{"id":150083,"date":"2022-09-06T15:15:41","date_gmt":"2022-09-06T19:15:41","guid":{"rendered":"https:\/\/effectsofanxiety.net\/?p=150083"},"modified":"2022-09-05T15:05:05","modified_gmt":"2022-09-05T19:05:05","slug":"a-strengths-based-approach-to-bipolar-disorder-treatment","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/150083","title":{"rendered":"A Strengths Based Approach to Bipolar Disorder Treatment"},"content":{"rendered":"<div class=\"jetpack-video-wrapper\"><iframe loading=\"lazy\" title=\"A Strengths Based Approach to Bipolar Disorder Treatment\" width=\"660\" height=\"371\" src=\"https:\/\/www.youtube.com\/embed\/uXFjn1jpB9g?feature=oembed\" frameborder=\"0\" allow=\"accelerometer; autoplay; clipboard-write; encrypted-media; gyroscope; picture-in-picture; web-share\" referrerpolicy=\"strict-origin-when-cross-origin\" allowfullscreen><\/iframe><\/div>\r\n\r\n&nbsp;\r\n\r\nthis episode was pre-recorded\r\nas part of a live continuing\u00a0\u00a0 education webinar on-demand, CEUs are\r\nstill available for this presentation\u00a0\u00a0 through all CEUs register at all\r\nCEUs comm slash counselor toolbox I’d like to welcome everybody to today’s\r\npresentation on a strengths-based biopsychosocial\u00a0\u00a0 approach to recovery from bipolar disorder\r\nso we’re going to talk a little bit about\u00a0\u00a0 what bipolar is what causes it and how to\r\nmitigate it by helping people understand their\u00a0\u00a0 own bipolar because what triggers it for John\r\nmay not trigger it for James help them identify\u00a0\u00a0 their warning signs because bipolar episodes\r\njust like depressive episodes and manic episodes\u00a0\u00a0 often don’t come from completely out of the\r\nblue if we look backward we can see where the\u00a0\u00a0 person was beginning to resume some unhealthy\r\nlifestyle habits that were making them\u00a0\u00a0 more vulnerable well look at the symptoms\r\nof depression and mania and real quickly\u00a0\u00a0 review bipolar one versus two and look at some\r\nco-occurring disorders and interventions another\u00a0\u00a0 thing I added to this presentation was a little\r\na short piece on differential diagnosis because\u00a0\u00a0 I often see people who are diagnosed either only\r\nwith bipolar when there’s also attention deficit\u00a0\u00a0 disorder present or they’re diagnosed with anxiety\r\nwhen it’s bipolar disorder so we’re going\u00a0\u00a0 to talk about how people might mistakenly diagnose\r\none for the other and how to kind of try to ferret\u00a0\u00a0 that out a little bit one way is using the online\r\nassessment measures there’s another measure\u00a0\u00a0 we’re going to talk about in here too so we care\r\nbecause uncontrolled bipolar puts people at risk\u00a0\u00a0 for suicide addiction and addiction relapse you\r\nknow even if somebody doesn’t have an addiction\u00a0\u00a0 when they are in a manic episode they can be more\r\nlikely to engage in potentially self-injurious\u00a0\u00a0 behaviors, not for self-injury but\r\njust because they’re looking for even more of a\u00a0\u00a0 rush and when they’re in a depressive episode\r\nthey can also be at risk for addictions because\u00a0\u00a0 they’re looking to feel better in some sort\r\nof the way so a lot of it we’re talking about well\u00a0\u00a0 with we’re talking about self-medication with\r\nmania we’re just talking about what they perceive\u00a0\u00a0 as something exciting and people are often in manic\r\nepisodes engage in extreme risk-taking behavior\u00a0\u00a0 we don’t want our clients to go down any of these\r\npaths so we want to be aware of what might trigger\u00a0\u00a0 it and I don’t think I talk about it anywhere\r\nelse in the presentation, it’s important to be\u00a0\u00a0 aware that for suicide when somebody is coming\r\nout of a depressive episode who somebody who’s\u00a0\u00a0 bipolar well or unipolar depression but when\r\nthey’re coming out of the depressive episode\u00a0\u00a0 and they start having more energy is actually\r\nwhen they’re at greater risk of suicide than\u00a0\u00a0 when they’re at their absolute bottom not saying\r\nthey’re safe at their absolute bottom but we don’t\u00a0\u00a0 want to get complacent when somebody starts\r\nfeeling better and assume that they’re out\u00a0\u00a0 of the woods with poorly controlled bipolar disorder\r\ncan leave people feeling hopeless and helpless\u00a0\u00a0 if they have bipolar one and they have at least\r\na full-blown manic episode but maybe more they\u00a0\u00a0 may not mind that they may because it disrupts\r\ntheir life the depressive episodes tend to be\u00a0\u00a0 when patients usually present when they’ve got\r\nbipolar disorder so we want to look at what’s\u00a0\u00a0 going on with them and help them see how the\r\nbipolar disorder disrupts their life because\u00a0\u00a0 that can go a fair way to encouraging medication\r\nand treatment compliance well controlled bipolar\u00a0\u00a0 like well-controlled addiction helps a person feel\r\nhappy optimistic motivated and energized the key\u00a0\u00a0 is helping them manage their vulnerabilities you\r\nnow take care of their body so they have\u00a0\u00a0 enough energy to do things but also make sure\r\nthat they get their medications right some of\u00a0\u00a0 the mood stabilizers can be flattened and make\r\npeople feel more exhausted and it’s important\u00a0\u00a0 it’s vital that they openly communicate with their\r\npsychiatrist or physician about the medications if\u00a0\u00a0 they are if the side effects are so significant\r\nis impairing their quality of life which means\u00a0\u00a0 they’re likely to be medication non-compliance so\r\nwe want to make sure that if they’re feeling too\u00a0\u00a0 flat that they talk it over with their medication\r\nprovider bipolar disorder is a brain disorder you\u00a0\u00a0 know sometimes with like depression we can look\r\nfor situational causes for anxiety we can look\u00a0\u00a0 for some situational causes we can look for some\r\ncognitive stuff we know in bipolar disorder something is going on in the brain that causes\r\nunusual shifts in mood energy activity levels\u00a0\u00a0 and the ability to carry out day-to-day tasks many\r\nvery successful let me go back to that so just to\u00a0\u00a0 be clear and generalized anxiety panic disorder\r\ndepression they also can have a brain organic\u00a0\u00a0 component to them but not always sometimes you\r\ncan have those from a situational cause whereas in bipolar disorder we know that there’s something\r\nthat’s not quite right with the balance of the\u00a0\u00a0 neurotransmitters for most people with bipolar\r\nokay so who has bipolar lots of people you’d be\u00a0\u00a0 surprised Mel Gibson demi Lovato Axl Rose, Britney\r\nSpears Jean-Claude Van Damme Marc Vonnegut and\u00a0\u00a0 Amy Winehouse to name just a few that I came\r\nacross you know doing some internet research\u00a0\u00a0 Lee Lee Thompson young and Robin Williams were\r\nalso, both are quite successful and revered in their\u00a0\u00a0 fields despite if you want to call it losing\r\ntheir battle with bipolar so why do I bring\u00a0\u00a0 that up because a lot of times people when they\r\nare given a diagnosis of bipolar disorder feel\u00a0\u00a0 very isolated feel very unique and I want them to\r\nrealize that there are a lot of really successful\u00a0\u00a0 awesome people who have bipolar disorder you\r\nknow it once it’s managed then people can\u00a0\u00a0 live a stereotypical life I work hard to\r\navoid the word normal because what’s normal for\u00a0\u00a0 one person may not be for another but we want\r\nto look at they can have a very high-quality active\u00a0\u00a0 life bipolar disorder is caused by imbalances and\r\nneurochemicals especially dopamine serotonin and\u00a0\u00a0 norepinephrine the imbalances could be genetic or\r\ntriggered by sex hormone changes or stress hormone\u00a0\u00a0 changes so they may be at you know steady state\r\nbut when there’s a particular stressor some sort\u00a0\u00a0 of change or you know other thing and it depends\r\non the person, it can throw those neurotransmitters\u00a0\u00a0 out of balance enough that it causes either a\r\nmanic episode hypomanic episode or a depressive\u00a0\u00a0 episode more than one in 50 adults are classified\r\nas having bipolar disorder in any 12 months so I encourage people when they’re walking around\r\nthe store when they’re walking around the grocery\u00a0\u00a0 store when they’re at church when they are sitting\r\nin a