Archive for May, 2012

Ask the therapist:
Keeping track of triggers

By Dr. Deborah Serani, PsyD
issue)
I’m told it’s important to identify my “triggers.” How?

Triggers are emotional, physical and psychological experiences that weaken your sense of well- being. Sometimes called stressors, triggers are best defined as powerful events that set into motion powerful responses. For many people, a difficult event or threatening interaction will “trigger” a relapse of depressive symptoms such as over-eating, isolation or obsessive thinking.

Learning what external events, toxic interactions, and even negative self-statements leave you vulnerable will help you offset a downward emotional spiral.

First, learn how to recognize the who, what, whys and whens of your emotional life. Start by looking at the calendar. Note dates that are meaningful or stressful for you, such as the holiday season or the anniversary of a divorce or death. Maybe it’s anxiety about a yearly physical exam, like a mammogram, or an annual family reunion that last time left you feeling emotionally raw. Noting difficult periods of the year allows you to anticipate and plan for threats to your well-being.

Consider all the hats you wear in your life. What circumstances at work affect your mood and behavior? At home, do certain actions of those around you tend to upset you? Are you feeling supported or overwhelmed? What happens when you don’t get enough “me” time? …

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Getting back in balance
Let’s talk relapse.

In a way, relapse is the dirty little secret of recovery. We can take our meds, watch our sleep, exercise religiously, practice mindfulness … and still be upended by a bolt from the blue.

“You can never say that someone with bipolar disorder has had their last episode; relapse is part of the illness,” Alan C. Swann, MD, explains in our story A Bumpy Road: Dealing With Relapse (Spring 2011).

Sound hopeless? Not at all.

In our current issue, columnist Stephen Propst admits that he used to equate relapse with failure. Now, he insists, “Working through a relapse can actually be enlightening, educational, and empowering.”

For example, relapse may be a signal to:

  • Look at whether you are trying to do too much on your own.
  • See if you’ve slacked off on healthy habits.
  • Double-check your self-talk.
  • Redirect your energy to spend time with friends or do fulfilling activities.

Here are 5 Tips to reduce summer hypomania

Wear Blue Blocker Glasses Outside

Every time you even step outside the house, put those blue blocker sunglasses on. Don’t forget them when working in the garden, going out for mail, or going for a drive.

Pull the House Curtains

Darken the house. This reduces the amount of blue light inside. Pull the shades and curtains and watch a good movie. Don’t worry about what others think.

Change Light Bulbs In Spring and Summer

Put those pink and warm toned incandescent bulbs in to reduce blue white light and add yellow red light. Never read summers under bright blue lights. Check out bulbs.com for low temp special florescent tube bulbs.

Get Special Dark Time.

If wound up, you have to wind down. Getting dark time, say reading is better than activity. Activity in the summer just gets you more wound up.

Reduce Activities

Don’t go crazy in the summer with activities or you will go manic or hypomanic. Cut some things out. Be aware of activities in bright light that will stimulate the eye, such as picnics, walks, etc. 
for our other lists at Listmy5, go to

We’ve discussed pets in prior posts and in the Soft Bipolar Cyclotymia books.

Here is a great book, a must have if you want to know anything about the hundreds of benefits of pets of all sorts, especially dogs, cats, and horses. Pets cause shifts in the brain, and for the better. This book is a must have for all mental health workers, and every person wondering what the the benefit of a pet is. The vast quantity of information on the subject is incontrovertible. Get the book at Amazon.com or any book store or pet store. Give it as a gift, just as Sheryl gave to me!!
Welcome visitors this week from: Ukraine, Russia, Canada, USA, Australia, China, Italy, Canada, Venezuela, Brazil, UK,  Czech Republic, Finland, and more!

There are several states where a person has lost touch with their story in life. One can feel empty, not have direction, and have difficulty accessing normal emotions of anger, frustration, desire, mischief, sexuality, and drive.

Of course, many bipolar medications inhibit the ability to have a life story going on. Those with years of experience on antipsychotics are happy just sitting around. They don’t know the life they’ve lost nor do they know what exists out in the greater world for them.

Psychiatrists have been greatly to blame for this problem in bipolar patients. It seems to have a patient come in zonked on meds, and empty life, and a empty smile seems to be the best patient. They are just less trouble, “messy”. Wake up psychiatrists: to have emptiness is as much a loss of life as is mania and mood swings.

Do you have these in your life:

feeling sexy
feeling sneaky
driven for the future
knowing your purpose
knowing your story in life
having interest
wanting to learn and explore
having fun
being entertained.

The loss of story and resultant emptiness can be caused by meds, ongoing depression, a unipolar depressive pattern, ptsd and more. But, a person can also just give up on life and resign. Guilt, fear, and shame often are underneath this choice.

Alexithymia:
Alexithymia is defined by:

  1. difficulty identifying feelings and distinguishing between feelings and the bodily sensations of emotional arousal
  2. difficulty describing feelings to other people
  3. constricted imaginal processes, as evidenced by a scarcity of fantasies
  4. a stimulus-bound, externally oriented cognitive style.

From Wikipedia

We refer to alexithymia in our books on Soft Bipolar Disorder. Would you like more information on Alexithymia, comment below.

Soft Bipolar Books and Resources

The understanding of binge eating and overeating has come into its own these days. I just finished some new training on binge eating and would like to pass on a few ideas and some resources.

First, I see it as the number one eating problem of bipolar disorder patients:

1. unconscious eating, heavy grazing of food
2. overeating, large amounts
3. eating when full or not hungry

Unlike Bulimia, there may not necessarily be planned binge eating with Binge Eating Disorder (which is a new term and evolving). However, there is overeating when not needing food. The triggers for this could be both genetic and inherited as well as primarily stress.

Unlike the rampant hunger given by Zyprexa and some other medications, the binge eat does not have a severe appetite problem. They feel full. While there are many ways to look at the triggers, it seems too much depth analysis of that may not help: insight into the triggers helps as does behavioral therapy, or actions to intervene. The number one aid for this is charting or monitoring.

There is a problem with BED for patients even treated well. I do see more BED with lamictal use as well as Abilify. But, for those on good regiments, say lithium, BED can come about because

1. mood and stress problems are reduced and to leave that chaotic lifestyle can actually be a stressor of itself: what do I do with my time and mind now it’s calmer
2. there is an expectation that the good mood medication alleviates all life woes and you are impervious to life stress and struggle. Change, shift, stress, work problems and so on will still come into your life.
3. there are problems in life like biting your nails and overeating that are pretty hard to overcome.

If you are an overeater, and you binge half the time in a month, putting 5 to 10 lbs a month is easy. And, most patients then blame their medication. While there are those that clearly cause weight gain, there are those that do not……hmmmm, the problem might be you and your eating? Ya think?

And, if it is you and binge eating, there is no mood medication that greatly impacts this. The diet medications should be used with extreme caution if you are bipolar. They could help and they could open mania. Its a big gamble.

I would like to recommend books and materials that are current to the last 8 years so that they include new information on overeating and different types of binging.

If you have a website or book like this you’d like to recommend, please put that in the comments section below. Thanks, Dr. Bunch

Here are a couple of recommendations for information: