Posted in Bipolar disorder, CBT, compassion, depression management, mental health, wellbeing

Monday Matters: The importance of self-awareness and self-acceptance when managing a mood disorder

Photo credit: Ava Sol for Unsplash

Those of you who follow my blog and regularly take the time to read my posts will know that I’ve recently been diagnosed with Bipolar Disorder 2. In brief, Bipolar Disorder is a mental health condition which is characterised by extreme mood swings including bouts of low mood known as depression, periods of elevated or high mood known as mania or hypomania and euthymic state where the mood is stable. Although it’s taken until the age of 43 to get what I now feel is an accurate diagnosis, I’ve been experiencing issues with my mood since the age of around 17 and, even though I’m not an expert in mental health conditions, I have developed a high level of self awareness through the years and have come to learn what helps me manage my moods and what doesn’t. So, in today’s Monday Matters, I’m going to talk about how important it is to be self- aware (which I believe I’m pretty good at) and self-accepting (which I’m probably not so good at – yet!). I’m also going to touch upon ways in which an individual can begin to make improvements and develop in both areas.

What is self awareness?

Self-awareness is a conscious knowledge of one’s own character, behaviours and feelings. Basically, it’s all about knowing exactly who you are and why you behave in the way you do. Self-awareness is not an inherent trait – it’s something than can be learnt and cultivated using a range of reflection and introspection techniques.

I believe increased self-awareness is vital in helping us to find ways of managing a range of mental health conditions including bipolar disorder, depression and S.A.D. (Seasonal Affective Disorder). It can also help anyone who has other issues with their moods too for example, in early pregnancy or in the days leading up to a period.

How does self-awareness help us to manage mood disorders?

Enables you to make helpful choices in terms of coping strategies If you know yourself well, you will be able to identify and describe how you feel more easily and be able to make better choices in terms of self help and coping strategies. For example, when you are depressed, you may need to focus on celebrating small achievements, practising gratitude or using distraction techniques to change the focus from negative thoughts. If you’re feeling manic, hypomanic, wound up or angry, you may need to turn to relaxation techniques or use some soothing rhythm breathing to create a sense of calm.

Helps you spot patterns and cycles If you have full knowledge of what your different moods look like e.g. the key features of your depressive cycle, or how you present when you are manic or hypomanic, then you can more easily spot patterns or cycles quickly and be more pro-active in managing your episodes. For example, careful monitoring has helped me to identify the times of year when I get depressed, triggers which impact on my mood and how long my cycles of low / high mood tend to last. This was particularly useful to share with my CPN (community psychiatric nurse) and the psychiatric but also really helps me to cope with my illness.

You can establish what works and what doesn’t more easily Through taking a step back and thinking about issues I’ve had in the past, I’m able to identify what works e.g. sticking to a routine, going for daily walks, practising yoga and mindfulness and what doesn’t work e.g. ruminating over past mistakes, avoiding all contact with friends and family.

Makes therapy even more useful When you attend therapy sessions, whether you access them via the NHS or if you pay for them privately, it’s really important to ensure quick progress due to the time constraints e.g. with CBT offered by the NHS there’s a maximum number of sessions you can have and if you are paying for each session you want to feel that each hour is worth the cost. Having a good understanding of how you’ve been feeling, the ability to explain the changes you’ve made and the impact they’ve had can all help with presenting issues, solving problems and making progress with your treatment. Obviously, professionals are very good at picking apart what you say but it helps speed up the process so you get better faster and learn new skills with maximum efficiency.

Helps you communicate better with others Whoever you are talking to about your illness, be it your CPN, psychiatrist, best friend, partner, family member or work colleague, having the confidence in your ability to explain how you feel and what you think might help or exacerbate your issues, is vital if you want help and support or to feel listened to. This can improve your relationships in a number of ways so that, depending on who you are talking to, you might feel accepted, closer in your friendships, better understood, more confident and able to assertive. It might also help others to see things from your point of view so that they can be more empathetic.