meeting at work with you know 50 other people\u00a0\u00a0 at least one person in that group has bipolar\r\ndisorder and or will be diagnosed with it in\u00a0\u00a0 the year I want them to recognize how common\r\nit is I want them to start looking around and\u00a0\u00a0 thinking when they’re driving down the road on\r\nrush-hour traffic you know every 50th car they\u00a0\u00a0 pass somebody in those 50 cars probably had\r\nbipolar disorder to help them realize again\u00a0\u00a0 it’s not us weird diagnosis is pretty\r\ndoggone common among patients seen in primary\u00a0\u00a0 care settings for depressive and\/or anxiety\r\nsymptoms twenty to thirty percent are estimated\u00a0\u00a0 to have bipolar disorder a lot of times primary\r\ncare physicians misdiagnosed bipolar disorder as\u00a0\u00a0 either generalized anxiety or unipolar depression\r\nso it’s you know eighty percent of the time\u00a0\u00a0 seventy eighty percent of the time they’re right\r\nbut the other twenty to thirty percent you’ve got\u00a0\u00a0 this person who is going to continue to struggle\r\nand get frustrated because the treatments\u00a0\u00a0 for generalized anxiety and depression are\r\ngenerally, SSRIs and SSRIs can trigger mania so it can make the mood lability worse bipolar\r\nthe disorder is still under-recognized primarily\u00a0\u00a0 due to misdiagnosis as unipolar depression and\r\nthat’s not just in primary care that’s also in\u00a0\u00a0 you know our field because if we see somebody who\r\nhas unipolar depression you know they may not have\u00a0\u00a0 had a manic episode yet likely they have but they\r\nmay not have had a manic episode yet or they may\u00a0\u00a0 not report it or if it’s a hypomanic episode they\r\nmay not note that as something problematic and yes diagnosis of mental health conditions\r\nis out of the scope for a lot of GPS and a lot\u00a0\u00a0 of them will tell you that a lot of them will say\r\nIf you’ve been diagnosed before I can help you\u00a0\u00a0 continue your medication but there are so many\r\nnuances to psychological diagnosis I want\u00a0\u00a0 you to get an evaluation from a psychiatrist in\r\norder to better make sure that we’re getting you\u00a0\u00a0 started on the right path because nothing is\r\nmore frustrating to somebody who is struggling\u00a0\u00a0 and again generally they present in a depressive\r\nepisode nobody is nothing is more troubling for\u00a0\u00a0 somebody who’s presenting and struggling then\r\ngetting on medication and not feeling like it’s\u00a0\u00a0 working is one of the things they see and I’m jumping\r\nahead of me is when somebody who has bipolar\u00a0\u00a0 disorder is started on an SSRI one effect could be\r\nto set off a manic episode another effect could be\u00a0\u00a0 to have rapid improvement and you know it\r\ntakes four to six weeks for the SSRIs to get in there but they tend to have rapid\r\nimprovement in days unfortunately that improvement\u00a0\u00a0 doesn’t last and then\u00a0 they tend to go back into\r\na depressive episode and they start to feel even\u00a0\u00a0 more defeated I want clients to understand us\r\nif they start talking about that pattern where\u00a0\u00a0 they’ve been on antidepressants and it works\r\nfor a little while but then it doesn’t anymore\u00a0\u00a0 you know that may just be the wrong medication\r\nfor them, their case is not hopeless so we know\u00a0\u00a0 the symptoms of depression apathy feeling down\r\nempty hopeless low energy decreased activity\u00a0\u00a0 sleep changes worrying difficulty concentrating\r\nforgetting things a lot of changes in eating habits\u00a0\u00a0 and feeling tired or slowed down how is this\r\ndifferent than Low Energy I’ve had clients ask\u00a0\u00a0 me this before and what I try to the way I try to\r\ndifferentiate is energy is your desire to get up\u00a0\u00a0 and do things and feel like you can when people\r\nare feeling tired or slowed down it almost feels\u00a0\u00a0 like they’ve got a 50-pound rucksack on their back\r\nor their arms and legs feel like they’re just lead\u00a0\u00a0 and it is exhausting to even get up and walk\r\nacross the room go to the kitchen go outside so\u00a0\u00a0 there’s a difference there’s energy to do things\r\nand then there’s just feeling like you’re filled\u00a0\u00a0 with cement mania people feel very up high or\r\nelated now after people come out of a depressive\u00a0\u00a0 episode even unipolar depression there’s a period\r\nof mild very very mild euphoria and we don’t want\u00a0\u00a0 to mistake that for hypomania or mania they’re\r\njust feeling good they’re like oh my gosh I see\u00a0\u00a0 the Sun again I see colors how awesome is this and\r\nthen you know it kind of levels out but you don’t\u00a0\u00a0 have a crash it’s just kind of a good and\r\nthen a-ok contentment people in a manic episode\u00a0\u00a0 have a lot of energy and increased activity levels\r\nthey often feel jumpy or wired you know like they\u00a0\u00a0 can’t settle down they want to sometimes but they\r\ncan’t they’re wide awake and they’re just looking\u00a0\u00a0 for something to do they have trouble sleeping\r\nmay talk fast about a lot of different\u00a0\u00a0 things so they’re jumping around and when we talk\r\nabout ADHD in a minute, we’re going to talk more\u00a0\u00a0 about these symptoms they may agitate irritably\r\nor touchy not everybody who’s manic is in a good\u00a0\u00a0 mood so they can be manic but agitated\r\nthey feel like their thoughts are going fast and think they can do a lot of things at\r\nonce people especially in a hypomanic episode\u00a0\u00a0 often find themselves taking on three four five\r\nsix projects and not being able to complete them\u00a0\u00a0 you know when they come out of their hypomanic\r\nIn the episode, they’re like oh my gosh what did I get\u00a0\u00a0 myself into but there’s no sense of time in a\r\nmanic or hypomanic episode and they can especially\u00a0\u00a0 in a manic episode engage in risky and reckless\r\nbehavior so mixed bipolar includes symptoms of\u00a0\u00a0 both manic and depressive symptoms at the same\r\ntime which can be confusing to clients\u00a0\u00a0 they’re up they feel like they’re wired but they\r\nhave no their flat they have apathy and just\u00a0\u00a0 that lack of pleasure and anything they may feel\r\nvery sad empty and hopeless and energized bipolar\u00a0\u00a0 one now that big difference is bipolar one has at\r\nAt least one full-blown manic episode if there hasn’t\u00a0\u00a0 been one full-blown manic episode then we’re going\r\nto look for bipolar 2 where you have hypomania and\u00a0\u00a0 major depressive disorder bipolar one can have\r\neither major depressive disorder or persistent\u00a0\u00a0 depressive disorder so the big difference is if\r\nthere’s a manic episode there they’re number one\u00a0\u00a0 bipolar one patients experienced depressive\r\nsymptoms more than three times as frequently\u00a0\u00a0 as manic or hypomanic symptoms so yeah when they\r\nhit a manic or hypomanic period it’s not a wonder\u00a0\u00a0 they feel pretty good and they don’t want it to\r\ngo away if they experienced it three times more\u00a0\u00a0 often bipolar 2 patients experience depressive\r\nsymptoms approximately hold your horses\u00a0\u00a0 39 that’s not a mistake 39 times more often than\r\nhypomanic symptoms so people with bipolar 2 can\u00a0\u00a0 have 39 depressives before a manic episode now\r\nunfortunately, the body is not that consistent\u00a0\u00a0 where we can go okay 38 39 you’re due for a manic\r\nepisode but we do know that both types of bipolar\u00a0\u00a0 depression are experienced a lot more frequently\r\nthan mania or hypomania so a common misdiagnosis is generalized anxiety disorder how do you\r\ndifferentiate because some people when they get\u00a0\u00a0 anxious get revved up and they feel\r\nlike they’re wired and they can’t sleep the\u00a0\u00a0 goal-directed activity and generalized anxiety\r\nthe disorder is often related to an anxiety theme\u00a0\u00a0 like if they think that there’s a problem with\r\ntheir finances or if they’re you know whatever\u00a0\u00a0 they’re worried about their activities and their\r\nthoughts generally race in that direction they’re\u00a0\u00a0 not all over the place they’re pretty directed in\r\nmore or less and their mood is often irritable and\u00a0\u00a0 energetic versus elated now again just because\r\nsomebody is irritable doesn’t mean it’s the anxiety\u00a0\u00a0 we want to look specifically at what is causing\r\nthe