Bipolar disorder is all about the fluctuation of moods. These fall on the spectrum between severe mania and severe depression. Most of the time people with bipolar disorder don’t fall on the extreme ends of the spectrum, but it does happen. It’s during these times that a person might be considered “in crisis” or at least in distress. When this happens, it’s important for us to focus on coping with symptoms and reducing stress. There are many skills we can develop to help cope in times of crisis and distress, and some are surprisingly simple.
The first part of dealing with a crisis is to recognize that you or someone you know is having a crisis. There are several signs including:
- Scattered thoughts
- Neglect of personal hygiene
- Changes in sleeping patterns
- Changes in weight
- Decline in performance at work or school
- Withdrawal from others
- Thoughts or plans of harming oneself or others
In the case of psychological distress, there are several actions that can be taken to alleviate distress in the moment and skills to build over the long-term. Some of the most successful of these are found in dialectical behavior therapy (DBT). DBT is typically used in treating borderline personality disorder, but has also seen success in bipolar disorder. Marsha M. Linehan, the developer of DBT, has two acronyms to remember that can help to deal with severe emotional distress.
The first is TIPP. In TIPP there are four actions that can be taken to reduce symptoms quickly. They are:
- Tip the temperature of your face with cold water. Hold your face in cold water for 30 seconds (or use a cold pack)
- Intense exercise. Use up excess energy with periods of intense movement.
- Paced breathing. Breathe deep into your diaphragm with only 5-6 breaths per minute.
- Paired muscle relaxation. While breathing, tense muscles, acknowledge the tension, then breathe out and relax the muscles.
The second acronym is ACCEPTS. These are ways to distract yourself from the distress you are experiencing, if only temporarily. You do this with:
- Activities like watching TV, cleaning the house, going out, etc.
- Contributing by volunteering, helping a friend, or just doing something nice.
- Comparisons of how you are feeling now to how you felt before or comparing yourself to those less fortunate. (Personally, I’m not a fan of this one.)
- Emotions: Get emotional on purpose whether through reading, watching a movie or listening to music.
- Pushing away by leaving the situation, or blocking thoughts and images.
- Thoughts like counting to 10 or repeating song lyrics.
- Sensations like holding ice in your hand or taking a hot or cold shower.
Try any or all of these ideas when dealing with severe distress, or come up with your own productive coping mechanisms.
When distress is intolerable and these actions aren’t enough, it may be that you are experiencing a psychological crisis. This is especially true when having thoughts or plans of harming yourself or others. A crisis is something you cannot deal with on your own. There are steps you can take in order to make it through with the help you need.
- Talk to someone like a friend or family member. Tell them exactly how you’re feeling.
- Call your doctor. It may be that a simple adjustment in your medication can help alleviate the pain and symptoms you’re experiencing.
- Reach out to a help line like the National Suicide Prevention Lifeline (1-800-273-8255) or the Crisis Text Line (text 741 741).
- Check yourself into an emergency room or a psychiatric hospital.
- Call 911.
During all of these steps, whether for distress or crisis, it’s important to remember to take care of yourself. Do what you need to do for your own mental health and never be afraid to reach out for help. No one needs to do this alone.
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