Improved personal and work relationships Being aware of yourself and your moods is useful for maintaining positive relationships with your partner, family, friends and work colleagues. If you know, for example that you are feeling particularly irritable, you can bear this is mind when you engage with others. For example, I know that one of my symptoms of hypomania is extreme irritability and that this results in little annoyances becoming hugely frustrating and me becoming less tolerant of situations and people. I have to try really hard not to display my irritation too much, accepting that it is my illness causing the difficulties and that others are not the issue. By recognising this symptom of my bipolar disorder, I can take steps to manage my feelings and hopefully avoid upsetting others with what I say and what I do. It doesn’t always work, but at least the awareness is there.

Another part of self-awareness is your knowledge of how you come across to other people. Sometimes people can become overly anxious about this to the point of becoming obsessed about what other people might think of them, but I think a little acknowledgement in this area can be useful. For example, in terms of my bipolar disorder, when my mood is stable, I’m probably seen as articulate, friendly, assertive and optimistic, whereas when I’m depressed, I’m probably viewed as quiet, negative and passive. During periods of hypomania, people are likely to see me as irritable, agitated, easily distracted, overly forward and impulsive. By knowing how you present to others, you can help your partner, family, friends and work colleagues to understand how your mood disorder impacts on you and it can also help them spot signs of deteriorating mental health so they can offer support.

What are some easy ways to develop my self-awareness?

You can improve your self-awareness by working with a trained therapist or by using a range of self help style strategies or a combination of both. Here are some ideas which may help.

Therapy Therapy sessions can be really useful for getting to grips with difficulties and the effect that thoughts, feelings and behaviours can have on each other and on our lives. I’ve had individual sessions which focus on CBT (Cognitive Behaviour Therapy) techniques and group sessions which have looked at compassion, mindfulness techniques and self-acceptance (i.e. it’s not your fault that you have difficulties etc) All of the forms of therapy I’ve accessed have been helpful and I’ve taken lots from them all but I think CBT is particularly good for finding out about yourself.

Journalling I wrote about the positive impacts of journalling a few weeks ago and if you choose a reflective style, you can find out lots about yourself, how you interact with others and positive and negative ways in which you tend to solve (or exacerbate) problems in every day life. You can either choose a free-form style where you just write what comes into your head, or a more structured style where you respond to particular prompts. Either way can be really eye opening. Try searching ‘journaling prompts’ on Pinterest and make a list of some of your favourites in your bullet journal or other notebook so you can pick and choose.

Try to be more open-minded It’s easy to think that our way of doing something is the best way or that our opinion is more valid than others, but what if someone else’s way is better or when you listen carefully enough, you find that a different opinion makes more sense or is more logical? Even if you don’t agree with another person, you should always try to listen to their point of view as it helps you learn things about yourself and can help you develop your own potential.

Take the helicopter view This one is a CBT technique and one which can be really difficult to do (for me anyway!). Basically, it’s a metaphor for taking a step back to see the bigger picture. If we’re too close in, our emotions take over and we lose the sense of perspective which we would likely gain if we were less involved. If you imagine a helicopter taking off and viewing your problem for a little further away, it would be able to assess the situation with clarity, see why you are reacting the way you are, offer impartial advice (as would be offered to you by a close friend) and take time to consider the best solution based on all of the information. If you would like more information about this click here for further explanation and a PDF worksheet.

Make some ‘about you’ lists If you love writing lists as much as I do, this is one which you’ll really enjoy whilst finding out about yourself as you go. Rather than writing endless to-do lists, why not write about you, your strengths and weaknesses, your likes and dislikes, what makes you happy, a personal bucket list etc. And no, this is not self-indulgent, it’s perfectly okay to make things all about you every once in a while – especially if you helps you get to know yourself and makes it easier to manage your moods.