sleep disruption and what are the themes of\u00a0\u00a0 the thoughts that the person is having the racing\r\nthoughts because if you know something’s going bad\u00a0\u00a0 at work you hear there’s going to be layoffs\r\nsomebody can get anxious and go well if\u00a0\u00a0 I get laid off then I’m going to lose my job if\r\nIf I lose my job then I’m not going to be able to\u00a0\u00a0 pay the house payment and I’m dead a debt a debt\r\nit and go in this rapid cycle of catastrophe and\u00a0\u00a0 get themselves all worked up and then not sleep\r\nthen they start trying to figure out okay what I need to do to make sure I can pay\r\nthe house payment what do I need to do to make\u00a0\u00a0 sure I can do this so anxiety disorder pretty\r\nfocused ADHD approximately 60 to 70 percent of\u00a0\u00a0 people with bipolar disorder also have ADHD and\r\n20% of people with ADHD have bipolar disorder\u00a0\u00a0 so you can draw your own Venn diagram if you\r\nwant the take-home message is we don’t want to\u00a0\u00a0 assume that they’re mutually exclusive because if\r\nyou’ve got somebody with bipolar disorder you can\u00a0\u00a0 get that controlled but they’ve still got the ADHD\r\nsymptoms going on over here they’re going to feel\u00a0\u00a0 often feel frustrated now what’s the difference\r\npeople with ADHD often have a hyper focus that’s\u00a0\u00a0 one of the hallmarks this may happen on a deadline\r\npressure or when wrapped up in a compelling book\u00a0\u00a0 project or video game and so you can you can\r\nsee where there’s a trigger for it hyper focus may\u00a0\u00a0 cause a decreased need for sleep and look like\r\nincreased goal-directed activity\u00a0\u00a0 but is often short-lived in people with ADHD who\r\nfeel exhausted when the hyper-focus fades so we\u00a0\u00a0 want to look for number one was there something\r\nthat triggered this hyper-focus could be a video\u00a0\u00a0 game could be an awesome book or even\r\na Netflix marathon whatever it is and once\u00a0\u00a0 that hyper-focus faded did they feel exhausted\r\nif so we’re probably looking more towards ADHD\u00a0\u00a0 than bipolar a manic episode is independent of\r\nexternal circumstances you know it’s not where\u00a0\u00a0 somebody gets a project and it sends them into\r\nIn a manic episode, there’s a lot less control and\u00a0\u00a0 predictability in people with bipolar disorder\r\nand people with bipolar often want to go to sleep\u00a0\u00a0 or relax but describe the feeling as if they can’t\r\nwind down which can go on for a week or more so\u00a0\u00a0 we’re looking at duration we’re looking at what\r\ntriggers it if they report let’s go back to here\u00a0\u00a0 sometimes having manic episodes that there was\r\nno trigger and they lasted a long time but they\u00a0\u00a0 also report manic goal-directed activity under\r\ndeadline pressure or you know they can have all\u00a0\u00a0 these symptoms which means you’re looking at ADHD\r\nand mania or bipolar disorder together potentially\u00a0\u00a0 in ADHD people often interrupt or talk too much\r\nwithout noticing because they miss social cues\u00a0\u00a0 or because they lose focus on the threads of\r\na conversation because their minds going six\u00a0\u00a0 ways till Sunday I had a friend of mine one time\r\nwho had ADHD she was in graduate school with me\u00a0\u00a0 and she gave a presentation on it one time and we\r\nwere talking and she was presenting and as she was\u00a0\u00a0 presenting somebody started flicking the lights on\r\nand off and all of us were looking around at each\u00a0\u00a0 other going this is annoying and then a little\r\nwhile later you know 30 seconds or a minute later\u00a0\u00a0 somebody turned on the radio not loud but\r\nlow in the background and we’re all looking at\u00a0\u00a0 each other and then she started doing something\r\nelse after that oh she turned on a fan so the fan\u00a0\u00a0 was oscillating and blowing in our faces and and\r\nfinally, she’s like is this annoying and we were\u00a0\u00a0 like yeah that’s annoying it’s hard\r\nto concentrate and she said this is what life\u00a0\u00a0 is like for somebody with ADHD many times because\r\nwe have difficulty filtering out what’s important\u00a0\u00a0 to pay attention to and what’s not so we’re paying\r\nattention to everything so that made it a lot more\u00a0\u00a0 understandable to me which was helpful later when\r\nmy son was diagnosed with ADHD because you know\u00a0\u00a0 it helped me tailor his learning environment\r\nso people with ADHD kind of get lost and they’re paying attention so much that they\r\ncan miss the social cues people experiencing manic\u00a0\u00a0 bipolar episodes are often very aware that they’re\r\nchanging topics quickly and sometimes randomly but\u00a0\u00a0 they feel powerless to stop or understand they’re\r\nquickly moving thoughts so they’re just trying\u00a0\u00a0 to keep you in the loop in everything and they\r\nmay notice that you’re getting uncomfortable or\u00a0\u00a0 irritated or impatient but they don’t feel like\r\nthey can stop racing thoughts you know all these\u00a0\u00a0 kind of go together but kind of not people with\r\nADHD report racing thoughts that they can grasp\u00a0\u00a0 and appreciate but can’t necessarily express\r\nor record quickly enough think about the time you\u00a0\u00a0 got excited about something and you just\r\nhad all these ideas whenever we get a new grant\u00a0\u00a0 that comes in I’m in charge of or I used to be in\r\ncharge of writing the grant so I get the grant and\u00a0\u00a0 I’d read through and I start identifying all the\r\ndifferent things that we could do to you\u00a0\u00a0 know get this grant and it would be hard for me to\r\nkeep my pencil going fast enough to keep up with\u00a0\u00a0 my ideas and you know I don’t have an and you\r\nknow that was perfectly normal but I was excited\u00a0\u00a0 and so my mind was racing people with ADHD can do\r\nthis a lot you know not just because of a grant\u00a0\u00a0 coming in people with mania the racing thoughts\r\nflash by like a flock of birds overtaking them\u00a0\u00a0 so fast that their color and type are impossible to\r\ndiscern I loved this explanation because it’s just like you have this whole massive bird coming\r\nin and then going out and you didn’t have a chance\u00a0\u00a0 to even notice what they were people with with\r\nmania often feels that way they don’t can’t grab\u00a0\u00a0 any of those thoughts and hook on to them they’re\r\njust in and out so helping people differentiate to make sure that if they’ve got anxiety and bipolar\r\nif they’ve got anxiety and ADHD and bipolar bless\u00a0\u00a0 their hearts that were attending to all of their\r\npresenting symptoms and issues so what do they do\u00a0\u00a0 to treat bipolar well we’re going to get down into\r\nthat in a minute sorry got ahead of myself things\u00a0\u00a0 that can trigger a bipolar episode medications\r\nantidepressants as I said can propel a patient\u00a0\u00a0 into mania captopril which is an ACE inhibitor\r\nsomething that’s used for high blood pressure can\u00a0\u00a0 also trigger a bipolar episode corticosteroids\r\ncertain immunosuppressant medications levodopa\u00a0\u00a0 which increases dopamine you may see patients\r\nwith schizophrenia or Parkinson’s taking web\u00a0\u00a0 dopa and methylphenidate or dexmethylphenidate\r\nwhich are ADHD medications all of these different\u00a0\u00a0 categories of medications can potentially trigger\r\na bipolar so do they trigger it in every single\u00a0\u00a0 person no so that makes it even more difficult\r\nbut it is important to be aware if somebody has\u00a0\u00a0 bipolar when they start taking medications\r\nthat they need to be conscious and cognizant of\u00a0\u00a0 their symptoms so they can you know identify\r\nearly onset of a depressive or a manic episode\u00a0\u00a0 circadian rhythm desynchronization can trigger\r\nor look like bipolar disorder hyperthyroidism can\u00a0\u00a0 look like a manic episode that means too much\r\nthyroid you know a lot of times we talk about\u00a0\u00a0 hypothyroidism and depression hyperthyroidism\r\ngets people to revved in children mania can be\u00a0\u00a0 misdiagnosed or look like oppositional defiant\r\ndisorder and substance use both intoxication and\u00a0\u00a0 withdrawal but more specifically intoxication can\r\nalso, look like mania or depression depending on\u00a0\u00a0 whether they’re taking stimulants or depressants\r\nso it’s important to make sure that the