Bipolar Disorder: Reaching Goals

INSHAPE NEWS MIND MATTERS

Phil Owens – Leading Australian Hypnotherapist and NLP Practitioner

Bipolar disorder is relatively uncommon in Australia, with a lifetime prevalence of about 1.5%.  It is characterised by abnormally elevated or expansive moods — at both ends of the spectrum, or ‘poles’.  That is, people who are ‘bipolar’ have times when they are exceptionally positive, creative and on a ‘high’.  The ‘up’ state can often be manic, with the person not needing sleep, thoughts racing, with over-inflated self belief and self concept. Then they have periods when they are apathetic, withdrawn and suffer severe ‘lows’.

Achieving Greatness with Bipolar

Many people with ‘bipolar’ conditions can function in the community and achieve greatness.  The NRL star Andrew Johns came out at the end of his career and confessed to having Bipolar disorder.  There are psychotherapies and drug interventions which can assist some people to ‘level out’ the highs and the lows and live highly functional lives.

Acknowledging the impact of Bipolar disorder can help sufferers stay on track to reach their personal goals. For example, if a person with Bipolar sets their goals when they are in their manic (‘up’) phase, the goals are likely to be big, bold, high-risk, high energy and short term. Whereas, if a person is in their ‘down’ period, then the goals will be depressed, limited and apathetic.  In fact, at times like this, the person suffering from Bipolar disorder often will see no attraction to goals, and their apathy will win out.

Bipolar Goal Setting

Setting goals should be considered at a time between these two states.  This ‘realism’ is the best time to create realistic goals.  For people with Bipolar disorder, it is useful to have three sets of goals around their personal success.  One is the ‘audacious’ goal.  Provided it is safe, having a powerful stretch goal to achieve can be useful for someone in a manic phase  — they are going to be hyper-focussed and driven in this period anyway, so having a goal to focus their attention is really useful.

The second type of goal is the ‘key goal’.  This is a very specific, smaller goal — perhaps chunked down into easily performed tasks — which, when the person is in their ‘down’ period, can then be used as small steps that they can take to keep moving forward.

The third type of goal is the ‘vision’ goal  — being clear about the bigger picture is always useful.  Knowing what the outcome of both the audacious and the key goals are and what each is working towards is valuable to set the landscape, and to provide motivation regardless of the Bipolar disorder state.

Often there is value in having a coach, therapist or friend who is trusted with the goals.  They can help align the person to what best serves them, and help keep them safe when they are at either extreme in their mood spectrum.

Philip Owens is owner and director of Reflective Resolutions and is a leading Australian hypnotherapist and NLP practitioner based in Melbourne, Australia. Using scientifically validated and pragmatic approaches, Philip is a passionate about creating lasting change in and for his clients.

Working in his clinic with individuals and also with corporate clients, Philip’s international experience, state of the art training and processes have led to successful and happy clients all over the world.  Focusing on the issues of modern life, Philip routinely works with clients presenting with anxiety, fears and phobias, addictions, traumas, weight loss, insomnia and smoking cessation.

Dr Heidi Heron – Psychotherapist and Coach

The ups and downs that accompany bipolar disorder are not always helpful for reaching your personal goals. However, many successful people throughout history have suffered from bipolar disorder and have made progress regardless. These include actors, such as Russel Brand, Mel Gibson and Catherine Zeta-Jones, just to name a few. Like them, if you suffer from Bipolar disorder, there are a few things that will help you to achieve your goals and maintain growth in your life. Bipolar disorder does not need to stop you from achieving, it just means you need to be more creative.

All or Nothing Attitude

One aspect of bipolar disorder is a tendency toward having an ‘all or nothing’ attitude and behaviour. Most likely the ‘all’ is during the manic phase, and the ‘nothing’ is during the depression stage. In order to keep momentum toward a goal, the key is moderation and incremental steps that slowly move you forward. Therefore, it is recommended that you write a detailed description of the goal you want to achieve – answering the questions of:

• What specifically do you want?
• Why do you want this?
• When do you want to achieve this?
• What are the steps you will take to achieve this goal?
• What will you see in your life when you have reached this goal?
• What will you feel in your life when you have reached this goal?

Create a Vision Board

Some people also create a vision/dream board as a visual representation of the goal. The idea behind this detailed description is twofold. Firstly, it allows your conscious and unconscious mind to know what you want and to prepare you to work toward it. And secondly, in both manic and depressive times, it serves as a reminder of what you want, and more importantly, why you want it. By getting into a habit every day of reading or seeing your goal statement, regardless of whether it’s a good day or not, lets your mind and body connect with it fully.

Write Down Your Goals

Take time to detail your goal/s. Then once this goal/s has been detailed, make time to carry out a task associated with this goal/s. This means making a 15-minute commitment with yourself. Fr example, every day, seven days of the week, set an alarm for 15 minutes and do something that is working towards your goal. This might be a small or big task. If you have the energy to work on your goal for more than 15 minutes, then go for it. On manic days — you will know when these are — limit yourself to no more than 45 minutes of working on your goal/s at one time. The reason for this is simple. When you are on the up-swing of bipolar disorder most things you choose to do seem like a great idea, but upon reflection, on a more balanced day, there is often a lot of changes to make.

