OVERCOMING MOOD SWINGS
CONTENTS:
Major Depression: Unipolar Depression is characterized by low mood with no ‘highs’.
Bipolar Disorder: Manic Depression is when mood swings occur between mania and depression and can be further defined as:
Bipolar I [Full-blown mania is experienced].
Bipolar II [Hypomanic (below manic) ‘highs’ that do not go to the extremes of mania].
Cyclothymia [Milder mood disturbance swinging between hypomania and dysthymia (persistent mild depression characterized by lack of enjoyment or pleasure – anhedonia)].
Feelings and emotions are explained by the term ‘mood’.
Event – thought – feeling – physical reaction – behaviour are all connected.
Your thoughts about an event will affect your feelings which will impact on your behaviour or reaction to the event.
During depressive episodes, thoughts tend to be negatively biased; when manic or hypomanic, thoughts are frequently positively biased. Occasionally, this series of operations causes a person to go in a downward spiral and become increasingly depressed. On the other hand it may result in an upward spiral with increasing elation.
A person’s mood can be influenced by their thoughts in a situation, and affects bodily processes and behaviour. Mood swings can be a detrimental force on the quality of a person’s life.
2. When are Mood Swings a Problem?
The features of mood disorders are mood that continues firmly to be disturbed, also thinking, behaviour and physical functioning that has an unchanging pattern of alteration.
Disorders linked to mood swings are:
Unipolar depression (low mood with no ‘highs’).
Bipolar depression – manic depression (mood with ‘highs’ and ‘lows’).
Cyclothymia (unstable mood with milder ‘highs’ and ‘lows’ than bipolar disorder).
The flow of a person’s life can be intensely interrupted by these disorders.
3. The Causes of Manic Depression
1-2% of the population suffers from bipolar disorder. Mood swings do not discriminate between men and women and affect individuals of all status. An episode of manic depression is likely to first arise around the age of 20-40 years. If there is a family history of mood disorder, it may occur earlier. A manic depressive will often suffer from four episodes of disorder during the first ten years.
According to the stress-vulnerability model some people are susceptible to developing a mood disorder and those ‘at risk’ are likely to develop the disorder when confronted by increased stress factors which can be environmental, emotional or physical.
A person is more likely to develop manic depression if vulnerability factors are present but these do not cause the disorder. Vulnerability factors can be biological, psychological or social/environmental. Biological factors include genetics, disturbed brain biochemistry and circadian rhythm disruption. Psychological factors play a role in the chances of having a relapse and include the different ways we think, feel, behave and cope. Social factors such as stress factors (whether physical stress or life events etc.), can leave an individual unprotected to susceptibility to an episode of mood disorder.
Treatment aims primarily to lessen symptoms, bring functioning back to its original state, and stop becoming worse after treatment. Medication and psychological support together are more effective than either alone.
Acute mania is treated with a mood stabilizer and an anti-psychotic drug or a benzodiazepine. Acute depression is treated with a mood stabilizer and an anti-depressant. Repeated episodes are lessened by long term treatment with mood stabilizers.
It may help to have supportive social contacts, be involved in a self-help group and have access to a mental health professional.
5. Understanding Your Mood Swings
There are four stages in understanding your mood swings.
To understand your past experiences construct a life chart. Draw the positive and negative y-axis of a graph with the former for high mood and the latter for depressed mood. Draw the positive x-axis and mark on it episodes of highs and lows above and below the x-axis respectively. Mark on it the ages at which the episodes occurred, life events and changes in medication.
Formulate a symptom profile to acquire understanding of your experiences during different mood swings. Make two columns, one for highs and the other for lows. For each, note your common symptoms, your less common symptoms and mark out early warning symptoms with a star.
To understand the factors which cause your mood swings to occur suddenly, compose a risk list. Consider key issues from your episodes and divide them into life events, life situations and personal actions. Next, list the high risk events, situations and activities separately.
Answer the following questions: What is the name of your problem? What makes your mood swings happen? Can you predict your episodes? How have mood swings affected your life? What can you do to control your mood swings?
This involves monitoring and regulating yourself.