person\u00a0\u00a0 when they’re being assessed is substance-free\r\nDo you know what medications they’re on they’ve\u00a0\u00a0 had a physical to rule out any hormone causes\r\nthe thyroid is a hormone and looks at their circadian\u00a0\u00a0 rhythms if they happen to be visually impaired\r\nthat can cause problems in circadian rhythm if\u00a0\u00a0 they are shift workers that can cause problems\r\nwith circadian rhythm so let’s make sure we don’t\u00a0\u00a0 label something as bipolar and start treating\r\nas such before we’ve ruled out everything else bipolar distinguishing factors and let’s see\r\nlet me see if I can get that open for me right\u00a0\u00a0 now well anyway spontaneous hypomania premorbid\r\naffective temperament particularly hyper thymic\u00a0\u00a0 or cyclothymic so before somebody had an episode\r\nthat they presented with do they have a history\u00a0\u00a0 of remembering dysthymic is feeling blue\r\nlow unhappy hyper thymic is more elated and\u00a0\u00a0 cyclothymic is rapidly switching Moodle ability\r\nincreased mental or physical energy even during\u00a0\u00a0 depressions family you know you know\r\nwe talked about the mixed episode if there’s a\u00a0\u00a0 family history of bipolar disorder or a good\r\nresponse to lithium for unipolar depression\u00a0\u00a0 or bipolar that’s a risk factor or a hallmark\r\nthat you might be dealing with bipolar in this\u00a0\u00a0 client if they have treatment-emergent hypomania\r\nmania or mixed States so as soon as they start\u00a0\u00a0 medication treatment generally SSRIs they have\r\nan uncharacteristically rapid response followed\u00a0\u00a0 by a crash again and or they have more than two\r\nfailures on antidepressants now we want to look at what that means because antidepressants work\r\ndifferently for different people, somebody can be\u00a0\u00a0 on and I’m going to use the trade names here just\r\nbecause I don’t have all of the generics memorized\u00a0\u00a0 I’m not promoting any particular trade name but\r\npeople could be on Lexapro or Paxil and feel like\u00a0\u00a0 they can’t wake up people can be on Prozac and\r\nfeel like they’ve got more energy some people are\u00a0\u00a0 on Zoloft and don’t feel any energy change some\r\npeople feel lousy but with antidepressants, we want\u00a0\u00a0 to look at what failure means did it fail to\r\nimprove the mood or were the side effects so bad\u00a0\u00a0 that the person had to switch if this if it was\r\nthe side effects that are not classified\u00a0\u00a0 as a failure because the person wasn’t able to\r\nstay on it long enough for that antidepressant\u00a0\u00a0 to get in their system now I do want\r\nyou to see the mood disorders questionnaire, haha and that’s in this article here but there\r\nare three all of these questions that you can\u00a0\u00a0 have people just complete at assessment and\r\nit helps you identify if they’ve had a manic\u00a0\u00a0 or hypomanic episode so have there ever been\r\na period of time when you are not your usual\u00a0\u00a0 self and you felt so good or hyper that people\r\nthought you are not the normal self you were so\u00a0\u00a0 irritable that you shouted at people or started\r\nfights you felt much more self-confident than\u00a0\u00a0 usual you got less sleep than usual and found\r\nyou didn’t miss it you were much more\u00a0\u00a0 interested in sex than usual spending money got\r\nyou or your family in trouble you know you can\u00a0\u00a0 go through all the rest of the questions and they\r\nidentify yes or no to each of these once they do\u00a0\u00a0 that if they did check yes to more than one of the\r\nabove have they ever happened during the same period if yes then again we’re probably looking\r\nat one of the bipolar and finally how much of a\u00a0\u00a0 problem did any of these cause for you and if it’s\r\na minor problem then we may want to look for other\u00a0\u00a0 things this does not diagnose bipolar but it is an\r\nexcellent screening instrument to give you an idea\u00a0\u00a0 about whether you need to look in that direction\r\nhave clients keep a life chart ideally for three\u00a0\u00a0 to six months where they chart their sleep their\r\ndietary habits their exercise their life stressors\u00a0\u00a0 hormones for women and any bipolar symptoms that\r\nthey’re having now when I have clients chart this\u00a0\u00a0 much I create a really simple fill in the blank\r\na chart like for sleep number of hours did you\u00a0\u00a0 feel rested yes or no dietary habits I have them\r\nkeep on their mobile device for exercise did you\u00a0\u00a0 exercise yes or no if so how much for how long you\r\nknow really simple things so they can complete the\u00a0\u00a0 chart in under five minutes otherwise, they’re\r\nnot going to do it for the bipolar symptoms I\u00a0\u00a0 have check blocks you know did you feel depressed\r\ndid you have difficulty sleeping yada-yada so\u00a0\u00a0 it’s easy it’s very very simple for them to fill\r\nout and it’s also simple for me to evaluate when\u00a0\u00a0 I go through it encourages people to understand\r\ntheir bipolar because everybody’s presentation\u00a0\u00a0 is going to be a little bit different have them\r\nidentify you know their cognitive patterns and negative thinking patterns that contribute to\r\ntheir depression and if so how do they handle\u00a0\u00a0 those in the past when they felt depressed how did\r\nthey change their thinking or what they do to\u00a0\u00a0 help themself be a little bit more optimistic and\r\nalso looking cognitively what if they got going\u00a0\u00a0 for them are they intelligent are they creative\r\nare they you know build on those if somebody is\u00a0\u00a0 creative you know I’m not so I it’s wonderful\r\nto see creative people but for somebody who’s creating one of the greatest things they can do\r\nto work with their depression is art therapy you\u00a0\u00a0 know it’s very therapeutic for a lot of people\r\nso find their strengths and use those to help\u00a0\u00a0 them resolve their current presenting symptoms\r\nphysically encourage them to get adequate sleep to avoid opiate and sedative medications alcohol and\r\nany sort of over-the-counter herbs including Jen\u00a0\u00a0 Singh Sant Sami 5htp without talking to their\r\nthe doctor first encourages them to eat a good diet\u00a0\u00a0 they may already be doing some of this so how much\r\nthey change at one time it is gonna vary between\u00a0\u00a0 the person and what they’re motivated to change\r\nremind them not to change too much at once let’s\u00a0\u00a0 just do one or two things right now and then you\r\ncan work on two more things once you have those\u00a0\u00a0 under underway situationally have them do\r\na coping skills inventory to figure out how they cope when things get stressful and have them\r\nidentify triggers for their bipolar that what\u00a0\u00a0 types of situations make you feel depressed what\r\ntypes of situations have you noticed might seem\u00a0\u00a0 to trigger a manic episode some people when they\r\nget stressed about something there’s that\u00a0\u00a0 anxiety it can the stress of that and having the\r\nHPA axis activated can trigger a manic episode for\u00a0\u00a0 them so encourage them to you know in their chart\r\nthey’re going to be keeping track of what might be\u00a0\u00a0 contributing to triggering and mitigating bipolar\r\nsymptoms so if they’re getting good sleep and eating\u00a0\u00a0 a decent diet their life stressors are pretty\r\nlow and they’re not having any symptoms well we\u00a0\u00a0 know what they can do interpersonally have them\r\nidentify supportive friends to help them learn about\u00a0\u00a0 interpersonal behaviors that trigger them and ways\r\nto deal with those interpersonal behaviors so if\u00a0\u00a0 when somebody tends to be in a manic episode or\r\neven in a depressive episode if they tend to be\u00a0\u00a0 irritable think about having them look at what\r\nbehaviors trigger their irritability trigger\u00a0\u00a0 their anger and figure out a plan to deal with\r\nit to minimize the impact that being on\u00a0\u00a0 one end of the spectrum or the other mood wise\r\nmight have on their relationships angers normal\u00a0\u00a0 irritability is normal don’t get me wrong but when\r\nsomebody is in a depressive episode or a manic\u00a0\u00a0 episode that irritability can be intensified\r\ntenfold and people may be taken aback by it\u00a0\u00a0 environmentally encourage clients to look around\r\ntheir environments and look at what they can do