Editor's Note: This is part two of a two-part Q&A with Stephanie Roberts, PhD, co-author of The Bipolar II Disorder Workbook. If you missed part one, read it here.
How can you manage early warning signs of bipolar II (BDII) to prevent a major depressive episode?
One of the best ways for people with BDII to manage their early warning signs is to track their mood on a daily basis so that they learn to identify the very first mood symptoms that appear—the “early warning signs.” This will also help them to understand how daily stressors, sleep changes, and medications are all related to their mood. There are mood charts found on websites, such as www.moodtracker.com, that may be helpful. There are also some apps, available for smartphone users, so that people can track their mood using their phone. When people with BDII learn to recognize early signs, they can then implement strategies (found in The Bipolar II Disorder Workbook) to reduce the likelihood of experiencing a full-blown mood episode.
What role do cognitive distortions play in exacerbating depressive or hypomanic moods?
Cognitive distortions can play a big role in exacerbating depressive or hypomanic moods. Think of cognitive distortions as magnets that attract certain types of information. When a person is depressed, cognitive distortions serve to “attract” negative thoughts and feelings; and when a person is hypomanic, cognitive distortions serve to “attract” positive thoughts and feelings. In this way, cognitive distortions can actually make a mood episode more intense. Therefore, it is very important for people with BDII to understand cognitive distortions so that they can recognize them early—before the mood episode has been exacerbated—and correct them.
What are the symptoms of hypomania, and how do they differ from mania?
Symptoms of hypomania are elevated or irritable mood, abnormally high self esteem, a decreased need for sleep, being more talkative than usual or feeling a pressure to keep talking, racing thoughts or more ideas than usual, distractibility, an increase in goal-directed behavior, and involvement in activities that have high likelihood to have negative consequences. A person must have at least three of these symptoms present (or four, if the mood is irritable rather than elevated) for at least four days. The actual symptoms of hypomania are identical to those of mania. The difference is that with mania, the symptoms cause significant impairment in social or occupational functioning, whereas they do not in hypomania.
What are key strategies for managing hypomanic behaviors? How can you take preventative measures to reduce impulsivity?
Hypomania can have a significant effect on thoughts and can lead to impulsive behaviors. One of the key strategies for managing hypomanic behaviors is to use automatic thought records to keep track of hyperpositive thoughts. Once these thoughts are recognized, they can be restructured into more realistic thoughts. To manage the impulsivity that can sometimes accompany hypomania, it may be helpful to keep the following tips in mind:
1. Check with two trusted friends or family members before making any major decisions.
2. Wait 48 hours before acting on any big plans or decisions.
3. Limit your access to money by giving your credit cards to a trusted friend or family member, and consider deleting any credit card information you have stored with online retailers.
4. Avoid interacting with people who you know can upset or irritate you.
5. Avoid alcohol and drugs.
What are good ways to tell others about your BDII?
For many people, it can feel very difficult to tell others about their BDII. Although the following suggestions cannot completely erase anxiety or nervousness, they may make such conversations a little easier. Here are a few rules of thumb:
1. Calm down—try to relax by taking a few deep breaths before entering such a conversation.
2. Know your illness—be sure that you are well informed about BPII and are ready to answer any questions.
3. Be aware of your mood—have such conversations when you are feeling relatively well, not when you feel depressed or hypomanic.
4. Choose your surroundings carefully—have such conversations in a quiet, private place where you are not likely to be interrupted and there are no time constraints.
If you're interested in learning more about bipolar II, check out the first and only workbook available specifically for BPII, The Bipolar II Disorder Workbook.