When you know more about how to manage bipolar disorder, you can get on track to achieving your goals and dreams. These goal/s will then become easier to achieve as time goes by.

Dr. Heidi is a Psychotherapist and Coach at her practice People Point and she a Principal Master Trainer with the Worldwide Institutes of NLP. She has spent the past 12 years working with individuals to move past their limits and into a life of success, freedom and motivation. Originally from the USA, she completed her Doctorate in Clinical Psychology from the University of Southern California and now resides in Sydney. She is the co-author of 30 Days to NLP and of many self-help articles, she is a regular guest on radio and has appeared on Channel 7’s Sunrise morning program with her inspiring message.

Peter Walker – Clinical Psychologist

In order to define Bipolar disorder, let me introduce you to Steve, a hypothetical patient of mine. Steve represents a typical Bipolar patient.

Steve and Bipolar

The room exhaled as Steve slumped sullenly into his chair for our appointment. It had been a few months since we had met due to a recent period of hospitalisation due to a manic episode.

“I reckon Hendrix was right Doc,” Steve mumbled, making only fleeting eye-contact. His voice was hoarse from chain-smoking and heavy drinking. He works in real-estate, and he has fluctuated between success and dramatic misfortune.  He attended the session unshaven, and his normally snappy attire had been exchanged for an ill-fitting leisure suit.

“Manic-depression is a frustrating mess.” His smirk betrayed the shame and regret that Steve was to reveal in the remainder of the session. His recent manic episode had left a broken relationship and a hefty credit card debt as debris.

Bipolar Affective Disorder

Bipolar Affective Disorder (BPAD) or manic depression as it was once known, is a mood disorder that has been diagnosed with increasing frequency in recent years. It consists of depressive episodes characterised by fatigue, a lack of motivation and reduced pleasure, as well as low self-esteem and a feeling of hopelessness. This is distinct from the distress we might experience at the end of the weekend or the despondency we might experience when our football team loses the grand-final. A depressive episode represents a profound and often disabling emotional state that can be difficult to emerge from independently.

There are also corresponding “high” periods that includes euphoria, irritability and grandiosity, along with a reduced need for sleep, escalating plans and rapid speech. This is referred to as “mania or hypomania,” depending on the severity and duration of the symptoms. This is the contrasting and apparently opposite “pole” to depression. Hence, the name bipolar affective disorder,  with “affective” in this sense referring to mood. Some individuals enjoy these episodes due to the feelings of euphoria, although some experience an aversive agitation. Most experience remorse and shame after episodes as they assess the damage the state created.

Steve’s journey with bipolar disorder was fairly typical. From adolescence, he experienced what he called “black depression” that would last for weeks or months. These episodes worsened in later life and interfered with work performance. He had difficulty getting out of bed, struggled to concentrate, became disorganised and struggled with the social skills that had normally come so easily. Like many people with the condition, Steve was highly creative and was considered to have great potential, however, as he describes it, “I’m always chasing my tail.” Steve has hundreds of ideas, but no follow-through. “I think I can conquer the world, ” said Steve.  “But then I can’t get out of bed.”

Steve sought treatment for depression and had little success with the treatment. Instead, he learned to withdraw and wait for his symptoms to pass. However, this cost him his business and his reputation.

He failed to mention the boundless energy, cascading ideas and a pervasive sense of invincibility. It was Steve’s impression that his gregariousness, quick wit and ability to work frenetically allowed for his success. “That’s the real me, ” he said.  “That’s how people are supposed to feel.”

Steve would argue when he was informed this was abnormal behaviour. Fifteen years after his initial consultation he was diagnosed with BPAD. The long and difficult process of adjusting to this illness then commenced.

Bipolar Affective Disorder and Goal Attainment

For those struggling with BPAD, a critical goal is accepting and adjusting to the nature of the condition. At present, the condition is, unfortunately, a life-long illness. The challenge for those experiencing BPAD is accepting this is an “illness” and not a character flaw,  and then finding ways to deal with it so that they can go on to live a rich and valued life despite it.

Some pharmacological and psychological treatments have been developed to improve mood stability, which can assist in goal achievement. These treatments help, but also come with costs that may represent obstacles for those adjusting to BPAD as they learn to make compromises. For example, let’s consider mood stabilisers, wellbeing plans and social rhythm therapy as treatment options.

Mood Stabilisers – This class of medications reduces the intensity of depressive and manic episodes. Most experts agree that medication is an essential first-line treatment in the management of BPAD.

Costs – All medications have side effects. Individual response to the medication also varies. Perhaps a more specific problem in the area of BPAD is the fact that while most patients are eager for the lifting of depression, some are unwilling to relinquish highs. This is a significant factor in medication non-compliance in BPAD.