to\u00a0\u00a0 make their environment cheerful calm and safe you\r\nknow what that looks like for that particular\u00a0\u00a0 person those are things that they can do because\r\nit’s you know when you felt calm and safe before\u00a0\u00a0 what was different or what was the same what helps\r\nyou feel cheerful we just recently had the inside\u00a0\u00a0 of the house repainted because it was time but\r\nI’ve always felt more cheerful, especially during\u00a0\u00a0 the winter and when there’s less sunlight when I\r\nhave like a light yellow color on the walls like\u00a0\u00a0 straw not bright yellow and that helps me feel\r\na little bit more cheerful which is in contrast to\u00a0\u00a0 all the black that I put in there but whatever it\r\nworks for me and that’s how I feel comfortable in\u00a0\u00a0 my environment to encourage clients especially\r\nyou know when they’re feeling like they’re\u00a0\u00a0 heading toward a depressive or manic episode\r\nto eliminate negativity from social media and television media you know if it stresses them out\r\nto watch the news do they have to watch the news\u00a0\u00a0 you know what will happen if they go for a month\r\nwithout watching the news and in their real-life environment encourage them to try to eliminate\r\nas much negativity as possible and that can\u00a0\u00a0 be altering how they deal with interpersonal\r\nrelationships that can be looking around and\u00a0\u00a0 finding things that stress them out and addressing\r\nthere are a lot of different things but we\u00a0\u00a0 want to look at it as biopsychosocial II Romania\r\nwe still want to build on strengths and encourage\u00a0\u00a0 them to become aware of any medications they’re\r\ntaking and how those medications affect them this\u00a0\u00a0 can include stimulants thyroid medications, Sammy\r\nand 5htp encourage them to avoid stimulants when\u00a0\u00a0 possible and don’t combine them with caffeine\r\nif they put ephedra for example in combination\u00a0\u00a0 with caffeine that used to be a common\r\ncombination in pre-workout supplements that can get somebody revved up and so we want\r\nto make sure that they’re aware of the effect\u00a0\u00a0 not only on their body but the likelihood\r\nthat could also trigger a mood episode have them identify warning signs and\r\ninterventions sometimes like I said\u00a0\u00a0 that for people with bipolar disorder the\r\ndepression and\/or manic episode may seem\u00a0\u00a0 like it comes out of the blue and sometimes\r\nit may but 99% of the time when I’ve traced it\u00a0\u00a0 back with clients they weren’t taking good\r\ncare of themselves they were either taking\u00a0\u00a0 on too much at work or they weren’t getting\r\nenough sleep or they weren’t eating well or\u00a0\u00a0 you know there had been something that had\r\nchanged from when they were doing well and\u00a0\u00a0 they felt good too when they started feeling\r\nlike they were heading down towards an episode some patients may try to identify triggers for\r\nmanic episodes to increase those we\u00a0\u00a0 want to encourage them not to do that because\r\nthat’s like driving your car with the RPMs up\u00a0\u00a0 at five indefinitely that’s not good for your\r\nthe car eventually something Bad’s gonna happen\u00a0\u00a0 so we don’t want them to read themselves up that\r\nmuch we need to help them find that happy medium\u00a0\u00a0 where they’re content there are three or four\r\non a scale of 1 to 5 and they’re feeling good\u00a0\u00a0 for some clients when they start feeling depressed\r\nthey notice thinking changes and have difficulty\u00a0\u00a0 concentrating this is a warning sign you know they\r\nmay not feel completely depressed yet but they may\u00a0\u00a0 be waking up in the morning going yeah not so sure\r\nI want to get out of it they may have low energy\u00a0\u00a0 changes in sleeping or eating irritability\r\nsadness negativity resentment withdrawal and\u00a0\u00a0 environmentally they may notice that they’re in\r\nthe area becomes more disorganized or they may just\u00a0\u00a0 not be caring as much about personal hygiene as these\r\nare all things that they can identify early on and\u00a0\u00a0 say huh you know it looks like maybe I need to\r\ntake a little bit better care of myself and it’s\u00a0\u00a0 hard for clients it’s hard for a lot of us to\r\nlisten to our body and go okay I wanted\u00a0\u00a0 to do XYZ but my body is telling me that maybe I\r\nneed to rest for mania warning signs can include\u00a0\u00a0 racing thoughts heightened creativity that’s\r\none that for people to be aware of especially\u00a0\u00a0 if you’re dealing with somebody who’s naturally\r\ncreative they may thrive during this period of\u00a0\u00a0 heightened creativity and get upset when\r\nyou start suggesting that they may need to temper\u00a0\u00a0 that to stabilize their mood they’re\r\ngonna have to cut the top off the highs and raise\u00a0\u00a0 the bottom on the lows physically they may have\r\ndifficulty sleeping or sitting still maybe may\u00a0\u00a0 feel elated excited irritable or thrill-seeking\r\nyou may have some anger outbursts frustration\u00a0\u00a0 with others and environmentally what I’ve seen\r\nwith patients especially with full-blown mania, it varies on what they do sometimes they are\r\ncleaning like crazy and other times it looks like\u00a0\u00a0 a whirlwind absolutely hit the room but so it’s\r\nusually extreme so treatment compliance we want\u00a0\u00a0 to encourage clients to do a decisional balance\r\nback exercise and I broke it down so it’s shorter\u00a0\u00a0 what are the benefits of eliminating depressive\r\nepisodes if the person was no longer depressed how\u00a0\u00a0 would they feel emotionally mentally physically\r\nand how would it impact their family and friends\u00a0\u00a0 a lot of times that this one’s easy to fill out\r\nthe drawbacks to eliminating depression are this can\u00a0\u00a0 be harder to fill out because they’re like well\r\nI’ll see any drawbacks okay we can leave that\u00a0\u00a0 for now sometimes patients come to the awareness\r\nthat if they’re no longer depressed they may not\u00a0\u00a0 get as much attention and people may expect more\r\nof them which is anxiety provoking but this\u00a0\u00a0 area usually doesn’t have a whole bunch of stuff\r\nin it and then we want to ask them what are the\u00a0\u00a0 benefits of eliminating the mania emotionally\r\nmentally physically and socially this one’s a\u00a0\u00a0 little harder not as hard as the drawbacks to\r\neliminating depression a lot of times clients\u00a0\u00a0 can see the benefits of eliminating the manic\r\nepisodes because they don’t have the periods I\u00a0\u00a0 mean they have the highs and those are awesome\r\nbut they don’t have the periods where they have\u00a0\u00a0 the lows and they don’t feel like they can do as\r\nmuch they don’t have the loss of time they don’t\u00a0\u00a0 kind of come out of it and realize that they’re\r\ncompletely overwhelmed because when they were in\u00a0\u00a0 the manic episode they took on 17 things so there\r\nare a lot of things that clients may identify as\u00a0\u00a0 benefits to eliminating the mania but we also\r\nwant to talk about the drawbacks to eliminating\u00a0\u00a0 it because like I said for some people that’s\r\nwhen they’re their most creative and if they’re\u00a0\u00a0 a writer or an artist or a musician this may be\r\nthe time when they are feeling like they’re uber\u00a0\u00a0 selves so they don’t want to get rid of it and\r\nit’s terrifying to them to think that they might\u00a0\u00a0 not be able to tap into what we can talk about\r\nways to tap into their creativity when they’re\u00a0\u00a0 not manic and you know there are techniques that\r\nthey can use it to get that focus that they\u00a0\u00a0 so desire but it depends on the person exactly\r\nwhat you’re going to use if we don’t address\u00a0\u00a0 all of these concerns about eliminating their\r\nmania treatment compliance is going to be lower\u00a0\u00a0 because people will just they’ll miss it they’ll\r\nmiss it a lot and they’ll want to feel that high again so general techniques in clot ask\r\nclients how do you deal with it up until now when\u00a0\u00a0 you felt depressed what have you done this helped\r\nyou feel better even for 10 minutes or an hour or\u00a0\u00a0 half a day you know maybe it didn’t work the whole\r\ntime but or it helped you feel instead of feeling\u00a0\u00a0 just devastated you felt sad you know it helps\r\nyou feel a little