Bipolar and Benefits of Therapy & Medication (Part II)
After learning I was bipolar I, a maniac-depressive disorder associated with severe mood swings, I tried to commit suicide. Subsequently I temporarily lost custody of my son. After consulting with my psychiatrist we decided that in addition to medication, I needed intensive outpatient therapy. The next day I started my therapeutic journey at New Dimensions, located in the Clear Lake area of Houston, TX.
Journey through therapy
The first step to being admitted as an outpatient at the New Dimensions Day Hospital is meeting with one of the facility's licensed clinicians for an assessment. During my assessment with one of the counselors, I was asked to basically explain why I was there - the problems I was experiencing that led me to therapy. The information relayed during the assessment provides the counselors a better understanding of the individual's struggles and then develop a treatment strategy. After being "processed" I immediately walked into the therapy room where a patient was "checking-in", a process where the leading counselor invites each patient to talk about how they are doing. I remember wanting to walk right back out, thinking this was going to be a waste of time and wasn't going to help. However, I knew I'd hit bottom and it might be worth sticking out. As I sat down with my red folder containing information about the hospital, I quietly listened to the other patients describe some of the exact same symptoms I was experiencing - the depression, panic attacks, mania and suicidal thoughts. The stories I heard are of course confidential but some would immediately bring me to tears and I knew then and there my life was not so bad and I could do this!
Each patient is given a weekly schedule according to their individual diagnosis. Since I was diagnosed with Bipolar I disorder, Post Traumatic Stress Disorder (PTSD) and tendencies toward substance abuse I was on a "dual diagnosis." This plan allowed me to attend a variety of therapy groups during the day and addictions groups during the evening. On my first day, after the check-ins during the morning, I attended a psychodrama therapy session in the afternoon. I was not at all prepared for what I was about to witness, which included issues on rape by incest and individuals on the brink of suicide. Led by Peter Demas, M.Ed., C.P., a Board Certified Psychodramatist and Group Psychotherapist, he began the session by explaining the psychodrama process. Demas explained that the therapeutic approach is a guided drama and role playing to work through one individual's problem. Before the process begins each participant is asked to first provide a problem they would like to work on and then Demas asks volunteers to be the protagonist or individual that will hold center stage. After the individual is selected and seated in the middle of the room, the other participants are asked to play different roles of significance, offering support and bringing to the surface underlying beliefs and issues. Although, only one person is focused on most of the participants will take away some clarity on their own issues and thus everyone has had a therapeutic experience. For more information on psychodrama and psychodramatists in your area visit http://www.crchealth.com/
The Collapse Process
Originally developed by one of the world's leading authorities on human behavior and personal development, , the collapse process is used when a client has unresolved "conflict" in their life. Mental conflict can be defined as a struggle resulting from incompatible or opposing needs, drives, wishes, or external or internal demands, according to the Meriam Webster dictionary. This conflict can be with a family member, co-worker or even a situation such as a job, role in a family, ect. It is harmful and a consuming part of our waking hours when these emotions become amplified and/or internalized, according to New Dimensions. Dr. John Demartini
The collapse process is a therapy tool that will "enable the individual to view the source as "human" instead of a larger-than life "monster. When this happens the source loses any power you have given it and the power is returned to the client," according to New Dimensions. Tracie Bein, MA, LPC, was the leader of the therapy groups I attended on the collapse process and shared personal experiences of how the therapy tool helped in her own life. Bein explained that her grandmother had always been the antagonist in her family, except with Bien whom she favored. For example, Bien explained that her grandmother would talk negatively about her parents in front of her and making her feel uncomfortable. After completing the collapse process, Bien said she no longer viewed her grandmother in a negative light and was left with nothing but appreciation and love.
The following is an example form for the collapse process chart.
The Collase Process
Explanation of the Collapse Process
According to the New Dimensions explanation of the collapse process, use the following steps on the form.
Step 1: Traits I like and dislike about the source (columns 1 and 4) The individual will identify the good and bad characteristics or traits of the source. Exhaust all traits you dislike about the source and then find just as many good traits that you admire in the source. The individual will need to find the same number of good traits as bad. This is extremely important because when negatives outweigh positives the individual will become emotionally repelled and resentful. When negatives do not equal the positives the individual lies. Lies are imbalances. When negatives equal the positives, you become grateful and unconditionally loving.
For example in my own collapse process the traits I listed for positives in column one included, strong work ethic, confident and organzied. For negative traits I listed disloyal, workaholic and critical.
Step 2: Where do I have these same traits, both good and bad? (columns 2 and 5)
The individual will analyze columns one and four and identify areas of their own life where they exhibit these same traits. For example, you may or may not be cruel to anyone, but are you cruel to yourself? Cruelty is still cruelty, even if you are your own offender. When analyzing these traits, think of these life areas as possibilities of where you may exhibit this same trait. For instance in the areas of, spiritual, mental, emotional, physical, family, social, career and financial.