Keep a mood diary I see lots of bullet journal spread mood trackers on Pinterest and Instagram which look really pretty any colourful by the end of the month due to different colours for the various moods. However, in my opinion, they tend to contain limited information and are therefore of limited use, as they just show that a person’s mood has changed throughout the month or has mainly stayed the same. Personally, I prefer to keep a detailed mood diary as this enables me to make notes about my mood alongside what has triggered it. I also like to be able to describe changes in my mood from one part of the day to the next. For example, I might wake up feeling really happy and full of energy, but then something might trigger a completely different mood e.g. I might see or hear something which upsets me or makes me cross. I find the Bipolar UK Mood Scale and Diary really useful as a starting point for tracking moods but I also like to create more detailed records by utilising space in sheets such as this one from Get Self Help. The first is designed to help individuals with lived experience of the various types of Bipolar Disorder but the second can be used by anyone who is dealing with mood changes.

What is self-acceptance?

Self-acceptance is about accepting everything about yourself – the good and the bad, the rough and the smooth. It’s about recognising that we are all unique, complex human beings with strengths and weaknesses. It’s also about knowing than no-one is perfect and that we all make mistakes and have periods of difficulty in our lives.

Self-acceptance is not about making excuses for bad or inappropriate behaviour, but it does make it easier for us to evaluate how our feelings and emotions may affect our actions so we can work on making changes for the better or recognising why we might be struggling with some of our relationships.

In my opinion, self-acceptance can be pretty difficult, especially if you have perfectionist tendencies like I do. Most of us are easily able to accept the good bits about ourselves, but can the same be said about our flaws and our failures?

How can I learn to accept myself?

Practise self compassion If you’re having a tough time at the moment, one of the worst things you can do is beat yourself up about it. During periods of difficulty, you need to be as compassionate towards yourself as you can. If you were ill with sickness or a headache you generally wouldn’t think twice about resting up, spending the day in bed or whatever you need to get well again. The same needs to apply during periods of high or low mood. Be kind and accept that you’re not your usual self and then either ask for help from one of your supporters or choose appropriate coping strategies that you know work. If you find it difficult to practise self compassion, think about what a good friend would say to you to make you feel better – then say it to yourself. Click here for some more ideas.

Be openly curious rather than judgemental

This is a primary aspect of mindfulness and one which I believe can be hugely helpful during times of difficult emotions. Being curious about what is going on for us allows us to accept what it happening and notice the associated feelings. For example, we might note that we feel anxious or angry and then explore the affect that this is having on us in terms of bodily sensations e.g. tension in the shoulders or tightness in the facial muscles. Then, rather than judging the feelings and sensations as good or bad, we accept that they are there are are just part of our experience.

Be proud of your strengths and celebrate your achievements We all have lots of strengths and we have all achieved things in our life (learning to manage our mental health is one of them). On a day when your mood is stable and you’re feeling okay, try making a list of things you’re good at and another of all of your achievements. So for example, you might be good at sleeping, drawing, cooking, papercrafting, planning, organising etc. You may have completed a degree or a distance learning course. You could be proud of yourself for all kinds of reasons such as singing in a choir, doing a presentation in front of others, teaching your children to have good manners or even developing a successful planning system in your bullet journal.

Find out more about your diagnosis Having recently been diagnosed with Bipolar Disorder (2) I am still coming to terms with accepting my diagnosis and learning more about the condition – including finding out about Lithium which is the medication I’ve been put on. For me, this was pretty straight forward as I have been dealing with the symptoms of the illness for a long time and it was more a case of finally being offered an explanation for the difficulties I have. But, everyone is different and you need to be patient with yourself and others in getting to grips with your mood disorder and what it means for you. The worst part for me, is knowing that I may improve my ability to manage my moods, but that doesn’t mean that I won’t continue to have difficulties in the future. This will take time to accept and also, due to different medication, I won’t know the effect this will have on my mood cycle in the future.