bit less intensely depressed\u00a0\u00a0 build on that ask them what they’re willing to do\r\nsome clients are gonna look at you and go no I’m\u00a0\u00a0 not gonna do that keep your\r\njournal no not gonna do that okay so what are you\u00a0\u00a0 willing to do I tell my clients a lot of times I’m\r\ngonna suggest things that you may not think fit\u00a0\u00a0 for you or work for you or you’re not going to do\r\nwell I’d rather you tell me number one that you’re\u00a0\u00a0 not going to do it and what I’m more\r\nconcerned about is what you’re gonna do instead if\u00a0\u00a0 you don’t want to keep the journal okay how are\r\nwe going to be able to notice changes and find\u00a0\u00a0 connections between your eating your sleeping your\r\nstress levels and your mood episodes you know\u00a0\u00a0 help me let’s figure out a way that we can we can\r\ndo this and they may come up with something you\u00a0\u00a0 know I state what it is that I want to\r\ndo or accomplish and why it’s important and I\u00a0\u00a0 say is there another way we can accomplish this\r\nwhen I work with clients and recovery sometimes\u00a0\u00a0 they don’t want to go to 12-step meetings okay\r\nif you’re not going to go then what are you gonna\u00a0\u00a0 do instead because you need to have some social\r\nsupport you need to have something to do besides sitting alone in your apartment from the time you get\r\noff work until the time you go to work the next\u00a0\u00a0 day because that’s a dangerous period encourage\r\nclients emotionally to practice mindfulness\u00a0\u00a0 because it does prevent episodes from sneaking up\r\nif they start feeling run down or tired or off you\u00a0\u00a0 know sometimes I hear that word I just feel off\r\nokay that’s when you need to stop and check in\u00a0\u00a0 with yourself and go what’s going on how do I feel\r\nwhat do I need and mindfulness also encourages\u00a0\u00a0 behaviors that prevent vulnerabilities when people\r\ncheck in with themselves they may say you know\u00a0\u00a0 what I’m really tired today I need to rest and\r\nthat’s a good thing because it keeps them from\u00a0\u00a0 becoming vulnerable and potentially triggering\r\nan episode of stress reduction encourages clients\u00a0\u00a0 to identify and eliminate or mitigate stressors\r\nso what stressors do you have and they can write\u00a0\u00a0 them down on the list they can a lot of times if\r\nI’m doing an individual I’ll have somebody write\u00a0\u00a0 down on our big whiteboard all of their stressors\r\nand then we go through on one by one and say okay\u00a0\u00a0 can this one be eliminated if so how and the\r\nthe client will start making a plan for how they’re\u00a0\u00a0 going to start eliminating stressors if there’s a\r\na stressor that can’t be eliminated maybe they don’t\u00a0\u00a0 get along with their in-laws and periodically\r\nthe in-laws come to visit or whatever okay well\u00a0\u00a0 you can’t eliminate that so how are you going\r\nto mitigate that stressor before your in-laws\u00a0\u00a0 come what can you do or may it be less stressful\r\nif you go to their house instead of them coming\u00a0\u00a0 to yours so we talk about different things we talk\r\nabout time management because in those manic and\u00a0\u00a0 hypomanic episodes people can take on too much and\r\nthen they feel a little overwhelmed when they’re\u00a0\u00a0 steady-state and they feel overwhelmed\r\nif they’re in a depressive episode I do want to\u00a0\u00a0 point out and I think most of us know this person\r\ndon’t usually cycle from a manic to a depressive\u00a0\u00a0 to a manic like that they can have a depressive\r\nepisode and then be asymptomatic for anything for\u00a0\u00a0 months and then have another depressive episode\r\nor a manic episode so it’s important to recognize\u00a0\u00a0 that most people who are bipolar don’t rapidly\r\ncycle and there are periods of remission or symptomatology in between cognitive processing\r\ntherapy can also help people mitigate stressors\u00a0\u00a0 when they start feeling overwhelmed encouraging\r\nthem to identify what thoughts they’re having\u00a0\u00a0 that are contributing to them feeling stressed\r\nor overwhelmed and then looking for the facts\u00a0\u00a0 for and against that thought if they’re feeling\r\nlike they’ve got too much to do what are the\u00a0\u00a0 facts for it what are the facts against it if\r\nthey do have too much to do then they need to\u00a0\u00a0 figure out how to address it but this helps keep\r\npeople from getting stuck in emotional reasoning\u00a0\u00a0 where every time they feel stressed or they feel\r\ndepressed or they feel anxious they think there’s\u00a0\u00a0 something to be dysphoric about encourage people\r\nto identify their anger management triggers they\u00a0\u00a0 differ for everyone they need to develop a plan\r\nfor de-escalation and begin addressing their anger\u00a0\u00a0 triggers to maintain control of their energy\r\nthey need to identify if driving in heavy traffic\u00a0\u00a0 stresses you out and makes you irritable and angry\r\nwell ok how can you address those triggers maybe\u00a0\u00a0 driving a different way or maybe putting on your\r\nfavorite music loud in the car or whatever\u00a0\u00a0 it is that you can do to mitigate that anger anger\r\ntakes a lot of energy everybody everybody’s energy\u00a0\u00a0 is precious but people with bipolar disorder\r\nstress and excess energy drain can potentially\u00a0\u00a0 trigger an episode so we want to help them\r\nconserve their energy so yeah they’re gonna\u00a0\u00a0 get angry about some stuff but help them identify\r\nwhat’s worth getting angry about and using their\u00a0\u00a0 anger energy for and how to deal with the\r\nrest of it so they have more energy to enjoy the life\u00a0\u00a0 we’ve been talking about the negatives but let’s\r\nlook at the positive they need to infuse happiness\u00a0\u00a0 have them make a list of what makes them happy and\r\ndo more of it or be around it more encourage them\u00a0\u00a0 to schedule a belly laugh every day and there are\r\nReddit forums there are YouTube videos there are\u00a0\u00a0 places they can go to get a good old belly laugh\r\nbut it helps release endorphins and release some\u00a0\u00a0 of the calming neurotransmitters that have them keep\r\na good things silver lining or gratitude journal\u00a0\u00a0 and it doesn’t have to be prose you can have them\r\nidentify at the end of the day three things three\u00a0\u00a0 good things that happen that day or three things\r\nthey’re grateful for or when things go bad they\u00a0\u00a0 say I got demoted at my job today alright well\r\nwhat’s the silver lining to that you didn’t get\u00a0\u00a0 fired and maybe have less responsibility now I\r\ndon’t know but there are different ways you can\u00a0\u00a0 approach it but encouraging people to be cognizant\r\nand try to embrace the dialectics there’s going to\u00a0\u00a0 be bad in life but help them focus on the good to\r\nreduce dysphoria mentally address cognitive errors\u00a0\u00a0 all Arnon thinking focusing on only the positive\r\nor negative using feelings as facts and focusing\u00a0\u00a0 only on a small piece when something happens maybe\r\nyou turned in a group project and your boss sent\u00a0\u00a0 it back and said uh no try again some people will\r\ntake it very personally and focus only on the fact\u00a0\u00a0 that the boss sent it back with feedback instead\r\nokay it wasn’t just me participating in this\u00a0\u00a0 project so you know all of us need to contribute\r\nto it again and you know yes it was given back to\u00a0\u00a0 us but we get a second opportunity so it’s looking\r\nat a bigger piece of the puzzle encourage clients\u00a0\u00a0 to develop their self-esteem and view failures\r\nas lessons applaud courage and creativity\u00a0\u00a0 and nurture their inner child I have an inner\r\nthe child my inner child comes out a lot more than\u00a0\u00a0 some people would like to admit or really\r\nlike to see but that’s okay you know on Saturday\u00a0\u00a0 morning it is not uncommon for me to be watching\r\ncartoons in the living room my kids are teenagers\u00a0\u00a0 I can’t say I’m watching it with them anymore I\r\nlike Yogi Bear I’m sorry I’m weird that way but\u00a0\u00a0 you know sometimes at the end of a long week of\r\nbeing serious and everything I just kind of need\u00a0\u00a0 to regress for you know half an hour two hours no\r\nencourage people to nurture their inner child and\u00a0\u00a0 don’t be afraid