This is the third article in a 3-part series. The blogger recommends reading the first article and second article before reading this one. 

When I was first diagnosed with bipolar disorder over 15 years ago, everything I read suggested that people with bipolar disorder should avoid stress as much as possible. As someone who had studied psychology and understood that stress is a normal part of life, that advice didn’t sit too well with me. Essentially, the message I got was that people with bipolar disorder should lead sheltered lives, avoid anything exciting or stimulating, and not take any risks. 

Unfortunately, that outdated view still lingers to some degree. But the more modern and enlightened view is that, rather than avoid stress, we should learn to manage it (while also respecting our own personal tolerances and limitations). I’ve spent years learning about stress management, applying it to my own life, and teaching it to others in workshops and my counseling practice. Stress management skills have helped me live with stability, take healthy risks, and maintain a level of well-being I wouldn’t have otherwise. I hope some of what I’ve learned will be helpful to you. 

What is stress management? 

Stress management is the use of skills and strategies to: 

• Prevent or reduce stress 
• Improve coping skills 
• Increase overall wellness. 

Managing stress can help prevent illness and improve health. It can make us feel calmer and happier on a daily basis. And, for people with bipolar disorder, it can reduce mood episodes, anger, and anxiety. 

What is stress hardiness?  

To get an idea of how to manage stress, it’s helpful to look to those who are naturally stress-resistant—people who stay calm and collected under stressful conditions. These people are considered high in hardiness. Hardiness is a personality trait that includes long-standing emotional, cognitive, and behavioral patterns. 

People high in hardiness deal with stress constructively. They tend to have three attitudes in common, known as the “3 Cs”: 

• Commitment: They have a strong interest in the people, places, and activities they value. They have a sense of purpose and are committed to family, friends, career, community, their religious faith or spiritual path, or whatever else is important to them. Because of this commitment, they don’t give up when things get difficult. Rather, they are motivated to put in the effort to solve problems. Their commitment also keeps them involved in events—so they are less likely to become isolated. 
• Control: When things start to head south, hardy people maintain the belief that they have mastery over what’s happening. They believe they have the power to influence situations, and don’t see themselves as victims. They struggle to try to change outcomes rather than becoming passive and helpless. Even when they know they can’t control an outcome, they maintain a positive, hopeful attitude. In other words, they recognize they have the power to choose how they react. 
• Challenge: They naturally appraise stressors as challenges rather than threats. They tackle problems head-on because they see them as tests of their abilities. Rather than seeing change as scary, they see it as an exciting opportunity for personal growth and new learning. 

People high in hardiness can give us some ideas on how to respond more effectively to stress ourselves. Research shows that those of us who aren’t naturally hardy can learn to be hardier with time and effort. Developing stress management skills can help us do that.  

How can I learn to respond more effectively to stress? 

As I’ve described in my last two posts, stress affects your body, behavior, and thoughts. And, at the same time, your body, behavior, and thoughts affect your stress level. That means there are three major ways you can intervene to manage stress:  

• Calm bodily reactions: This involves turning off the fight or flight response and turning on the relaxation response. It includes things like meditation, exercise, avoiding or limiting caffeine intake, massage, and relaxation techniques such as breathing or progressive relaxation (which are described in The Relaxation and Stress Reduction Workbook, which I recommended in my first post). For people with bipolar disorder, prescription mood stabilizing medication also helps. Mood stabilizers work opposite to stress in the brain and help prevent relapses in part because they decrease vulnerability to stress.
• Modify ineffective behavior: This involves changing behaviors that make stress worse. For example, it may include avoiding social isolation, engaging in behaviors that prevent rumination, learning to be assertive, or improving your time management and organization skills.
• Change unhelpful thinking: This can involve two things: 1) changing the content of your thoughts so they are more reality-based (for example, reappraising how threatening a stressor is), or 2) changing the process of your thinking so you use more effective cognitive styles (for example, focusing your attention on a concrete activity rather than ruminating about a stressor). 

How do I know when I need to manage stress? 