Try to be more accepting of others You might think this is a strange one to have on a list of ways to accept yourself, but bear with me! If you learn to accept others for who they are and accept that you can’t change how others think, feel and react, then you can focus on how you react to them. This can help you accept that everyone is different and we all have valid thoughts, ideas, beliefs etc. By doing this, you can increase your tolerance levels and improve your relationships with others whether it’s a romantic relationship that you want to develop or a work relationship which you find difficult to bear. It will also help you see that there’s no set right or wrong way to do things and may help you be more assertive, stopping you from worrying about the approval of others so much.

Use positive self talk Affirmations are a great way of accepting yourself as you are and recognising your strength to recover from periods of difficulty. Here are some good examples:

  • I choose to love and accept myself
  • I love and appreciate myself
  • I have many accomplishments that are worth celebrating
  • I value myself above all else
  • I’m proud of myself and my achievements
  • I’m filled with gratitude for who I am
  • I love that I am real, rather than perfect
  • I have enough, I do enough and I am enough
  • I am proud of myself for daring to try.
  • I am resilient and can get through this.

Final words…

Mood disorders are very common and there are lots of us out there who are striving to help ourselves manage our condition in any way we can. Even if you don’t have a diagnosis, I hope today’s post has been useful in some way. I appreciate that it is difficult to put into practice some or all of the ideas when you’re really struggling but if you develop a routine of self care during periods of euthymic (stable) mood it should be a little easier to keep going during high or low periods.

Wishing you all well,

Posted in wellbeing, wellness

Monday Matters: Creating a W.R.A.P. Part 4

The cover I made for my file using MS Word

In this series, I’m breaking down the aspects involved in creating a Wellness Recovery Action Plan (W.R.A.P.) and sharing my experiences of the course I did at my local recovery college where I worked on my own individual plan. In Part 1, I talked about what a W.R.A.P. is and why they are helpful. I identified the main principles and introduced the idea of making a wellness toolbox to help you think about activities which you find help your mental health. In Part 2, the focus was on identifying what you are like when you are well and making a list of every day activities which you should do to keep yourself feeling well. For Part 3, we looked at the importance of recognising your triggers or stressors and creating a plan of methods for coping with these when they occur. We also considered our own personal warning signs that we are beginning to become unwell and I shared examples of my signs and actions for combatting these. Today, the focus is on signs of further decline when your coping methods and action plans are not helping you and simple steps you can take to remediate.

Sometimes, I find that even though I’m trying really hard to keep myself well, certain sets of circumstances or aspects of life cause my mental health to deteriorate. When I start to become depressed, it seems like nothing I can do will help and thoughts such as ‘I’m never going to get better’ kick in. Even though I’ve got through periods of depression and anxiety countless times before, I always panic that this is going to be the one time when I stay unwell indefinitely.

When I made my list of signs of decline, I was actually living that depressive and anxious side of my life so it was easy to write everything down but also quite upsetting. I also struggled to come up with coping methods and an action plan and this is where the support of the course facilitator at the college became so important. If you are struggling it’s really important to reach out for help. A family member, a close friend or a therapist can all help to provide objectivity and encouragement in finding a way forward.

Now I’m feeling stable, I have added to my list. In fact, I’ve turned it into two lists – one for times of depression and anxiety and the other for when I’m struggling with hypomania. Here are some examples that may help you get started with creating your own list or lists:

Depressive episodes

crying a lot

lack of motivation

avoid doing things

anxiety on waking

isolating myself

feeling hopeless

can’t see a way forward

rocking and pacing

fragile

lots of negative self talk

let things upset me that I wouldn’t ordinarily

feeling tired all of the time

sleeping in

very poor appetite – feeling sick

hopelessness

convinced I will never get better

Hypomania

erratic driving

spending money on unnecessary things

talking non-stop

not sleeping properly

taking on too much

jumping from one activity to another

thinking I’m superior / better than most

My coping methods / action plan

Go back to my wellness toolbox and choose self soothing and mindful activities

Do things ion my ‘Daily Maintenance’ list even though I don’t feel like doing them

Get some exercise – a gentle walk in nature

Do a meditative activity e.g. colouring in

Write a short action plan for each day

Try to celebrate small achievements

Write a done list of all of the things I have achieved each day e.g. had a shower, ate some lunch etc

I hope my posts are helping in terms of managing your mental health conditions and has shown how a Wellness Recovery Action plan can help with anxiety, depression and symptoms of bipolar illness. The fifth part will be about crisis planning which is particularly relevant for those of you who may struggle with manic episodes and severe periods of depression where someone else needs to take over your care. As my mood disorder is not as debilitating as this and I have learnt to manage hypomania and moderate depression, I did not fill in this part of the plan but I will still be sharing ideas for its completion.