Wellbeing Plans – These are detailed plans that compile early warning signs for changes in mood and outline appropriate psycho-social interventions. It is thought that by reducing the intensity of mania, which may be achieved if identified and treated early, this can then reduce the intensity of the depressive episode that follows. Wellbeing plans can induce other people and bring them into the project, so that increased control over the course of the condition is gained and this then reduces the likelihood of hospitalisation.

Costs – the costs are similar to mood stabilisers, in that people are often reluctant to act in ways that reduce their mania. They may believe they’ve “earned” a manic episode after having endured depression. Further, acting in ways that are inconsistent with a mood state is tough. Engaging in exercise when you’re depressed, is very effective, but difficult, and reducing stimulation when you want to party can feel impossible.

Social Rhythm Therapy – the development of a structured daily routine can help to reduce the impact of mood fluctuations. This treatment encourages a regular sleep and wake time, regular meal times and, wherever possible, consistent time spent on an individual’s daily activity. This means doing the same shift at work each day or the spending the same time each day studying. This, in turn, then reduces mood dependent behaviour or doing what you feel like when you feel like it,  which can increase productivity and lead to goal attainment.

Costs – this type of treatment may feel excessively mechanical and robotic. Plus, some consistent bedtimes may interfere with social life.

Peter Walker has over 12 years experience working as a clinical psychologist. He has worked in both public and private practice, having specialised in complex presentations. He established his private practice, Peter Walker & Associates, clinical psychologists, in 2002 as a service to provide psychological treatments for those experiencing difficulties with anxiety, depression and couples in distress. In addition, the practice was relatively unique in that it offered specialised treatments for those experiencing psychotic disorders and bipolar disorder. At the time Peter Walker & Associates was established the development of psychological treatments for these conditions was in its infancy and Peter was considered an innovator in this field. Peter provides clinical supervision for mental health practitioners, is a sought after presenter and has experience providing expert opinion in the media. In recognition of his experience treating mood disorders he has been asked to take on a role at the Black Dog Institute in 2013.

Jay Spence – Clinical Psychologist and PhD Candidate

Achieving your goals is important for all of us. Research shows that people with healthy self-esteem are people who can (a) define their goals; and (b) have a belief that their goals are achievable. However, it is particularly important for people with bipolar disorder to understand how to achieve goals since their condition affects parts of the brain related to impulsivity and sabotaging goals.

What is Bipolar?

Simply put, Bipolar disorder is a mental health condition where periods of goal-directed activity, known as hypomania, can often lead to very risky or damaging behaviours like gambling, overspending and substance use or losing touch with reality. This action is called mania. After this, there is a crash in mood and extended periods of depression are commonplace.

Bipolar and Goals

The most important thing for achieving goals with bipolar disorder is to incorporate relapse prevention techniques into goal planning. Relapse prevention techniques include things like getting good regular sleep, called sleep hygiene, consistently using medication, in consultation with your doctor, as well as leading a healthy lifestyle that is designed to minimise too much stress that could lead to hypomania or mania. These skills are important for anyone, but they need to be the foundation for people with bipolar disorder for them to achieve other goals.

The reason for this is that people with a stable mood are less at risk of the sabotaging effects of mania, hypomania and depression. For example, let’s say that I have bipolar and my goal is to write a book. The book is really important to me, so I focus on writing more than I do on relapse prevention. For me, I enjoy the hypomanic phase because I have lots of energy, I don’t need to sleep or rest much, and my ideas are great. So I stay up and write a lot and don’t focus on diet, exercise, medication or stress levels. The sad reality is that pretty soon I will crash into depression. I might be so depressed I give up on the book, and I have to battle through depression for several weeks or months to feel normal again.

There is an old saying that states that “the most important thing is to figure out the most important thing.” For bipolar sufferers, the most important thing is to integrate relapse prevention tools into daily and weekly goals. This creates a foundation to be able to achieve the longer term goals. If you would like more information about bipolar disorder and how to effectively manage the symptoms of this condition, more information is available at BeyondBlue and the Black Dog Institute.

Jay Spence is a Clinical Psychologist and PhD candidate who specialises in adult and adolescent mental health. He was joint recipient of the Gold Prize at the Australian and New Zealand Mental Health Service Achievement Awards (2010) and of the St Vincent’s Health Australia National Invention and Innovation Award (2010) and was the recipient of the 2011 New South Wales Institute of Psychiatry Fellowship. He has published numerous papers on the treatment of post-traumatic stress, social phobia, and panic, as well as generalized anxiety and transdiagnostic anxiety processes. He held a conjoint lecturer position at the University of New South Wales from 2009 to 2011, lecturing on the treatment of anxiety and depression. He is currently completing a PhD on internet-based interventions for post-traumatic stress disorder (PTSD). He is developing these treatments as part of the Centre for Emotional Health at Macquarie University because PTSD is the most prevalent anxiety disorder in Australia. However, many people do not have access to effective treatments. He sees patients in private practice in Darlinghurst, Sydney.

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