254- A Strengths Based Biopsychosocial Approach to Addressing Bipolar Disorder
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Strengths Based Biopsychosocial Approach to Recovery from Bipolar
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs
Podcast Host: Counselor Toolbox and Happiness Isn’t Brain Surgery
Objectives
What is bipolar
What causes bipolar disorder (and how to mitigate it)
Emotionally (Stress reduction, Anger Mangement, Happiness)
Mentally (Cognitive Errors and Negativity, Self-Esteem)
Physically (Exercise, Nutrition, Sleep, Medication)
Environmentally
Understanding your bipolar
Triggers (Depression & Mania) and interventions
Warning Signs (Depression & Mania) and interventions
Symptoms (Depression & Mania)
Co-Occurring Conditions (and interventions)

Why I Care/How It Impacts Recovery
Uncontrolled bipolar disorder puts people at risk for
Suicide
Addictions and Addiction Relapse
Extreme risk taking behavior
Poorly controlled bipolar disorder can leave people feeling hopeless and helpless
Well controlled bipolar, like well controlled addictions helps a person feel happy, optimistic, motivated and energized.
What is Bipolar Disorder
It is a brain a disorder that causes unusual shifts in mood, energy, activity levels, and the ability to carry out day-to-day tasks.
Many very successful people have managed their bipolar disorder including
Mel Gibson
Demi Lovato
Axl Rose
Britney Spears
Jean-Claude Van Damme
Mark Vonnegut
Amy Winehaus
Lee Thompson Young & Robin Williams were both quite successful and revered in their fields, despite losing the battle with bipolar

What Causes Bipolar Disorder
What causes bipolar disorder
Imbalances in neurochemicals, especially dopamine, serotonin and norepinephrine
Imbalances can be genetic, triggered by sex-hormone changes or stress-hormone changes
Prevalence
More than 1 in 50 adults are classified as having bipolar disorder in any 12-month period (2.6% of the adult population)
Among patients seen in a primary care setting for depressive and/or anxiety symptoms, 20% to 30% are estimated to have bipolar disorder.
Bipolar disorder is still underrecognized, primarily due to misdiagnosis as unipolar depression.
Understanding Your Bipolar
Understanding your bipolar
Symptoms
Depression
Feel very sad, down, empty, or hopeless
Have very little energy
Have decreased activity levels
Sleeping changes
Feel worried and empty
Have trouble concentrating
Forget things a lot
Eat too much or too little
Feel tired or “slowed down”

Understanding Your Bipolar
Understanding your bipolar
Symptoms
Mania
Feel very “up,” “high,” or elated
Have a lot of energy and increased activity levels
Feel “jumpy” or “wired”
Have trouble sleeping
Talk really fast about a lot of different things
Be agitated, irritable, or “touchy”
Feel like their thoughts are going very fast
Think they can do a lot of things at once
Engage in risky and/or reckless behavior

Understanding Your Bipolar
Understanding your bipolar
Symptoms
Mixed
Includes symptoms of both manic and depressive symptoms
Feeling very sad, empty, or hopeless AND
Feeling extremely energized.
Bipolar I: At least one manic episode
Bipolar II:

Understanding Your Bipolar
Bipolar I patients experiencing depressive symptoms more than 3 times as frequently as manic or hypomanic symptoms
Bipolar II patients experiencing depressive symptoms approximately 39 times more often than hypomanic symptoms.
Common misdiagnoses
Generalized anxiety disorder
Goal directed activity is often related to an anxiety theme
Mood is more irritable and energetic vs. elated
Understanding Your Bipolar
ADHD
Approximately 60 to 70 percent of people with bipolar disorder also have ADHD.
20 percent of people with ADHD have bipolar disorder.
Hyperfocus.
This may happen on deadline pressure or when wrapped up in a compelling project, book, or video game.
Hyperfocus may cause a decreased need for sleep and look like “increased goal-directed activity,” but is short-lived in people with ADHD, who often feel exhausted when hyperfocus fades.
A manic episode is independent of external circumstances
People with bipolar often want to go to sleep or relax, but describe feeling as if they cannot wind down which can go on for a week
Understanding Your Bipolar
ADHD
Interrupting
People with ADHD often interrupt or talk too much without noticing because they miss social cues or because they lose focus on the threads of a conversation.
Patients experiencing a manic bipolar episode are often aware they are changing topics quickly and sometimes randomly, but they feel powerless to stop or understand their quickly moving thoughts.
Racing Thoughts
People with ADHD report racing thoughts, which they can grasp and appreciate but can’t necessarily express or record quickly enough.
With mania, the patient’s racing thoughts flash by like a flock of birds overtaking them so fast that their color and type is impossible to discern.

