Fall is upon us, and for many people it’s the season of stress. School starts back, work picks up, the days get shorter, the weather gets colder, and the holiday season begins—all potential sources of stress. So in honor of fall, I’m writing a series about managing stress when you have bipolar disorder. It will be divided into 3 parts: 

• The Basics of Stress 
• The Connection Between Stress and Bipolar Disorder
• Tools and Techniques for Managing Stress

Stress management is an important skill for everyone to learn. Stress can have an enormous effect on our health, playing a role in (among many other conditions) high blood pressure, back pain, headaches, digestive problems, and heart disease. It can impact our immune systems and increase the chances that we’ll get sick with colds or other infections. 

When you have bipolar disorder, stress management is even more essential. In addition to its potential effects on overall health, stress can make bipolar disorder worse. Fortunately, it’s possible to get a handle on stress by understanding and managing it. Stress management can help you remain stable and prevent relapses—in fact, for many people a big part of managing bipolar disorder is managing stress. 

This series is based on a stress management workshop I developed and first taught about 10 years ago. At that time, I hadn’t learned to manage stress too well myself—to say the least. I was living with my parents and had just finished graduate school in counseling, and at my internship I was given the opportunity to teach workshops to foster parents. I decided to do my first one on managing stress. As I headed out of the house that evening, I announced that I was going to teach a stress management workshop. Recognizing the irony, both of my parents burst out laughing. I can’t say I’ve mastered stress management in my own life yet, but I’ve gotten much better at it over the years—and it’s helped immensely in managing my bipolar disorder. 

What is stress? 

Stress is the mental and physical condition that occurs when a person has to adjust or adapt to a situation. If you think about how often we have to adjust or adapt, it’s pretty easy to see that we all experience stress on a regular basis. To quote a pioneer in stress research, Hans Selye, “To be totally without stress is to be dead.” Stress isn’t bad in and of itself—how it impacts you depends a lot on two things: 

• How you interpret what’s happening (do you see it as a challenge, or do you see it as a threat?) 
• How well you think you can cope with what’s happening. 

Ideally, stress stimulates and motivates you, but doesn’t overwhelm you. 

What is a stressor? 

A stressor is any event, condition, or other factor that causes you to experience stress. These are all kinds of stressors, but here are some examples of common psychosocial ones: 

• Life events: Changes in our lives require us to adjust or adapt more than usual. These can be negative events such as the death of a loved one, a loss of income, or having an injury or illness. They can also be positive events, such as starting a new job, getting married, or even going on vacation. There’s a well-known scale called the Social Readjustment Rating Scale (SSRS) that’s used to measure how many life changes a person has had recently. The SSRS is related to health—the higher a person’s score, the more likely they are to become ill. 
• Daily hassles (also called microstressors): These are all the distressing, day-to-day annoyances we all experience. They include things like traffic, noise, bad weather, long lines, transportation problems, not having time to relax, and so on. Daily hassles tend to have a shorter-term impact on health, while life events tend to have a longer-term impact. 
• Relationship difficulties or interpersonal conflict: Arguments, rejection, unfair treatment, and other social struggles can be a big source of stress. While relationship problems can produce stress, stress can also produce relationship problems. Stress sets you up to react in ways that create further conflict—for example with anger or avoidance—which means a vicious cycle can develop. 
• Work or school stress: Work stress often involves interpersonal stress, but it can also include things like a heavy workload, unclear expectations, unexpected interruptions, an unpleasant work environment, or having a schedule that doesn’t allow for breaks or flexibility. For students, things like assignment deadlines, heavy course loads, and finals week can be significant stressors. 
• Not identifying or expressing your emotions: A less apparent but common source of stress is not recognizing your own feelings or internal signals, or bottling up your feelings rather than expressing them. Exactly how or why these cause stress isn’t clear, but these are a few possibilities: 1) the state of not being clear about what you’re feeling may itself be stressful; 2) if you do not identify that you’re experiencing a difficult emotion, you’re unlikely to use coping skills and stress may build; and 3) the effort it takes to inhibit your emotions is believed to be a stressor. 