Note: The individual must continue to find areas in their own life where they exhibit these traits - good and bad - until the person can honestly say the trait is to the same degree as the source. The individual may have to identify several areas in which this trait is exhibited to equal the source. When it is felt these traits are to the same degree as the source, then the trait can be checked as completed.
In column two for my own collapse process I found the trait of strong work ethic in myself as a good mother, parenting and with kids; in the area of confident I found that trait in my appearance, kids and family; and with organized I found this trait in myself at home, with kids, medicine and religion.
In column five I found that I have been disloyal in relationships, a workaholic with parenting, cleaning and cooking and critical of myself, spouse and family members.
Step 3: How traits in them affect me. (columns 3 and 6)
Analyze the traits in columns 3 and 6 and focus on how this trait in the source - good and bad- affects the individual. Column three will contain how the good trait in the source is a drawback to the individual and column six will focus on the drawback. For example - the individual may ask how is the fact that the person is a hard worker a drawback to me? Maybe they do not have time for me. Maybe they set too high of expectations. It is more difficult to look at how the bad traits are a benefit to the individual. The trait is still considered a benefit even if the only impact this trait has on the individual's life is by refusing to be the same way.
In column three the drawback to me of the person being having a strong work ethic, confident and organized all made me feel inferior or worthless. I couldn't live up to the person's unattainable high standards.
In column six, how the negative traits are benefit to me, I listed that since the person was disloyal I should be more loyal, bond with my son and be more independent instead of a workaholic; and not be critical - be more open.
Once the collapse process is complete, which could take days to weeks to months, the individual should no longer feel strong emotions toward the source. If any feelings of anger, hurt, hate, ect., are still felt then the individual has not exhausted all the traits on the source in the collapse process and should work with a therapist on finding more traits.
I completed the collapse process on my ex-husband who I had held a lot of anger and resentment towards, especially after temporarily taking custody of our son after my attempted suicide. After completing the collapse process I was honestly left with no emotions towards him and even felt a sense of gratefulness. Although this did not happen over night and took a lot of hard work, I would have paid millions to be given the gift that this process gave me - a sense of peace.
Additional forms of therapy for bipolar
Specific to bipolar, cognitive behavior therapy is individual therapy that focuses on identifying unhealthy, negative beliefs and behaviors and replacing these with healthy, positive ones. It can also help identify what triggers bipolar episodes and help the patient to learn effective strategies to manage stress and cope with upsetting situations, according to the Mayo Clinic. "A number of triggers can set off or worsen bipolar episodes," says Michael First, MD, a professor of clinical psychiatry at Columbia University and first attending psychiatrist at New York Presbyterian Hospital. The most common triggers for bipolar mood swing are: stress, lack of sleep, erratic schedules, caffeine and alcohol, certain medications (such as antidepressants and corticosteroids), seasonal changes (for example: winter can worsen depression while summer can increase risk of mania), stopping bipolar medication(s), thyroid problems, and substance abuse, according to Everyday Health.
Psychoeducation is counseling to help the patient and their family and friends understand bipolar disorder. It is important for the patient, as well as family and friends to recognize the warning signs of mood swings. Family therapy involves visiting with a psychologist or other mental health provider along with the patient's family members. Family therapy can help indentify and reduce stress within your family and help the patient's family learn how to communicate better, solve problems and manage conflicts, according to the Mayo Clinic.
Other forms of therapy include transcranial magnetic stimulation and Electroconvulsive therapy (ECT). The former treatment applies rapid pulses of a magnetic field to the head. However, according to the Mayo Clinic, not enough research has been performed on this treatment to provide clarity of its benefits and even how it helps. ECT can be effective for those individuals who have episodes of severe depression or feel suicidal or those who have not seen improvements of symptoms despite treatment. With ECT, electrical currents are passed through the individual's brain. Although researchers do not fully understand how the process works, it is thought that the electric shock causes changes in brain chemistry that lead to improvements in mood.
Since the 2nd century, when the idea of the relationship between mania and melancholia was described by Soranus of Ephesus (98-177AD) as a distinct disease the medical industry has researched and provided bipolar patients with a vast array of medications to help with the symptoms. According to , "bipolar disorder is a complex disease that requires medications that often are accompanied by close monitoring of blood levels. A successful medication regimen typically involves trial and error, and demands a close relationship with your medical doctor." Bipolar 101 - A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More
"After World War II, John Cade, an Australian psychiatrist, was investigating the effects of various compounds on veteran patients with manic depressive psychosis. In 1949, Cade discovered that lithium carbonate could be used as a successful treatment of manic depressive psychosis," according to wikipedia. It was not until the 1950s, U.S. hospitals began experimenting with lithium on patients. By the mid-60s, reports started surfacing regarding lithium's effectiveness and by the 70s, the U.S. Food and Drug Administration had approved the drug.
Lithium carbonate is a chemical compound of lithium, carbon, and oxygen with the formula Li2CO3. This colorless salt is widely used in the processing of metal oxides, according to Wikipedia. The drug has been recognized as effective in stabilizing mood and preventing the extreme highs and lows of bipolar disorder. Periodic blood tests are requried, since lithium can cause thyroid and kidney problems. Common side effects include restlessness, dry mouth, and digestive issues, according to the Mayo Clinic.
