By: Catherine Ness LCPC
Struggling with Bipolar Disorder is an on-going and exhausting battle for the affected individual; Watching someone you love struggle with Bipolar Disorder can be equally challenging and exhausting. Seeing your loved one experience hopelessness, frequent crying spells, social and career frustrations and feelings of worthlessness can be heartbreaking. Conversely, being the target of anger and anxiety and witnessing successive poor life choices can be frustrating. Never knowing how your loved one will feel on any given day makes you feel equally helpless and puts you on perpetual egg-shells.
The first step in supporting someone with Bipolar Disorder is gaining a deeper understanding of Bipolar Disorder (see Understanding Bipolar Disorder). Bipolar Disorder is not a fluctuation between sad and happy, but between manic and depressed; extreme mood states over which the individual has little control. Attending family counseling sessions with your loved one can be hugely beneficial in better understanding how these emotional extremes affect your loved one and how you can offer effective support.
It is infinitely easier to help your loved one remain in a euthymic state (stable mood state) than to help them recover from a manic or depressive episode. If your loved one has been diagnosed with Bipolar Disorder, accepts the diagnosis and is motivated to seek treatment, individual psychotherapy in conjunction with medication management offers the best treatment outcomes. Encouraging your loved one to remain compliant with medication is extremely helpful as stopping medications is one of the biggest triggers for relapse.
Ask your loved one how you can offer them support if their mood becomes unstable; although there are general techniques that can be helpful, individually tailored supports are most effective. This will involve the loved one working in counseling to identify what interventions have been helpful in the past and what interventions they think could be helpful in the future. Writing down what to do if your loved one is depressed or manic can be a good reminder. For example
When I’m feeling depressed . . .
1. Give me a hug and tell me you love me
2. Sit down and watch a comedy with me
3. Encourage me to leave the house and go out with friends
1. Try to problem solve for me
2. Tell me I have no reason to be depressed
When I’m feeling manic . . . .
1. Point out my mood seems too high
2. Ask me to reach out to my psychiatrist and therapist
3. Remind me to prioritize sleep
1. Tell me I’m acting crazy
2. Encourage me to make big decisions
It is also helpful if your loved one can provide you with information about what their thought process is a depressed, neutral and manic state. Frequently, an individual does not recognize that their thoughts are not “logical” when they are experiencing a severe mood swing. It can be beneficial if you assist your loved one in recognizing that their mood is affecting their thoughts. “The Bipolar Workbook” by Dr. Monica Ramirez offers tangible CBT (cognitive behavioral therapy) interventions that assist individuals in identifying these type of thought patterns. For example:
1. When I feel depressed . . . I feel like everyone hates me
When I feel manic . . . . . . I feel like everyone loves me and wants to be around me
When I feel “ok” . . . . . . . I know I have some close friends and acquaintances
2. When I feel depressed . . . I sleep 12 hours a day and am still feel exhausted
When I feel manic . . . . . . I barely sleep, but still have lots of energy
When I feel “ok” . . . . . . . I sleep 6-8 hours and feel a little tired when I get up
Helping the loved one recognize that their thoughts and behaviors have changed and reminding them with their own words that they may be experiencing a mood swing, can help convince them that an intervention is needed.
How to help a loved one who is actively depressed or manic
Even when someone diagnosed with Bipolar Disorder is doing everything right and their mood has been stable, they can experience break-through symptoms. The return of symptoms can be a result of a change in medication, increased level of stress or can occur for no obvious reason.
Frequently when I work with family members who are trying to learn to support someone with Bipolar Disorder, they complain that they offer logical feedback or solutions to their loved ones, but this type of feedback is either dismissed, or in some cases makes it worse because the person struggling feels like they are not understood. The reason logical solutions do not work, is because a person in a depressive or manic state is not thinking logically. The emotion is so overwhelming that it skews the way they look at themselves and the world in general. There are no satisfying solutions, and therefore, the focus should not be problem-solving, but instead diminishing the current emotional state so that the individual can be more open to logical suggestions.
If your loved one is talking about self-harm or is psychotic, they need to go to the hospital; there are no other options. If the mood is so extreme that it puts the person’s health or well-being at risk, they require a supervised environment and medication to break the severe mood state.
If the mood is not this extreme, reminding your loved one to take any prescribed PRN (as needed) medication can be helpful and relatively immediate way to deescalate the emotion. The ultimate goal is to get the individual to stop ruminating on whatever distressing or obcessive thought is stuck in their head. If the loved on has put together a list of coping skills, remind them of this list and encourage them to try each skill until something is helpful. Any significant change in mood should be reported to the loved one’s therapist and psychiatrist as soon as possible. The more people working together to support the loved one, the more likely the mood can me resolved quickly. Managing Bipolar Disorder is a challenge for the individual and for those who care about him/her, but is a worthwhile pursuit.