to be silly don’t be afraid to\r\nlaugh or do something goofy physically increase\u00a0\u00a0 clients to exercise class to increase exercise\r\nit increases serotonin levels reduces stress\u00a0\u00a0 helps balance hormones and neurochemicals and\r\nmay combat some medication side effects exercise\u00a0\u00a0 is anything that moves the body gardening cleaning\r\ngoing to the gym of course walking the dog playing\u00a0\u00a0 soccer with the kid anything like that so what\r\nis it that they like to do or at least they’re\u00a0\u00a0 willing to do nutrition provides the building\r\nblocks for the neurochemicals so people need\u00a0\u00a0 to have quality proteins and a nutritionist\r\nA friend of mine suggested always try to have\u00a0\u00a0 three colors on your plate at every meal and use\r\na salad plate that is smaller instead of a dinner\u00a0\u00a0 plate because it tricks your brain into thinking\r\nthat you’re getting more food as Americans we tend\u00a0\u00a0 to eat way more than we need and try\r\nto avoid mindless or comfort eating when people\u00a0\u00a0 start comfort eating a lot of times they’re not\r\nbeing mindful they’re eating to deal with stress\u00a0\u00a0 instead of acknowledging the stress and dealing\r\nwith it so yeah they’re infusing themselves with\u00a0\u00a0 carbohydrates and fats and getting the serotonin\r\nand dopamine flowing but when all that goes away\u00a0\u00a0 whatever was causing the stress is probably\r\nstill there so they’re either gonna have to\u00a0\u00a0 stress eat again or deal with it so encouraging\r\npeople to be mindful of their eating sleep\u00a0\u00a0 helps the body repair and rebalance and sleep\r\ndeprivation is known to trigger both manic and\u00a0\u00a0 depressive episodes too much sleep or sleeping\r\nat the wrong times can also mess up circadian\u00a0\u00a0 rhythms so keeping naps to a minimum of 45 minutes\r\none time a day, if the person has to take a nap, is\u00a0\u00a0 important so they don’t get into that deep\r\nsleep and preferably try to avoid naps for most of a 15-minute power nap where you’re\r\nclosing your eyes and you don’t ever completely\u00a0\u00a0 drift off has been shown to increase focus in\r\nthe afternoon but naps where you’re laying down\u00a0\u00a0 and getting under the covers tend to mess\r\nup circadian rhythms, if people are on medication\u00a0\u00a0 for their bipolar which they probably will be\r\nhave them work with their doctor to adjust the\u00a0\u00a0 dosages and dosage times to fit their schedule so\r\nif they have a medication that makes them feel sleepy maybe they take it right before\r\ndinner so it’s worn off completely by the time\u00a0\u00a0 they get up in the morning and it’ll be up to the\r\nperson to work with their doctor I had one client\u00a0\u00a0 who took Seroquel and she ended up having to take\r\nit at 2:00 in the afternoon for it to be\u00a0\u00a0 out of her system enough where she felt alert\r\nwhen she woke up at 6 o’clock the next morning\u00a0\u00a0 so it’s gonna differ for different clients again\r\nencourage them to discuss any negative medication\u00a0\u00a0 side effects with their doctor and not to expect\r\na pill to do everything you know the pill can help\u00a0\u00a0 stabilize the moods but if you’re taking this pill\r\nbut then you’re still you know pulling the rug out\u00a0\u00a0 from under it by not sleeping and using cocaine or\r\nor whatever it’s likely the pill is just not going\u00a0\u00a0 to be able to do it all interpersonally support\r\ngroups are really helpful to chat rooms if the person\u00a0\u00a0 is either in a rural area working shift work can’t\r\nget to an appropriate support group not all\u00a0\u00a0 communities have support groups that are embracing\r\nof all different types of people so it’s important\u00a0\u00a0 to recognize that even though there may be a support\r\ngroup the person that you’re working with may not\u00a0\u00a0 feel comfortable with the people that are in that\r\nthe particular group so chat rooms can be helpful in\u00a0\u00a0 the know family and friends and I say in the know\r\nthese are people who have to understand or have to\u00a0\u00a0 know that the person has bipolar disorder and be\r\naware of their warning signs trigger their\u00a0\u00a0 symptoms which helps so they can be supportive\r\nand facilitative environmental clients can\u00a0\u00a0 explore things that improve their environment\r\ndifferent pictures a temperature can also be\u00a0\u00a0 a big thing if you’re too cold or too hot it can\r\nmake people irritable certain essential oils can\u00a0\u00a0 help increase energy such as peppermint rosemary\r\nor lemon calming essential oils if somebody tends\u00a0\u00a0 to have some anxiety going on lavender chamomile\r\nvalerian Valerians kind of they say woody some\u00a0\u00a0 people think it stinks to high heaven some people\r\nlove it catnip is the same way yes stuff you use\u00a0\u00a0 for your cats you can get it in essential oil\r\nand it’s a sedative type essential oil\u00a0\u00a0 for humans bergamot it’s a pretty mild smell\r\nrose is helpful rose geranium is a little bit\u00a0\u00a0 less expensive and frankincense is all supposed\r\nto help with calming so he’s hypomanic having\u00a0\u00a0 difficulty winding down anxious whatever some of\r\nthese may help memory triggering include ginger\u00a0\u00a0 cloves cinnamon orange and jasmine which works for\r\none person is not necessarily going to work for\u00a0\u00a0 another I mean there are studies out there that\r\nshow certain essential oils have effectiveness at\u00a0\u00a0 anxiety reduction and depression improvement but\r\nit’s going to be up to that person and I\u00a0\u00a0 found that when a person smells something if it\r\nsmells noxious to them then it’s probably not\u00a0\u00a0 something that they need if they smell valerian\r\nand they’re like oh my gosh that stinks okay\u00a0\u00a0 that’s not triggering what their brain needs their\r\nthe brain knows what it needs I do the same thing with\u00a0\u00a0 my rescue animals you know I let them take a\r\na good whiff of it and if they like it they’ll\u00a0\u00a0 stick around and they’ll sniff it some more if\r\nit’s not what they need then they’ll go somewhere\u00a0\u00a0 else I tried fur for our donkeys when we first\r\ngot them into rescue I tried lavender because I\u00a0\u00a0 thought you know that’ll help them calm down they\r\nhated it they liked valerian so I learned that for\u00a0\u00a0 them they preferred that particular\r\nessential oil for whatever way it works in the\u00a0\u00a0 brain and encourage clients to visit a store that\r\nsells essential oils because they have testers and\u00a0\u00a0 they can sniff them to see which ones work for\r\nthey and essential oils also smell different\u00a0\u00a0 from different manufacturers so it’s important\r\nagain for them to figure out places that they can\u00a0\u00a0 get their essential oils and try to stick with\r\nthe same company once they find one that works organization can help another thing that’s\r\nimportant for people with Bipolar is to\u00a0\u00a0 manage impulse items when they go into a manic or\r\nhypomanic episode especially and they’re prone to\u00a0\u00a0 engage in risk-taking behavior or less restrained\r\nbehavior car keys need to be somewhere where maybe\u00a0\u00a0 they can’t access them if they’re known to go out\r\nand drag race or you know drive 100 miles an hour\u00a0\u00a0 just to see how it feels credit cards that’s a\r\nbig one credit cards need to be somewhere some\u00a0\u00a0 of my clients will freeze their credit cards in\r\na block of ice so they can’t get to them and they\u00a0\u00a0 can’t see the numbers to read them and\r\nput them in on the phone this can help prevent unrestrained spending, especially at 2:00 a.m.