As with many aspects of recovery from bipolar disorder, awareness is key. It’s not always easy to recognize when you are experiencing stress—and if you don’t notice it, you can’t manage it. In order to tackle stress before it starts affecting your mental and physical health, it’s important to learn to: 

• Notice when you experience a stressor. When you experience a life event or other stressor, you may not consciously notice how much it is affecting you. You may not acknowledge you are stressed for a number of reasons: you might be in denial that the stressor is even happening, you might minimize its significance, or you might believe it “shouldn’t” cause stress. A good rule of thumb is that people experience stress when they lose something important (a loved one, a job, their health) or when they experience change (a new job or relationship, a new family member, a vacation). Those of us with bipolar disorder also need to be aware of stressors that aren’t usually acknowledged or understood by others, such as lifestyle adjustments, decisions about disclosing our illness, or sensory overload.
• Notice when you experience stress in your body. In some ways your body is much smarter than your mind. It often knows you are stressed long before your conscious mind does. Sometimes you might have stress in your body without being able to identify a particular stressor. Even if you don’t consciously know why you are stressed, if you can recognize stress in your body (muscle tension, increased heart or breathing rate, sweaty palms, etc.) you can manage it. In addition, when you recognize bodily stress you can often connect it with a stressor in your life. Noticing stress in your body requires body awareness, a skill that can be acquired by learning to tune in to your internal experience.

In addition to using stress management skills in response to a specific stressor or episode of physiological stress, it also helps to have a daily (or almost daily) stress management practice. This could be something like exercise, meditation, yoga, journaling, or another practice that helps you manage stress. A regular practice helps keep your baseline physiological arousal level down and gives you ongoing mental and physical health benefits. A practice is often most effective if done at the same time every day (such as first thing in the morning, when you arrive home from work, or right before bed)—but the most important thing is that you make time to do it regularly. You can monitor the effects of your practice and adjust or change it as appropriate. 

How do I decide what strategy to use to cope with a stressor? 

In general, when you encounter something you find threatening, there are two ways to cope: try to solve the problem, or try to deal with your emotions. The best strategy to use at a particular time depends on the nature of the stressor, for example:

• How long will it last? Is it a one-time stressor or is it repeated?
• Did it come out of nowhere, or did you anticipate it?
• How much control over or ability to change the stressor do you have? 

With problem-focused coping you deal with the cause of the problem directly, either by managing or changing the situation. For example, you might:

• Develop a plan
• Gain information
• Ask someone for help
• Learn a new skill
• Take action on something you have been avoiding or putting off.

In general, problem-focused coping is effective for longer-term or repeated, predictable, or controllable stressors.

With emotion-focused coping you deal with the way you are feeling about the problem, or control your emotional reaction to it. You might:

• Release bottled up feelings through writing or talking to someone
• Distract yourself, for example by watching a funny movie or cleaning the house
• Self-soothe with enjoyable sensory experiences (I wrote about self-soothing in an article about dialectical behavior therapy)
• Exercise or practice a relaxation technique
• Change your perspective on the situation.

In general, emotion-focused coping is effective for stressors that are shorter-term or one-time, unexpected, or uncontrollable.

Here are some additional tips:

• Sometimes one tool or technique addresses both the emotional and problem solving aspects of a stressor. For example, cognitive behavior therapy thought records (which I described in a previous post) tend to help you feel better and come up with solutions. Likewise, writing or talking to release feelings often leads naturally to problem solving.
• Sometimes you might need both types of strategies to manage a stressor effectively. For example, let’s say you are stressed about an upcoming job interview. To cope you could prepare to the best of your ability by researching the company and practicing interview questions (a problem-focused strategy), and use a breathing technique to calm yourself down before the interview (an emotion-focused strategy).
• Try not to overuse emotion-focused strategies in order to avoid problem solving. That reinforces the belief that you don’t have any control, and deprives you of an opportunity to grow. Emotion-focused strategies can be lifesavers in the short-term, but over time it’s useful to develop the ability to solve problems.
• On the other hand, try not to rush into problem solving just to avoid uncomfortable emotions (for example, making a hasty decision or hurrying to fix a problem before taking some time to relax and breathe).
• Relaxation, which is an emotion-focused strategy, often increases your ability to solve problems. When you are relaxed, insights and solutions often come spontaneously. I’ve seen this over and over with clients (and myself), though it never ceases to amaze me. When you calm the body you also calm the mind—and a calm mind brings clarity.

Coming Soon: An A to Z Guide to Stress Management

I realized as I was working on this article that I had a great deal of information to share, more than would be feasible for a single post. So I decided to write an additional, longer series starting with my next post. Over the next several months, I’ll be posting an A to Z Guide to Stress Management for People with Bipolar Disorder. I will cover a specific tool or technique in each post. I’ll include a wide variety of approaches that can help you:

• Prevent unnecessary stress
• Cope with stressors
• Reduce the likelihood that stress will lead to a mood episode relapse.

 You will have an opportunity to try out all kinds of methods and notice how they work for you. In the meantime I invite you to share your favorite stress management methods in the comments to this post.

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.