Draw yourself a mood chart with the y-axis from -10 to +10 and the x-axis from 0 to 10. Mark mania at +10, a normal mood state at 0 and severe depression at -10. Label the x-axis from Monday to Sunday. Decide which moods you need to monitor and do so for each day of the week. Your normal day-to-day fluctuations could range from -2 to +2. Consider how your mood would be and what activities or behaviour you would participate in, for each rating.
For the anchor points +10, +8, +6, +4, +2, 0, -2, -4, -6, -8, -10, note the changes in mood, thinking and behaviour.
You may decide that you are hypomanic at +6 and depressed at -6. In this case you will need to take action, to avoid serious difficulties, at +3 and -3. Note your action points.
Monitor and record your daily activities on a schedule that covers 24 hours a day for 7 days a week.
Rate your activities for pleasure (P) 0-10 where 10 is a very pleasurable activity and for mastery/achievement (M) 0-10 where 10 is very high achievement.
See Program 1: Coping Strategies Counselling Advice – Planning an Activity Schedule.
From the activity schedule you may be able to detect activities that are high risk or over-stimulating. It may be that stimulating activities make you more susceptible to highs. Consider your mood and the behaviour associated with it as your mood varies.
Using three or four activity schedules decide whether they are demanding and organized or not. Develop regular routines for sleeping, eating, social activities, exercise, relaxation, and plan your schedule in advance.
See Program 1: Coping Strategies Counselling Advice – Nutrition, Exercise, Managing Your Time and Sleep Management.
Make sure that your schedule is reasonably demanding and that your daily activities are organized. Be realistic and balanced in your daily activities, avoiding excessive use of stimulants, and keeping positive experiences.
Think about how your mood, behaviour and physical state are connected. Self-regulation may lessen the chances of a minor mood shift turning into a serious mood disorder.
You need to know the limits of your coping resources so that you can adjust your activities to meet these limits (e.g. when depressed do not offer to cook single-handedly for a dinner party; or when manic or hypomanic, do not offer to chaperone the kids at a Theme Park). Lifestyle choices (e.g. where to live, where to work, whether to have children, what to do during the holidays) are larger decisions that set limits.
People with Bipolar Disorder who are perfectionists can feel frustrated when they lack energy, motivation, or concentration to realize their ideal.
For some helpful strategies:
See Program 1: Coping Strategies Counselling Advice - Competitiveness and Perfectionism, Frustration, Procrastination and Persistence.
Deal with your distress in situations you fear by exposure – FEAR (face everything and recover).
See Program 1: Coping Strategies Counselling Advice –Controlled Breathing and Relaxation Techniques, Eye Movement Technique (EMT), Mood Induction Procedure, Rational Emotive Imagery (REI), Imago Graded Exposure and In Vivo Graded Exposure.
About half of all people on long-term medication stop taking them at least once and many are uncertain about taking medication.
Reasons for not taking medication include:
Treatment issues such as insufficient knowledge about treatment.
Lifestyle issues such as chaotic lifestyles leading to forgetting to take medication.
Attitudes and beliefs such that treatment will not be of help or is not the correct approach.
Approaches to improve medication adherence include:
Knowledge – ensure that your treatment method is understandable (i.e. it fits together coherently), acceptable (i.e. the side effects are reasonable) and manageable (i.e. it is simple to remember which treatment to take).
Practical Strategies – reminding yourself to take the medication and getting others to remind you to take the medication, monitoring and regulating yourself and making a written treatment plan for the medication you plan to take; the benefits and barriers of this approach and how you might overcome these barriers.
Cognitive Strategies – be clear about the facts of your mood disorder as opposed to your personal beliefs or the views of others. TOC’s (task-orientating cognitions) are thoughts that encourage adherence. They tend to occur when you think about your goals and aims in life and you should list them as they arise so that you can use them to counter TIC’s (task-interfering cognitions) which are a form of negative automatic thoughts occurring when you are about to take medication.