\r\nor something when the infomercials are on porn\u00a0\u00a0 sites if the client happens to have an attraction\r\nto porn sites having those blocked because it’s\u00a0\u00a0 really easy to get sucked into that same thing\r\nwith video games and alcohol and other drugs\u00a0\u00a0 alcohol a lot of people have in their house so\r\nif this is a dangerous impulse item for somebody make sure they have it locked up somewhere so if\r\nthey do and have a hypomanic or manic episode they\u00a0\u00a0 can’t drink the same thing with certain medications\r\nespecially the benzos and the opiates if you can\u00a0\u00a0 keep it locked up somewhere all the better and\r\nduring the day keep it light and bright try not\u00a0\u00a0 to be in an office where it’s dark\r\nsome people can’t help it I mean if you’re a nurse\u00a0\u00a0 and you’re working in the neonatal intensive\r\ncare unit it’s going to be dark most of the\u00a0\u00a0 time and there’s nothing you can do about that\r\nbut if you can help it keep the lights on if you\u00a0\u00a0 don’t like fluorescent lights get lots of stand up\r\nlights that you can put around to keep it bright\u00a0\u00a0 so your brain knows that it’s time to be awake\r\nco-occurring disorders depression can co-occur\u00a0\u00a0 with bipolar I mean you can have part\r\nof bipolar is depression so when somebody is in depressive episode suicidality high-risk and\r\naddictive behaviors and self-medication we want\u00a0\u00a0 to shout for it just like we would for unipolar\r\ndepression with mania we want to help the person\u00a0\u00a0 become aware and look out for explosive anger\r\nwhich can get them into legal trouble relationship\u00a0\u00a0 issues etc heightened libido which also can get\r\nthem into legal trouble and relationship issues\u00a0\u00a0 etc and any other risk-taking that they do because\r\nwhen they’re in a manic episode is like they’re\u00a0\u00a0 this is a bad idea filter is completely turned off\r\nor it’s switched on the other way and as the let’s\u00a0\u00a0 try this filter so helping them understand that\r\nwhen they’re in that manic state it’s important to\u00a0\u00a0 have safeguards so that when they come out of it they\r\nhaven’t done something that they’re going to end\u00a0\u00a0 up regretting or have to undo so bipolar is caused\r\nby neurochemical imbalances especially among\u00a0\u00a0 serotonin dopamine and norepinephrine the symptoms\r\nand presentation varies widely depending on the\u00a0\u00a0 person it’s more important to address each symptom\r\nthen to address bipolar as a whole you know we\u00a0\u00a0 want to look at what symptoms this person\r\npresenting with and how can we help them manage\u00a0\u00a0 those the medication provider is going to be\r\nmanaging kind of the bipolar as a whole and trying\u00a0\u00a0 to stabilize the mood but we want to help them\r\nstart addressing their symptoms so they\u00a0\u00a0 can feel as healthy happy healthy and productive as\r\npossible help them address each symptom identify\u00a0\u00a0 warning signs and eliminate or mitigate\r\ntriggers and vulnerabilities remember that\u00a0\u00a0 treatment compliance is a huge issue because the mood\r\nstabilizers tend to flatten those highs and people\u00a0\u00a0 miss the most dangerous times for suicidal\r\nideation and people with bipolar disorder are\u00a0\u00a0 when they’re coming out of a depressive episode\r\nor and I didn’t mention this before or during a\u00a0\u00a0 mixed episode remember mixed they can be depressed\r\nand have high energy both at the same time ensure\u00a0\u00a0 people with bipolar disorder have a crisis plan\r\nand people who interact with them daily who are\u00a0\u00a0 aware of their warning signs and symptoms because\r\nsometimes they’re not being mindful and most of\u00a0\u00a0 us are guilty of not being mindful all the time\r\nsometimes these symptoms can creep up so if they\u00a0\u00a0 have people they interact with daily\r\nwho are in the know and can say you know John\u00a0\u00a0 it seems like you’re starting to destabilize a\r\nlittle bit then John can take a look at it people\u00a0\u00a0 with co-occurring addictions also need to be aware\r\nthat a bipolar episode can trigger an addiction\u00a0\u00a0 relapse and vice versa so they need to be aware\r\nand have an extra-special relapse addiction\u00a0\u00a0 relapse prevention plan for when their mood\r\nsymptoms arise if you haven’t already signed up\u00a0\u00a0 please remember that addiction and mental health\r\ncounseling and Social Work continuing education\u00a0\u00a0 credits are available for this presentation and\r\nare accepted in most US states Canadian provinces\u00a0\u00a0 Great Britain Australia and South Africa go to all\r\nCEUs com counselor toolbox and click on the link counselor toolbox CEU spreadsheet to easily\r\nlocate the course based on this presentation okay are there any questions now remember we’re not having class\r\ntomorrow but we’re having class on\u00a0\u00a0 Thursday and that is just chock-full of\r\nstuff that I’ve never actually presented\u00a0\u00a0 before so there is no repeat possible there\r\noh and then next Tuesday we’re going to be\u00a0\u00a0 talking about enhancing social justice\r\nand why that’s important for recovery you\r\n\r\n&nbsp;\r\n\r\n<img decoding=\"async\" src=\"https:\/\/images.pexels.com\/photos\/261909\/pexels-photo-261909.jpeg?auto=compress&amp;cs=tinysrgb&amp;h=650&amp;w=940\" \/>\r\n\r\n\r\n<a href=\"https:\/\/www.youtube.com\/watch?v=uXFjn1jpB9g\" target=\"_blank\" rel=\"noopener\">As found on YouTube<\/a>\r\n\r\n<a href=\"http:\/\/flywait.4brain.hop.clickbank.net\">Alzheimer’s Dementia Brain Health \u27ab\u27ac \ua19b\u30b7\u27ab I was losing my memory, focus \u2013 and my mind! And then\u2026 I got it all back again. Case study: Brian Thompson There\u2019s nothing more terrifying than watching your brain health fail. You can feel it\u2026 but you can\u2019t stop it.<\/a>","protected":false},"excerpt":{"rendered":"<p>&nbsp; this episode was pre-recorded as part of a live continuing\u00a0\u00a0 education webinar on-demand, CEUs are still available for this presentation\u00a0\u00a0 through all CEUs register at all CEUs comm slash counselor toolbox I’d like to welcome everybody to today’s presentation on a strengths-based biopsychosocial\u00a0\u00a0 approach to recovery from bipolar disorder so we’re going to talk &hellip; <a href=\"https:\/\/effectsofanxiety.net\/archives\/150083\" class=\"more-link\">Continue reading <span class=\"screen-reader-text\">A Strengths Based Approach to Bipolar Disorder Treatment<\/span><\/a><\/p>\n","protected":false},"author":3,"featured_media":150082,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_jetpack_memberships_contains_paid_content":false,"footnotes":"","jetpack_publicize_message":"","jetpack_publicize_feature_enabled":true,"jetpack_social_post_already_shared":false,"jetpack_social_options":{"image_generator_settings":{"template":"highway","enabled":false},"version":2}},"categories":[1,781,111,7,122,140,63,72,305],"tags":[38507,34232,38512,37759,59805,37897,37895,38513,38514,38515,37905,38531,38510,38518,38505,38516,38519,37878,38508,38509,1629,38533,37893,37894,38517,36776,38522,38523,37876,34002,38525,38526,38532,38527,38528,38530,59807,35373,7139,38506,38511],"class_list":["post-150083","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-anxiety","category-crime-justice","category-diy","category-getting-help","category-lgbt","category-lgbtqq","category-life","category-style","category-unrest-conflicts-war","tag-adacb","tag-addiction","tag-alcohol-and-drug","tag-bipolar-disorder","tag-bipolar-treatment","tag-cadc","tag-cap","tag-ccapp","tag-ccdc","tag-ce","tag-ce4less","tag-cebynet","tag-certification","tag-certification-board","tag-cheap-ce","tag-chemical-dependency","tag-continuing-education","tag-counseling","tag-counselling","tag-counsellor","tag-florida","tag-homestudy","tag-ladc","tag-lcdc","tag-lcsw","tag-lmft","tag-lmhc","tag-lpc","tag-lpc-ceus","tag-mindfulness","tag-naadac","tag-nbcc","tag-online-ceu","tag-online-training","tag-relapse-prevention","tag-sex-addiction","tag-strengths-based","tag-studies","tag-training","tag-unlimited-ce","tag-worker"],"jetpack_publicize_connections":[],"jetpack_sharing_enabled":true,"jetpack_featured_media_url":"https:\/\/effectsofanxiety.net\/wp-content\/uploads\/2022\/09\/htmlF_IMG_63163d54bae16.jpg","_links":{"self":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150083","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/comments?post=150083"}],"version-history":[{"count":2,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150083\/revisions"}],"predecessor-version":[{"id":150093,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/posts\/150083\/revisions\/150093"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media\/150082"}],"wp:attachment":[{"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/media?parent=150083"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/categories?post=150083"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/effectsofanxiety.net\/wp-json\/wp\/v2\/tags?post=150083"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}