Whats Different about Thinking Patterns in Bipolar Depression

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So far, the cognitive restructuring method I've described could apply to almost any form of depression or anxiety. The method applies well to bipolar disorder, but bipolar depressions tend to be much more severe than those experienced by people going through life transitions. So, in constructing your alternative or balanced thoughts, consider the role of your disorder—particularly, its biological and genetic underpinnings—in modulating your view of the causes of negative events. Do chemical imbalances of the nervous system explain your behavior in certain situations better than character flaws? Could your emotional reactions in the heat of the moment have been due to your disorder rather than your inability to deal with people?

Jacob, for example, recognized that soccer coaching did not go as well when he experienced the physical signs of depression or anxiety (for example, poor concentration, headaches, low energy). On days in which his coaching and athletic performance were impaired, he introduced balanced thoughts, such as, "I can tell that my mood and energy are off kilter today; this is one of those days I can't expect as much from myself. . . . This is not about my flawed character; it's about my biology. . . My depression is causing me to view things more pessimistically than I have to—it doesn't follow that I'm not a good person because I can't control my moods." These thoughts gave him a sense of self-acceptance when his moods interfered with his high standards of performance.

Katrina worried that "I'm too emotionally unstable to be a consistent figure in their (her students') eyes." Indeed, negative interactions with her students probably had a more powerful effect on her mood states than might be the case for a person without bipolar disorder, but not out of her own choice . She learned to internally rehearse the self-statements "I'm going to have more severe ups and downs than the ordinary teacher," "Not all of my emotional reactions will be under my control, but that doesn't mean I can't teach," and "I'm good at what I do, and there is a great deal of meaning in it." She also recognized the need to give herself more time to relax and decompress after work than might be required by some of her coworkers.

Consider another example. Say you've had a string of negative interactions with your employer over the last week but generally have had good rela tions with him or her. Is it possible that your irritability with your boss derives from depressive or mixed symptoms rather than your "short fuse," "angry nature," "problems getting along with people," or "problems with authority figures"? I am not saying, "Blame everything on your bipolar disorder." I'm recommending that you take a more balanced perspective on the factors influencing events in your life, including your disorder.

To sum up, cognitive restructuring has the potential to help you alleviate your depressed mood by identifying and revising the automatic thoughts that trigger low mood states. The role your bipolar disorder may play in stimulating your emotional reactions to persons, situations, and challenging events should not be underestimated. In combination with behavioral activation methods, cognitive restructuring has the potential to help alleviate your depression or, at minimum, keep it in check.

This chapter has introduced you to important self-management tools for coping with your depression. Implementing these tools—identifying your early warning signs, scheduling pleasurable and/or activating events, and reconsidering the way you think about, and respond to, the events in your life— can go a long way toward controlling the negative spiral of depression.

Don't be too concerned if you don't take to these methods right away. They require guided practice and skill before they feel natural. If you have access to a cognitive-behavioral therapist, consider doing these exercises with his or her guidance at first.

The next chapter deals with an issue that many—in fact, most—people with bipolar disorder deal with at one time or another: suicidal thoughts or actions. This topic is, for many, an uncomfortable one. But like many other attributes of bipolar disorder, you will put yourself in the driver's seat once you are able to understand suicidal impulses as symptoms of your illness that require management. You will see the special role of psychotherapy, medication, social supports, and self-management tools in alleviating suicidal despair.

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