Myths, misconceptions and misunderstandings go hand-in-hand with all forms of mental illness; bipolar disorder is no exception to this. One stubborn misconception is that bipolar disorder, a mood disorder characterized by extreme shifts in mood, energy and activity levels, can be effectively treated solely with medications. This isn’t to say that pharmacological interventions aren’t critical; for many people, they represent the bedrock of treatment. They save lives. The importance of pharmacological approaches in treating bipolar disorder is also prioritized by people with the condition themselves. However, just medication management is not usually sufficient for people with this complex condition to flourish, recover and experience full health and quality of life.
As with all chronic health conditions, self-care or ‘self-management’ strategies play a crucial role. At a basic level, self-management in bipolar disorder refers to the routine activities the person undertakes to maintain wellness and stability. While the person with bipolar disorder is in the driver’s seat when it comes to enacting self-management behaviors, it’s often most effective if their friends, family and healthcare providers are also passengers on the journey, like a support crew. Ideally though, they’re in the back seat, enhancing the driver’s autonomy, empowerment and independence.
Research illustrates that most bipolar disorder self-management strategies are akin to the healthy lifestyle behaviors many of us aspire to, regardless of whether we live with a mental health condition or not: balanced diet, regular exercise, sound sleep, and so on. It’s not so much that the nature of the activities is different for people with bipolar disorder. Instead, it’s the cost of not doing them that differs. Take sleep as an example. Most people can manage with a few days disrupted sleep. People with bipolar disorder, however, can be exquisitely sensitive to disruptions in sleep routine – the cost of not prioritizing regular sleep can be high (for example, increased risk of an episode of mania). This represents a mundane reality for many people with bipolar disorder. Going to bed and waking at regular times, avoiding late night stimulation, planning carefully for time zone changes when travelling, monitoring diet, caffeine and alcohol intake so as not to disrupt sleep are often tiresome, but necessary, activities.
Research also demonstrates, however, that effective self-management in bipolar disorder, for many people, goes well beyond just attention to healthy lifestyle behaviors. In a recent study we used community-based research methods to ask people with bipolar disorder and expert treatment providers to assess the importance of diverse self-management strategies for their effectiveness in ‘maintaining balance in mood’ and ‘stopping progression into hypomania or mania’. As expected, core approaches included strategies such as medical management, calming activities, physical activity, planning ahead, intervening early and decreasing use of stimulants. A new finding, however, was that study participants’ also described “maintaining hope” as an important aspect of self-management. This finding invites us to collectively challenge perhaps the most important myth about bipolar disorder of all: that there is little hope for recovery.
Interested in learning more about the self-care strategies we found effective for living well with bipolar disorder? In addition to reading our publications (links provided above) you can view the self—management strategies we found to be most effective via these interactive visualizations produced by CREST.BD deputy director Dr. Steven Barnes:
Maintaining Balance in Mood: http://www.stevenjbarnes.com/sketches/maintainingBalanceV1/
Stopping Progression into Hypomania and Mania: http://www.stevenjbarnes.com/sketches/stoppingProgressionV7/