It is not possible to protect the person you care for from all stress. Although certain stressors that trigger symptoms should be avoided, not all stress is avoidable. The person needs to find ways to manage stress (e.g. exercise, talk things over with someone, write or paint). However, there are things you can do to assist the person to reduce triggers and maintain a lifestyle that helps them to keep well.
Identifying the person’s bipolar triggers
It can be helpful to have an idea of what commonly triggers bipolar symptoms. People differ in what triggers they are especially sensitive to. To identify the person’s triggers:
- Discuss with the person what they think triggers their illness.
- Think back to the person’s previous episodes, and work out if there were particular stressors that occurred just before they became ill (e.g. their sleep routine was disrupted by travel).
- If the person is already unwell, notice what factors seem to make their mood worse.
Lifestyle factors to encourage
Setting manageable goals
Positive strategies the person may use to reduce stress and keep well include:
- Taking ongoing medication prescribed for bipolar disorder.
- Having regular sleep patterns.
- Maintaining a basic routine.
- Exercising regularly (provided this is not done close to bedtime as this can interfere with sleep). Besides enhancing physical health, regular exercise has a positive effect on anxiety, depression, sleep problems and self esteem. 1, 2.
- Regulating the stimulation they receive (e.g. support the person’s decision to have quiet times between social engagements or restore sleep habits after celebrations)
- Setting realistic manageable goals.
- Stopping or reducing the use of substances that make bipolar moods worse (e.g. caffeine, alcohol or street drugs
- Eating a healthy diet
- Finding ways to relax and unwind
- Adopting a problem solving approach to difficulties.
- Accepting that not all problems can be solved, but people can try to make the most of things the way they are.
Providing practical help
There might also be practical things you can do to help reduce triggers such as arranging more quiet evenings at home together if the person is becoming manic. The person may also benefit from practical assistance if a stressful event occurs. When a stressful event occurs you could also:
- Offer to listen if the person needs to talk
- Offer to discuss solutions to a problem the person is finding stressful, without solving the problem for them.
Reducing conflict
Some people with bipolar disorder are very sensitive to stressful interactions (e.g. conflict or distressing criticism), and this can contribute to relapse. Bipolar disorder can put a strain on relationships. If there is conflict in your relationship with the person, it may help to find out about good communication skills, and ways to express grievances that are not hostile and can bring about positive change. In relationships it is also important to communicate about positive things; not only about problems. However, do not blame yourself for the occasional emotional outburst.
References
- Barbour K.A, Edenfield TM, Blumenthal J.A. Exercise as a treatment for depression and other psychiatric disorders: A review. J Cardiopulm Rehabil Prev 2007; 27(6): 359-367
- Ng F, Dodd S, Berk M. The effects of physical activity in the acute treatment of bipolar disorder: A pilot study. J Affect Disorders 2007; 101:259-262