Anticonvulsants. "The mood stabilizing medications include valproic acid (Depakene, Stavzor), divalproex (Depakote) and lamotrigine (Lamictal)," according to the Mayo Clinic. The clinic also states that the medication asenapine (Saphris) may be helpful in treating mixed episodes. Common side effects include weight gain, dizziness and drowsiness.
Antipsychotics. For those who do not respond well to anticonvulsants, certain antipsychotic medications may fair better. These include, aripiprazole (Abilify), onlanzapine (Zyprexa), risperidone (Risperdal) and quetiapine (Seroquel). Although side effects depend on the medication the most common in this class of drugs include, weight gain, sleepiness, tremors, blurred vision and rapid heartbeat.
The first medication my psychiatrist and I agreed upon, mainly because I was highly against taking anything that may make me gain weight, was the anticonvulsant Trileptal (oxcarbazepine). I started at a low dose, and waited a couple weeks for the medication to control the racing thoughts and help me sleep but that miracle never did occur. Hence, my psychiatrist added abilify at the lowest dose and I almost immediately started feeling a lift in spirits. I was still experiencing several episodes a week of highs and lows, so we gradually increased the dosage until I got to a dose that made me hallucinate. Yes, my first ever hallucination brought on by a legal substance. After the "episode" I called my pharmacist and she said that the dosage was probably too high for me and to cut back. Since completing intensive outpatient therapy and now back on a low dose of Abilify I have had no manic or depressive episodes, knock on wood.
Antidepressants. Although antidepressants can trigger manic episodes in bipolar patients, this class of drugs may be beneficial when taken along with a mood stabilizer. The most common antidepressant side effects include reduced sexual desire and problems reaching orgasm.
Benzodiazepines. These are in a class of drugs called anti-anxiety medications and can help to improve sleep. Examples according to the Mayo Clinic include clonazepam (Klonopin), lorazepam (Ativan), diazepam (Valium), chlordiazepoxide (Librium) and alprazolam (Niravam, Xanax). These are typically used only a short-term bases as they are potentially habit forming.
In order avoid triggering manic or depressive episodes it is extremely important to follow a regimented plan for adhering to medications prescribed. Although it can be frustrating when trying to find the right mix of medications, taking the medications as prescribed is still the best way to maintain balanced moods in someone with bipolar disorder.
According to Bipolar 101, the following are a few examples for ensuring the bipolar patient takes medications appropriately.
- Create text messages to be sent to yourself periodically as a reminder.
- Set your watch or cellular phone alarm to remind you to take medications.
- Put a note on the bathroom mirror or on the front door.
- Note the times for your medication dosage as an appointment in your daily calendar or PDA.
- Purchase a pill dispenser that helps remind you of the medication you need to take each day.
- For people who travel frequently, when crossing borders, it is best to keep medication in the prescription bottle so that, if traveling with controlled substances such as Klonopin (clonazepam), there will be no risk of being arrested for importation of a controlled substance.
- Keep a medication log as a motivator to take medications regularly while keeping track of side effects and your intake of other substances that may interact with the medications.
Example Medication Log
Lifestyle and home remedies
To stop cycles of behavior that may worsen bipolar disorder, lifestyle changes may be needed. According to the Mayo Clinic, the following are some steps to live a healthier lifestyle with bipolar disorder:
- Quite drinking alcohol or using illegal drugs
- Steer clear of unhealthy relationships
- Exercise regularly
- Get plenty of sleep
Although there is not much proven research on alternative medicine, the following is a list from the Mayo Clinic that could be beneficial for bipolar disorder symptoms:
- Omega-3 fatty acids - These are oils that may help improve brain function and depression associated with bipolar disorder. Bipolar disorder appears to be less common in areas of the world where people regularly eat fish rich in omega-3s.
- Magnesium - Several small studies have suggested that magnesium supplements may lessen mania and rapid cycling of bipolar symptoms.
- St. John's wort - This herb may be helpful with depression. However, it can also interact with antidepressants and other medications, and it has the potential to trigger mania in some people.
- S-adenosyl-L-methionine (SAMe) - This amino acid supplement appears to help brain function related to depression. As with St. John's wort, SAMe can trigger mania in some people.
- Acupuncture - This ancient Chinese practice of inserting tiny needles into the skin may relieve depression. Acupuncture is safe and can be done along with other bipolar disorder treatments.
- Yoga - Yoga may help ease depression and mood swings associated with bipolar disorder. It also has a number of health benefits.
- Massage therapy - Massage may also help relieve anxiety and stress, which can worsen bipolar symptoms.
In part 3 of this series on bipolar disorder, we will discuss in depth about anxiety and depression. What exactly are panic attacks and depression and the coping skills to live a healthier and happier life. I'll also discuss my own personal experiences with anxiety and depression and the coping skills I utilize to help manage the symptoms of bipolar disorder.