Do a cost-benefit analysis listing all the advantages and disadvantages of taking medication and the advantages and disadvantages of not taking medication. Challenge negative automatic thoughts by recognizing and recording your negative automatic thoughts about taking medication. Rate the strength of your belief 0-100% and the intensity of your emotional reaction 0-100%. Review the negative thought: What is the evidence both for and against this idea? What are the pros and cons of this idea? Are there alternative ways of thinking about this situation? Respond by re-rating the credibility of your belief in your original thought and the intensity of your current emotion.
If you are unable to keep taking your medication make sure that your doctor is aware, reduce the medication slowly and monitor your symptoms while you are off medication.
8. Dealing with Depressive Episodes
Managing Depression Involves:
Comprehending detrimental behaviours such as avoidance of fulfilling activities; withdrawal from supportive social situations; procrastination – putting off doing tasks or being unable to finish them.
Those with Bipolar Disorder can be over-sensitive to rejection or criticism.
Learn to deal effectively with your inner critic.
See Program 1: Coping Strategies Counselling Advice – Improving Your Self-Image and Combating Self-Harm, Coping with the Need for Approval, Criticism, Countering Self-Criticism and Program 16: Overcoming Low Self-Esteem.
You may find it helpful to plan your day using 24 hour weekly activity schedules as described in Self-Management. Keep it simple and set realistic and balanced targets. Try to list activities you can do on your own or with others, in particular activities that are enjoyable. Include one social interaction for each of the first few days then increase to two toward the end of the week. Be specific about your planned activity and become aware of changes in your mood. If an activity does not have the desired effect, think about how you can alter it so that it is more successful next time. Acknowledge your successes by rewarding yourself for completing activities.
Improve interpersonal relationships.
See Program 1: Coping Strategies Counselling Advice – Social Skills Training, Communication Training, Negotiation Training, Troublesome Emotions and Program 13: Overcoming Destructive Relationships.
Approach tasks and problems step-by-step – list your tasks in order of difficulty then break down the easiest task into manageable steps and work your way down the list to the most complex task. For each problem, list all the alternative solutions and consider the pros and cons of each then choose the most promising solution; if it is unsuccessful move to your next choice of solution.
Improve your decision making.
See Program 1: Coping Strategies Counselling Advice – Problem-Solving.
Negative thoughts tend to occur during depression and lessen during remission. When depressed you may feel overwhelmed by the demands on you; think slowly; be unable to focus.
Identify and record your automatic thoughts – write down the situation and your automatic thought, rating the strength of your belief (0-100%) and the intensity of your emotions (0-100%). Review your automatic thought by considering and noting the evidence for and against the thought. Next, think of alternative views and note them. Re-rate the credibility of your belief (0-100%) and intensity of emotions (0-100%) for the original automatic thought. Write down an action plan or outcome.
See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.
Build your self-confidence.
See Program 1: Coping Strategies Counselling Advice – Assertiveness Training, Neuro-Linguistic Programming (NLP), Building Confidence I, Building Confidence II, Building Confidence III and Building Confidence IV.
If you cannot overcome your hopelessness you should seek additional help and support.
See Program 12: Overcoming Depression and Program 15: Overcoming Grief And Bereavement.
9. Dealing with Hypomanic and Manic Episodes
Managing Highs Involves:
Comprehending detrimental behaviour such as being easily distracted; taking risks; being impulsive and disinhibited; being irritable.
Factors that contribute to the development/worsening of mania are: medication non-compliance; sleep deprivation; over-stimulation; use of alcohol and drugs of abuse.
See Program 4: Overcoming Addiction.
Plan ahead for over-stimulating situations; you may choose to not take part; limit participation; or take time out if feeling overwhelmed.
You need to identify the changes in mood (affect), activity level (behaviour), and interest (cognition) that are precursors to mania.
When hypomanic or manic you may have heightened awareness of colours, smells, touch, sounds and taste; racing thoughts; poor concentration (easily distracted); be disorganized. Hypomania or mania can make you feel an overpowering urge to alter your life, routine or relationship; your positive thoughts may be over-optimistic.