Understanding Your Bipolar
Medications
Antidepressants can propel a patient into mania
Captopril: ACE inhibitor for HBP
Corticosteroids
Cyclosporine: Immunosuppressant, anti-rejection
Levodopa: Increases dopamine, Parkinson’s symptoms
Methylphenidate and dexmethylphenidate: ADHD
Circadian rhythm desynchronization
Hyperthyroidism
Oppositional defiant disorder (in children)
Substance abuse disorders
Bipolar Distinguishing Factors
Spontaneous hypomania
Premorbid affective temperament, particularly hyperthymic or cyclothymic temperament
Mood lability
Increased mental/physical energy during depressions
Family history of bipolar disorder or response to lithium
Treatment-emergent hypomania/mania/mixed states
Uncharacteristically rapid response to SSRIs followed by crash again
>2 Antidepressant failures
Mood Disorder Questionnaire
Keeping a Life Chart
Ideally for 3-6 months
Chart
Sleep
Dietary Habits
Exercise
Life stressors
Hormones (women)
Bipolar symptoms

Motivation & Treatment Compliance
Depression
Benefits of eliminating manic episodes (If I were no longer manic…)
Emotional
Mental
Physical
Social (Family and Friends)
Drawbacks to eliminating manic episodes (If I were no longer depressed…)
Emotional
Mental
Physical
Social (Family and Friends)

Motivation & Treatment Compliance
Manic Episodes
Benefits of eliminating depression (If I were no longer depressed…)
Emotional
Mental
Physical
Social (Family and Friends)
Drawbacks to eliminating depression (If I were no longer depressed…)
Emotional
Mental
Physical
Social (Family and Friends)

General Techniques for Addressing Bipolar
How do you deal with it?
What are you willing to do?
Emotionally
Mindfulness
Prevents episodes from “sneaking up”
Encourages behaviors to prevent vulnerabilities
Stress reduction
Identify and eliminate or mitigate stressors
Time Management
Cognitive Processing Therapy

General Techniques…
Emotionally
Anger Management
Identify and understand anger triggers
Develop a plan for de-escalation
Begin addressing anger triggers to maintain control of your own energy
Happiness
What makes you happy….do more of it
Schedule a belly laugh every day
Keep a Good Things/Silver Lining/Gratitude Journal

General Techniques cont…
Mentally
Cognitive Errors
All or nothing thinking
Focusing on only the positive or negative
Using feelings as facts
Focusing only on a small piece
Negativity and the Silver Lining
Self-Esteem
View failures as lessons
Applaud courage and creativity
Nurture your inner child

General Techniques…
Physically
Exercise
Increases serotonin
Reduces stress
Helps balance hormones and neurochemicals
May help combat some medication side effects
Nutrition
Provides the building blocks for the neurochemicals (quality protein, 3 colors on a salad plate)
Stay hydrated to keep medication levels stable
Avoid mindless or comfort eating

General Techniques…
Physically
Sleep
Helps the body repair and rebalance
Sleep deprivation is known to trigger episodes
Too much sleep, or sleeping at the wrong times can mess up circadian rhythms
Keep daytime naps to less than 45 minutes 1x/day
Medication
Adjust dosage times to fit your schedule
Discuss negative side effects with your doctor
Don’t expect a pill to do everything

General Techniques…
Interpersonally
Support groups
Chat rooms
In-the-know family and friends
Self-awareness of the Jekyl-Hyde syndrome
General Techniques…
Environmentally
Essential oil aromatherapy
Energizing: Peppermint (any of the mints actually), Rosemary, Lemon
Calming: Lavender, Chamomile, Valerian, Catnip, Bergamot, Rose (Rose-Geranium is less expensive), Frankincense
Memory Triggering: Ginger, Clove, Cinnamon, Orange, Jasmine
Visit a store selling essential oils and sniff them to see which ones work for you.

General Techniques…
Environmentally
Organization
Eliminate or manage impulse items
Car keys
Credit Cards
Porn Sites
Video Games
Alcohol
During the day keep it light and bright

Co-Occurring Conditions
Depression
Suicidality
Addictive Behaviors/self-medication
Mania (Excessive and Impulsive)
Explosive Anger
Heightened Libido
Risk Taking
Legal
Physical

Summary
Bipolar is caused by neurochemical imbalances, especially among serotonin, dopamine and norepinephrine
The symptoms and presentation vary widely
It is more important to:
Address each symptom
Identify warning signs
Eliminate or mitigate triggers and vulnerabilities
Treatment compliance is a huge issue because mood stabilizers tend to flatten the highs
Summary
The most dangerous times for suicidal ideation in people with bipolar disorder are:
Coming out of a depressive episode
During a mixed episode
Ensure people with bipolar disorder have:
A crisis plan
People who interact with them daily who are aware of their warning signs and symptoms
People with co-occurring addictions also need to be aware that a bipolar episode (relapse) can trigger an addiction relapse and vice versa

CEUs
If you haven’t already signed up, please remember that Addiction and Mental Health Counseling and Social Work continuing education credits are available for this presentation and are accepted in most US states, Canadian provinces, Great Britain, Australia and South Africa.

Go to https://www.allceus.com/counselortoolbox and click on the link “Counselor Toolbox CEU Spreadsheet” to easily locate the course based on this presentation