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A to Z Guide to Stress Management for People with Bipolar Disorder, Part 1: Appraise Stressors Realistically

This is the first in a series of 26 posts covering a variety of stress management tools and techniques. For some background information on stress and bipolar disorder, the blogger recommends reading her three-part series, “Getting a Handle on Stress When You Have Bipolar Disorder,” starting with the first one. 

Welcome to the A to Z Guide to Stress Management for People with Bipolar Disorder. In this series I will give you a wide variety of stress management tools and techniques to try. Some go hand and hand, and some may appear contradictory—for example, changing your thoughts and accepting your thoughts can both work. Everyone is different. There will probably be some methods you like and some that don’t work for you. Also, a particular tool or technique may work better in some situations than in others. Keep an open mind, experiment, and discover what helps most. 

So let’s get started with “A”: Appraise Stressors Realistically

When faced with a stressor, people with depression and anxiety tend to overestimate how difficult or threatening it is (“This is absolutely horrible!”; “This is going to be so hard!”) and underestimate how well they can cope (“I can’t handle this!”; “Nothing I do is going to help!”). Since people with bipolar disorder spend a lot of time on the depressive end of the pole, and many have co-occurring anxiety, this very often applies to them as well. 

I should point out that things are a little more complex for people with bipolar disorder. Since they experience the other end of the pole, mania/hypomania, they may do the opposite at times: underestimate how difficult or problematic something might be (“This is the best thing that’s ever happened to me!”; “Nothing can go wrong here!”) and overestimate their abilities (“I can do anything!”; “This will be a piece of cake!”). Although it’s important to learn to appraise all situations realistically, in this post I’m focusing on cases in which you feel threatened and don’t feel confident to handle things. 

Stress-hardy people naturally appraise stressors as challenges rather than threats. When faced with something difficult, they believe they are in control and can cope. The good news is that people who aren’t naturally stress-hardy can change their beliefs. One way of doing that is cognitive reappraisal, a technique used in cognitive behavior therapy (CBT) that helps people learn to control their reactions to events. CBT is based on the ancient belief that suffering is not the result of what happens in our lives, but of how we interpret or appraise what happens. It’s effective for a variety of issues, including stress. 

What to Reappraise 

When you’re feeling really stressed out about something, there are two major things you can reappraise: 

  • How threatening (difficult, intimidating, important, urgent) the stressor is 
  • How well-equipped you are to deal with it. 

Of course sometimes very stressful or traumatic things happen, and sometimes your coping skills aren’t quite up to par with what you’re facing. If difficulties in your life outweigh your capacity to cope, a crisis ensues—and it’s important to seek help. In less severe situations you can use techniques like reappraisal. 

How to Reappraise 

So how do you learn to appraise stressful situations more realistically? The first step is to notice the thoughts or beliefs behind your emotional reaction—these tend to be habitual or automatic so it takes awareness to recognize them. Next, critique those thoughts and beliefs. Depending on the situation, ask yourself questions like: 

  • How threatening is this, really? What’s the worst that could happen? What are the odds it will happen? 
  • Is there a way to reframe this? Can I look at it as a challenge? An opportunity for growth or learning? A positive (or at least neutral) experience? 
  • Is it possible my coping abilities are better than I think? Have I gotten through something similar before? What strengths or skills can I draw on to cope? 
  • Do I really need to focus on this right now? Can I take a break and return to it later, or even let it go altogether? What are my priorities? 
  • How big of a deal will this be in a week? A month? A year? Five years? Will I even remember it?

My personal experience: I’ll give a recent example of applying reappraisal in my own life. I was feeling very stressed because I had an unusually large list of things to do on a particular morning. Because of the stress, I was having difficulty focusing and felt somewhat helpless. I thought that if I just kept rushing I would get everything done, but in the process I was going further and further into fight or flight mode. 

When I became aware of what was happening, I decided to pause, take a few deep breaths, and try to get some perspective on the situation. As I began reappraising, I quickly realized that this wasn’t the end of the world and that I wasn’t helpless. I told myself that I could figure out a way to get through it. 

Next I discovered I had a firm belief that I had to get all of those things done that morning. I challenged that belief and recognized it was not based in reality. I reminded myself that my priority is my mental health and that the consequences of not getting everything done would not be that bad. Then I reappraised the urgency of the things on the list, chose the ones that couldn’t wait, and let the rest go. 

The process of reappraisal almost immediately lowered my stress level a few notches and helped me feel more confident and in control. 

How to start: The next time you experience stress in relation to an event or situation (for example, you’re stressed out about how much you have to do, you’re having trouble in a relationship or at work, you’re worried about the outcome or consequences of something), pause and tell yourself that you are going to rethink things. Try to identify what thoughts or beliefs are behind your feelings. Then ask yourself some of the questions I’ve suggested. Write down your answers if possible, or talk them through with someone you trust. 

Additional resources: As I mentioned above, CBT can help you learn to appraise situations more realistically. You can search online for a therapist with CBT expertise or a CBT-focused class or group. You can also try self-help resources. There are tons of CBT self-help books, including the classic Mind Over Mood. There are also free online programs—for example, e-couch teaches you coping skills for life events such as divorce and bereavement, as well as methods of overcoming depression and anxiety. 

You can find the rest of Carrie’s IBPF posts here or read additional articles on her Addiction.com blog. You can also visit the website for Counseling and More, her private practice, or Bipolar Beast, a company designed to empower people with bipolar disorder.

Comments

Dear Carrie Elizabeth and IBPF, thank you for this series. I'm in the middle of a manic episode right now. I'm being treated and well looked after. Luckier than most. Yet, I'm always looking for research into what I can do to help myself. Just this week I did a search looking for ways to help come down and what to do once I began to recover. While there's heaps of stuff about prevention and for what carers of people with bipolar can do info for people actually living with bipolar is very hard to come by. I hope this series will touch more on that too. I already practice CBT. Can't wait to hear more. Thanks again.

There have been two hefty accomplishments on my 'to do' list. For two weeks I've been waking up feeling overwhelmed with the need to accomplish one of them at least, this weekend. Well, today I did. And for some reason I don't feel any better about myself, in fact what I want to do is self impose even more tasks since I have cleared the decks of this one. Unbelievable. I am going to print all of this series as a tool for myself because lately been really aware of my negativity and tendency to be overwhelmed with things that don't threaten me in any way.

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