There are two basic behavioural interventions which need to be employed before a manic episode, to be effective:
Keeping Safe – make a simple and predictable activity schedule that you can use when you are high and thus, avoid exposing yourself to risky circumstances. Avoid difficult tasks – complete each activity and have a break between each one. If you have a complex task use a step by step approach and get the support of a friend. Avoid stimulating substances and circumstances. Try to keep to your schedule and if you feel you have excess energy, disperse it by exercising in a safe place. Review your plan after a week to see if you need to include more exercise to calm and dissipate your excess energy.
Learn to relax – you could try sitting in the dark and listening to relaxing music. If you feel you cannot resist excitement, try finding safe alternatives and only expose yourself to these for half an hour a day and do calming activities afterwards. Avoid even these safe alternatives if you are becoming manic. Avoid situations involving large gatherings. If you do participate in social interaction, ensure you spread them out over the week and that your schedule is predictable. In any social situation try to sit upright in a chair controlling your breathing, before you start conversing. Talk calmly and slowly.
Maximizing Self-Control – control that which is in your power to control and delay and avoid behaviour you are unable to control. Record your ideas in a notebook and evaluate them when you are better. Others will be more convinced by your ideas if you are your normal self. Do not make any major decisions when you are high – delay these decisions till you are better by noting them in your notebook. Use the 48 Hour Delay Rule to approach situations, in particular impulsive expenditure. When you are your usual self decide on two people whose judgment you trust and turn to them for Third Party Advice when you are high.
Identify unhelpful automatic thoughts. You may: overestimate gains or underestimate losses; be overly focused on yourself; make over-optimistic predictions.
See Program 1: Coping Strategies Counselling Advice – Modifying Maladaptive Thinking.
Useful cognitive strategies for modifying these unhelpful automatic thoughts include:
Active Distraction – when you feel like acting on an idea, distract yourself actively by strongly focusing on perhaps relaxing scenes or bad outcomes of the past. You could also try repeating phrases such as ‘Stop, it’s harmful’ or ‘There’s no need to do anything now’.
See Program 1: Coping Strategies Counselling Advice – Distraction Techniques.
Considering the Pros and Cons – write your idea at the top of the page then make two columns. In one note each reason for acting on your idea and for each, note in the other column reasons for not acting on your idea. Consider how your idea might harm others and its potential for destruction and losses. Write down a conclusion and use the 48 Hour Delay Rule and Third Party Advice.
Reframing – list situations that frustrate you even when you are your usual self and avoid them when you are high. Reframe ‘should’ statements as ‘I would prefer it if…’ to reduce the intensity of your reaction. Think about the disadvantages of acting on your negative thought. If you still have control over your high you could identify, review and modify your thoughts as in:
Dealing with Depressive Episodes.
Many of your automatic thoughts may be linked to anger or irritability due to perceived criticism. When you recover from your high examine the evidence for these comments and find alternatives. Write down the situation, your angry thoughts, initial automatic thoughts and initial reaction. Note your response and decision. Rate the perceived criticism and perceived sensitivity, each 0-100%.
Get used to employing these techniques when you are your normal self and set them in action in the early stages of a manic episode as they will be hard to implement when you are high.
See Program 1: Coping Strategies Counselling Advice – Forgiveness, Program 6: Overcoming Anger, Program 8: Overcoming Anxiety, Program 22: Overcoming Stress and Program 23: Overcoming Stress At Work.
It has been observed that in patients with Bipolar Disorder, progressively fewer or less severe stressors lead to episodes of depression or mania as the illness progresses (i.e. the patient becomes sensitized to the stressors). Thus, Stress Management is crucial in maintaining good health.
Relapse Prevention includes: Identifying and recording triggers such as high-risk events or behaviour and early warning symptoms - decide how often you need to check for these. Write out an action plan – monitor, manage and medicate yourself. Set up support systems and get in touch early, with mental health services.
Summarize the above on a flashcard to have close at hand. Practise recognizing triggers and early warning symptoms, and implementing your action plan.
Looking forward with confidence requires:
Overcoming low self-esteem.
Overcoming a negative self-image.
Forming strong relationships and developing realistic life goals.
See Program 1: Coping Strategies Counselling Advice – Relapse Prevention.
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