Good Video on ADD / ADHD

I watched the video ADD & Loving It?! on PBS last night.  It was great. Funny and full of insights.  Not perfect, but sure worth the watch. The best part is that Rick Green (you might know him from The Red Green Show) describes how ADD feels for him, as do several other adults.  This is more geared to adults than children, although probably teenagers could find this video useful too.

It is easy to see how the hyperactive components of ADHD - the impulsiveness especially - are similar to the symptoms of mania.  No wonder there's confusion!

I actually don't have ADD.  I did take Ritalin at one point, and while it helped for awhile, I just don't have the ADD symptoms on a continual basis.  My attention problems come and go depending upon my mood. When my mood is doing well, my attention is fine. 

Feeling ON is so much better than Feeling OFF!

Photo Credit

Here's a list I wrote several years ago.  It describes what feeling off is like and what feeling on is like.  I'm sure this could apply to a myriad of other mental illnesses, like ADHD, generalized anxiety, etc.


FEELING OFF (not well)
Paranoid Thinking
Difficulty in Making Fast Decisions
Inability to Detect Subtleties (jokes, nuances, sarcasm etc)
Increase in number of errors (when working)
Anxiety - flushing, sweating, nervousness
Impatience
Frustration
Sensory Overload - Flourescent lights bothersome
Weird Feeling
Dazed Feeling
Out-of-it Feeling

FEELING ON
Clear-Minded
Good Memory
Efficient
Good Decision Making
Sure of Myself
Fast Thinking (at a normal pace for me, though)

I think at the time when I wrote this, I wasn't taking any medicine.  I was going through a period of "See, I don't need medicine!"  I was med free and proud of it.  Now I am medicated and happy about it. Times change.  I can tell you that I now spend way less time feeling off.

I know that the feeling off list doesn't exactly read like a list of Bipolar Disorder symptoms.  I think that's because I was having anxiety too.  Also, the in-the-moment sensory experience of being in a hypomanic or depressed mood doesn't exactly read like a list out of the DSM manual.  There's a difference between the internal experience and the external view of what's going on.  

Lithium Flatness and Dosage

In a previous blog post, I hypothesized that taking too much lithium is the cause for the flatness that some people experience.

After reading a lot more, I have to correct myself.  Apparently lithium just makes some people feel flat. Period.  It doesn't happen to me.  But it does happen to some people.  It's a side effect that you might or might not have. And it probably has more to do with individual differences than dosage.

I'm sorry if lithium makes you feel flat. I hope that you will find a medicine that does work perfectly - removing the mania and depression but allowing for life's normal ups and downs.  That's how it should be.

New Blog about Supplements

I'm not leaving this blog.  I intend to continue posting here about Bipolar Disorder.  This includes posts about supplements for bipolar disorder.  But topics like supplements for toe fungus will be carefully crafted on my new Soup and Supplements blog.  I know some people write about everything on one blog, but after careful thought, I've decided that I want to have two blogs. Maybe even three, or four...  :)

This way if you are only interested in bipolar disorder, you won't have to read my other ramblings!