On the last track, we discussed the three types of treatments
may take in addition to therapy: psychotropic medications; non-medicinal
treatments; and hospitalization.
As you know, clients who suffer from a mental disorder are extremely
sensitive to stress or stressful situations.
On this track, we will examine
how stress affects those with bipolar disorder and how clients can monitor
their stress: kindling; short-term and chronic stress; and stress symptoms.
3 Ways to Monitor Stress
The first topic we will discuss is kindling. As you may be aware, kindling
occurs when a client’s body becomes sensitized to stress. A stress
that initiates a mood episode leaves the client more vulnerable to
additional stressors later on in life. To explain it more comprehensibly
clients, I use this analogy. When you sprain an ankle or any other part
your body for that matter, that joint becomes more susceptible to sprains
Geraldine, a 48 year old bipolar client of mine, had her first
encounter with severe stress at the age of 23 when her mother died. During
that time, Geraldine remembered having her first depressive episode during
which she gained approximately twenty pounds from overeating. After this
initial trigger, Geraldine became more and more sensitive to every day
occurrences. Such minor stressors as bills became a life and death
situation for her and would send her into a depressive state.
after twenty five years of this type of kindling, Geraldine would fall
into a depressive state without any noticeable stressors. Geraldine stated, "It
was as though I could just
think about stress and I would become depressed. That feeling of not knowing what to do is terrifying." As you can see, Geraldine had fallen
victim to kindling. To prevent kindling, some researchers promote the use
of mood stabilizers such as lithium which seem to block the initial stages.
Anticonvulsants such as valproic acid appear to affect kindling later on.
2. Short-Term and Chronic Stress
To help Geraldine and other clients like her, I emphasize the positive
values of some stressors. To do so, I separate stress into two categories:
short-term and chronic. Short-term stress, such as a near collision while
driving a car, can actually help the immune system. During short-term
stress, small amounts of adrenaline and cortisol are released. I explain
my clients that cortisol can help maintain blood pressure; slow the immune
system’s inflammatory response; balance the effects of insulin, affecting
energy; and regulate protein, carbohydrate, and fat metabolism.
during a depressive episode, high levels of cortisol are produced all day
long, which negatively affects the cerebral cortex’s ability to process
crisis and stressful events. This type of stress falls under the category
of chronic stress. This type of stress relegates normally non-stressful
circumstances to a crises. This can almost be called a chicken-or-egg type
of question. While chronic stress can instigate depression, depression
can also worsen chronic
3. Recognizing Stress Symptoms
In addition to kindling and short-term and chronic stress, the third topic
we will discuss is helping a client recognize their stress symptoms. Often,
when bipolar clients become distracted by their lives, they don’t realize
that their bodies are actually telling them to slow down and take a break.
If left unnoticed, these stressful symptoms will escalate into full-on
depression or mania.
Checklist of Symptoms
Because I knew that Geraldine’s episodes occurred
after encountering stressful situations, I gave her a "Checklist of Symptoms" that I asked her to place somewhere around her house where
would see it every day. Geraldine chose her bathroom mirror. On this
checklist were several symptoms that indicated a body was undergoing stress.
These symptoms included:
1. Anxiety and nervousness
2. Appetite and weight changes
3. Avoidance and procrastination
4. Concentration and memory problems
5. Constipation or diarrhea
6. Dizziness, faintness, or weakness
9. Muscle pain or tension
Whenever Geraldine began to feel these effects or any other symptoms that
she equated with stress, she would be reminded that these symptoms were
signs that her body needed to slow down.
Technique: Me Day
To help Geraldine relieve her stress, I suggested she make up a plan to give
herself a "Me Day". I explained to Geraldine that a "Me
Day" was a day in
which she took off work and her other responsibilities to pamper and indulge
herself. Several of the mood relaxing ideas to try were massage, manicure,
exercise, shopping, or a long hot bath. I found it important to emphasize
to Geraldine that her "Me Day" should be designed to fit her own
To plan out some ideas for her Me Day, Geraldine wrote "Sleep in
until at least nine o’clock. Go for a morning bike ride if weather
If it’s cloudy, try some yoga. Fix a large breakfast of eggs, toast
and bacon. Go to the hair salon and get hair done. Do some scrap booking.
Watch favorite comedy. Call up some friends and go to a concert that night.
Go to a coffee shop and read a book. At night, make myself an ice cream sundae."
After writing it out, Geraldine stated, "Just thinking
my favorite things to do relaxed me. I actually can’t wait to have
nice knowing that when I do get stressed, there’s a positive awaiting me."
As you can see, by taking the time to listen to the body’s needs, Geraldine
could better handle her stress and not face it with a fatalistic attitude.
On this track, we discussed how stress affects those with bipolar disorder
and how clients can monitor their stress: kindling; short-term and chronic
stress; and stress symptoms.
On the next track, we will examine the several types of substance abuse most
common in bipolar disorder clients: alcohol, illegal drug abuse, and
Peer-Reviewed Journal Article Reference:
Johnson, S. L., Tharp, J. A., Peckham, A. D., & McMaster, K. J. (2016). Emotion in bipolar I disorder: Implications for functional and symptom outcomes. Journal of Abnormal Psychology, 125(1), 40–52.
Mneimne, M., Fleeson, W., Arnold, E. M., & Furr, R. M. (2018). Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personality Disorders: Theory, Research, and Treatment, 9(2), 192–196.
Weiss, R. B., Stange, J. P., Boland, E. M., Black, S. K., LaBelle, D. R., Abramson, L. Y., & Alloy, L. B. (2015). Kindling of life stress in bipolar disorder: Comparison of sensitization and autonomy models. Journal of Abnormal Psychology, 124(1), 4–16.
Online Continuing Education
What occurs when a bipolar client becomes sensitized to stress?
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