Until next time,

Posted in compassion, mental health, Mindfulness, wellbeing, wellness

Monday Matters: Creating a W.R.A.P. Part 3

Over the past couple of weeks, I’ve been sharing my experiences of writing a Wellness Recovery Action Plan to support my mental health. In Part 1, I shared what a W.R.A.P. is and why it’s useful as well as how to create a wellness toolbox. In Part 2, I wrote about making a detailed list of adjectives to describe what you are like when you are feeling well and also how to make a maintenance plan of every day activities that help to keep you well. This week, the focus is on triggers and how to cope with them, plus creating a list of early warning signs of deteriorating mental health. Obviously, this is very personal to you as an individual but I hope by sharing some of my lists you get the idea so you can have a go at making your own.

Triggers (AKA Stressors)

Triggers in your life are external events or circumstances that make you feel uncomfortable. They can include situations in your work or personal life that you know tend to stress you out or upset you. Writing these triggers down won’t stop them from happening, but it can help us put coping methods and action plans in place for dealing with the emotions that are felt.

The following are some examples of my triggers so you can get the idea for making your own list:

spending too much time alone

criticism from others

being overly tired

family friction

making a mistake

not being listened to

change to routine

packing to go on holiday

mental health themes in TV dramas

feeling left out

being wrongly judged

My coping methods / action plan

Do everything on my daily maintenance plan – keep routines going

Pick out some activities from my wellness toolbox

Talk to a supportive person about what has happened

Turn negative self talk into positive

Use mindfulness techniques

Do some soothing rhythm breathing

Focus on tasks that are easy to do

Make lists e.g. a packing list for holidays

Early Warning Signs

For this part of the WRAP plan, you make a list of signs that tell you and others that you’re not feeling mentally well. This helps friends and family to look for signs of deterioration and is also good for sharing with medical professionals. For me personally, I have different signs depending on whether I’m starting to become depressed or anxious or developing hypermania.

Signs of depression and anxiety

loss of appetite / comfort eating

feeling tearful over things that wouldn’t usually affect me

lack of motivation

feeling tired even after lots of sleep

agitation

want to be alone

irritability

poor concentration

feeling worthless / helpless

Signs of hypomania

constant talking – unable to switch off

mind in overdrive

erratic driving

spending lots of money to fix things

hyperactivity

sleeplessness

agitation

irritability

flick from one task to another in a bid to get it all done

Coping methods / action plan

Do relaxation exercises – meditation, yoga etc.

Pick out some activities from my wellness tools

Tell someone I trust how I feel

Do everything on my daily maintenance list

Seek medical help

Get some exercise

Ask for support with household tasks

Challenge negative thoughts

Celebrate small achievements

Although I found these tasks difficult to do at the time as I was living with the depression and anxiety symptoms, I do think they are really useful lists to make. I also found it beneficial to talk with others about coping methods and get ideas from them too.

I hope you are finding these posts informative and useful. I really recommend creating your own WRAP either by yourself or with a loved one or therapist. Sitting down and really thinking about yourself and what you are like at different times can really help. Also if you can feel yourself becoming stressed or unwell, you can put things in place to help prevent you from becoming worse.

Of course, the current situation with the virus is a huge source of stress and worry so, now more than ever, we need to look after ourselves and ensure self care activities are high on our agenda. A lot of our routines and aspects of our daily lives have changed beyond our control and for many, this will be one of your main triggers so make sure you put things in place to help you cope.

Until next time, stay home and stay safe and well,