Detect & Prevent Mania

Goal

To learn strategies for detecting and preventing mania.

Thinking Errors (Otto et al., pp. 140-142)

In lessons 2-3 you learned about how depression contributes to thinking errors. Mania can contribute to problematic thinking as well in the form of hyperpositive thoughts. It is important to learn how to recognize these types of thoughts so you can intervene before a full-blown episode of mania occurs. Here are some hypomanic cognitive errors:

Positive fortune-telling. Being overly optimistic about unknown outcomes.

Overreliance on luck. “I can get away with it.”

Underestimating risk or danger. “It will work out one way or another.”

Overly positive appraisal of one’s talents and abilities. “I can do no wrong.”

Disqualifying the negative. Minimizing problems and/or not thinking through the negative consequences. “I don’t have a care in the world.”

Overvaluing of immediate gratification. “I want what I want when I want it.”

Suspiciousness or paranoia. “Everyone is looking at me.”

Misinterpreting the intentions of others. Seeing sexual content or innuendo where there is none (“They want me.”) or seeing slights or aggressive content where there is none (“They’re out to get me.”)

Inappropriate use of humor. “They think I’m funny.”

Seeing special connections or heightened religious significance.

Thinking Errors Exercise

Instructions: Choose three of the above thinking errors and come up with examples from the past when you have made the thinking error.

Examining Thoughts (Otto et al., pp. 143-144)

The same techniques that you learned in lessons 2-3 about improving your depressed mood can be used to examine and challenge hyperpositive thinking. Early detection of problematic, hyperpositive thoughts is crucial. Trying to change these types of thoughts once you are in a full-blown manic episode is futile. Therefore, the goal is to recognize and test out hyperpositive thoughts before escalating into a full manic episode.

Thought Record Exercise (Otto et al., p. 144)

Instructions: Complete an entry on the below thought record using a recent situation that led to a hyperpositive emotion.

General Strategies (Otto et al., pp. 145-146)

Here are some helpful strategies to interfere with impulsive, hypomanic behaviors:

• Avoid major financial decisions, such as new purchases or major investments. Avoid using a credit card. If you feel like you must make a decision when you are feeling positive or high, it is best to check with at least two valued advisors to help you decide whether the decision is sound.
• Avoid alcohol and drug use when hypomanic. Mood episodes impair your judgment.
• Avoid relationship decisions. When hypomanic, don’t give out your phone number, ask out new people, or engage in sexual behavior with new partners.
• Avoid confrontation. Mania/hypomania often bring irritability. Sometimes the best choice is to take a day off work or agree with family members or friends to not have major discussions until your mood stabilizes.

Problem Solving Strategies (Otto et al., p. 164)

When you are depressed or manic, it is difficult to think clearly and problem solve effectively. By following these problem solving steps, you will be more likely to make a decision that you will benefit from both now and in the future:

1. Identify the problem
2. Clearly define the problem (what about the situation makes it bothersome?)
3. Brainstorm a list of all possible solutions, even those that may seem silly or impossible
4. Evaluate the solutions (advantages and disadvantages of each)
5. Select a solution or combination of solutions (taking into account the benefits and liabilities of each solution)
6. Implement the solution
7. Evaluate the effectiveness of the solution

Problem Solving Exercise

Instructions: Resolve a conflict with a friend or family member using the 7 problem solving steps listed above. Then answer the following questions to evaluate how it went:

1. What went well?
2. What did not go well?
3. Which of the steps did you find most difficult? Why?
4. What specifically will you do differently the next time you are in a similar situation?

Relationship Strategies (Otto et al., pp. 169-170; 180-181)

People who have bipolar disorder may experience difficulties with social situations since irritability and depression often leads to conflict with others while hypomania may lead someone to violate social norms. By learning how to respond to situation assertively, you can work toward enhancing the quality of your relationships despite the negative effect of your mood. First, step back in order to calm down. Then you can examine your feelings and thoughts about the situation. This examination is followed by challenging any negative, unrealistic, or judgmental thinking patterns that you may have identified.

Once you’ve decided on an appropriate response for the situation, focus on communicating assertively. You can do this by describing the situation to the other person in an objective, factual manner-focusing on the problem at-hand rather than bring up past difficulties. Use “I” statements as opposed to “you”. For example, saying, “I feel upset when�” versus, “You messed up when�” is likely to result in a nondefensive reaction from the other person. Ask for what you want in a straightforward, specific manner. Additionally, explain how the suggested change will be beneficial to both parties. Try to make positive statements about the other person.

Next Step

Stress can also contribute to mood instability and relationship difficulties. One method for reducing stress is progressive muscle relaxation. Learn how to do this type of relaxation by watching the following video:

References

Otto, M. W., Reilly-Harrington, N. A., Kogan, J. N., Henin, A., Knauz, R. O., & Sachs, G. S. (2009). Managing bipolar disorder: A Cognitive-Behavioral approach therapist guide. New York, NY: Oxford University Press, Inc.