What are the signs or symptoms of stress? 

Stress is a real, measurable process in the body, which I’ll talk more about in my next post. If it isn’t managed, it can start affecting you on emotional, cognitive, behavioral, and physical levels. 

Emotional signs or symptoms include: 

• Irritability 
• Apathy 
• Feeling overwhelmed or helpless 
• Being more easily frustrated than usual 
• Being more emotionally reactive than usual. 

Cognitive signs or symptoms include: 

• Difficulty concentrating 
• Difficulty making decisions 
• Forgetfulness 
• Poor judgment 
• Worrying. 

Behavioral signs or symptoms include: 

• Avoidance of responsibilities and relationships 
• Self-destructive behavior or self-neglect 
• Crying spells 
• Lashing out at others 
• Alcohol or other drug use. 

Physical signs or symptoms include: 

• Fatigue or exhaustion 
• Appetite and sleep disturbances 
• Frequent colds and infections 
• Headaches, back pain, or neck pain 
• Stomach or digestive problems. 

What determines how stressful something is? 

There are wide individual differences in what people find stressful, depending on personality, strengths, sensitivities, and other factors. For example, I generally don’t find school all that stressful; academics is one of my strong suits, and I view exams and papers as a challenge rather than a threat. But take me to a noisy restaurant with people shouting over blaring music, and my stress level will start going through the roof before the appetizers come. 

That said, stress is usually worse—that is, more distressing for you or more damaging to your body—if the stressor involves any of the following factors: 

• You can’t control it. Stress tends to be worse if you have little or no control over what happens. Some examples are not being able to leave a situation when you need a break, not having a say in how something is done, or not being able to do act according to your own needs. Lack of control is often an aspect of work stress. People are generally less stressed and more satisfied at work if they have some measure of control. 
• You can’t predict it. If you can foresee a stressful event, you usually experience it as less stressful than if you can’t predict it. Being able to predict a stressor allows you to brace yourself for it and plan how to cope with it. Terrorism is based on the premise that unpredictability is scary and stressful. 
• You believe it’s getting worse. If you think a situation is getting worse, you’ll probably experience more stress than if you think it’s getting better. Let’s say we have two people who are currently experiencing the same exact stressor, but for one it’s better than before and for the other it’s worse. The person who perceives that things are improving is likely to be less stressed than the one who thinks things are worsening, even though both people are technically in the same situation. 
• It’s intense. Intense stressors are ones that are extreme and out of the ordinary. What’s perceived as intense is to some degree in the eye of the beholder, but examples would be 9/11, being the victim of crime or abuse, or being in a serious accident. If you experience an intense stressor as traumatic and don’t recover, you can develop post-traumatic stress disorder. 
• There’s pressure involved. Pressure involves the stress of having to meet urgent demands or requirements. Examples include working under tight deadlines, handling crises or emergencies, or having to finish a large quantity of work in a short period of time. 
• You don’t have an outlet for your frustration. Stress is more likely to be damaging if you don’t have an outlet for coping with it. Unfortunately, outlets for stress often involve displaced aggression (taking your frustration out on someone else). But there are also healthy outlets, such as exercise and creative expression. 
• You don’t have support. It’s usually much easier to get through difficult situations if you have an ear to listen and a shoulder to cry on. Ongoing support from others protects you significantly from the damaging effects of stress. 

That covers the basics of what stress is, how it shows up, and what makes it worse. In my next post, I’ll talk about what’s going on in the body during stress, as well as how stress and bipolar disorder are connected. If you want to learn more about stress and how to manage it right away, I recommend The Relaxation and Stress Reduction Workbook (a classic workbook that’s been around for 35 years) or Why Zebras Don’t Get Ulcers (a well-written and entertaining guide to stress and coping). 

Here’s to a calm and relaxing fall season! 

You can find the rest of Carrie’s IBPF posts here or read additional articles on her Addiction.com blog.