Bipolar II Disorder and Teenagers: Part Four -- Positive Coping Skills

In the final part of this series, we continue with Wendy's story and discuss the positive coping skills that can help people with bipolar II lead successful lives.

We have come a long way in terms of treatment for bipolar conditions, and many people benefit from a combination of therapy and medication. Nevertheless, more research is needed in determining how people can manage this challenging illness. Here are several important skills that can help teenagers, and adults, with bipolar disorder:

Determination: One of the most important things to develop is a determination to make positive coping skills lifelong friends that can turn symptoms into assets. Positive thinking in a rhyme format will help teens remember important mental maps that can help them get up, get going and get things done. Adults can also help teens write their own rhymes based on inspiring words that motivate them. Do whatever works! Here is a verse to give your teens if they struggle with lethargy and lack of persistence:

Persistence
I can pull myself up against my own resistance
To get a job done that I don't want to do
And I can do it over and over for as long as it takes
To alter my existence, based on my insistence
That I can create the world that I want.

©2006 by Patrice Wolters

Focus on health and strength: Teenagers with bipolar disorder generally need a variety of outlets for their energy and good strategies to pull out of a depression. They often require some form of medication, the benefit of a healthy diet, and good sleep hygiene.

Since bipolar teens may feel bad about themselves, it's essential to help guide them to think realistically and optimistically about themselves and their condition. To help cultivate their strengths, teach your teens and patients to write their strengths on an index card and have them post it where they can see it regularly as a reminder. People with bipolar disorder, and depression, need to find positive thoughts to replace the chronic negative ones. Remind your teens that they are brilliant, talented and resourceful (or whatever words might inspire them).

Postponement: Hypersexual behavior had a compulsive quality for Wendy, but the medication decreased the intensity of her urges and helped her settle down. Still, she needed some strategies to manage her urges, so I taught Wendy to use postponement techniques. When she felt hypersexual, she learned to take charge of her thinking by saying to herself "I can postpone this urge and get something physical done instead." She would often lift weights, do yoga, run or work on an unfinished project. With practice, Wendy learned to develop the habit of postponing her desires to masturbate, go to parties, and buy sexy clothes. Wendy gradually learned to be more in charge of her hypomania and developed some self-esteem as a result. She sometimes reflected, "I can do anything I set my mind to."

Wendy also made use of a thinking tool I developed called "Take charge, channel and change." When she felt a sexual urge, she would talk to herself in a proactive and realistic manner by saying something like "Okay, I'm starting to feel hypersexual, and this is a signal that I need to get moving with my projects. I am 'in charge' of my moods. Right now, I'm going to postpone acting on these urges and 'channel' my energy to get a project done. It's self-destructive to act on these urges, and I will not. I am in charge of me, and I can 'change' to get results each day." These realistic thinking patterns helped Wendy take charge of her sexual urges. Learning to postpone any behavior that feels excessive or intense can be challenging at first, but it can do wonders for self-esteem and a sense of empowerment.

Wendy made up a list of the following projects to get involved in when she felt either hypomanic or depressed. The projects periodically required a push with the persistence rhyme, but they were easy physical tasks that gave her a sense of accomplishment and got her moving through the challenging symptoms.

• Clean room
• Organize closet
• Wash clothes
• Iron clothes
• Clean bathroom
• Run, practice tennis or weight train
• Vacuum room
• Organize email

These were all things that she could do at home, and they provided a focus for her excessive energy. When broken down into mini-steps, the projects also provided a focus for when she was depressed, and they facilitated "change." Wendy was artistic, so she created a picture with the tasks drawn in cartoons that helped her get going when she felt down.

Of course, Wendy would still get some urges while involved in her projects, but she practiced bringing her mind back to the task at hand. The statement "I am in charge, I can channel and I can change" became her mantra to get started, follow through and complete daily living tasks. Her second mantra was "I am lovable, talented and have a bright future." The completion of tasks reinforces positive thinking, which eventually became a mind-set for Wendy.

Get up and going -- 1-2-3-4: When Wendy was depressed, her biggest challenge was to get out of bed. Together, Wendy and I laid out an initial 1-2-3-4 routine that would get her up and going on the weekends. This routine has helped many teenagers with bipolar depression beat the bipolar blues. It has also helped those with unipolar depression.

1. Lie in bed and set a priority for the day. When Wendy was depressed, her priority was often to get out and practice some tennis because she knew it helped her mood. Most any athletic activity is an effective treatment for depression and a great way to start the day.

2. Shout, "Two, I can bust my mood!" and jump out of bed.
Just getting up is a big achievement when a person is depressed, and shouting (along with a fun rhyme) gets the energy going.

3. Make the bed. This gives a beginning sense of accomplishment and makes it harder to get back in bed.

4. Get a cup of coffee or tea, and eat some breakfast to provide nutrients for the day and get some energy flowing.

At this point, it was time to perform the next four steps and to continue this process throughout the day. Built into this behavioral pattern was breaking Wendy's day into small tasks that helped her build some momentum. While people vary on their steps, the next four for Wendy consisted of the following:

1. Put on makeup.
2. Brush teeth and floss.
3. Get dressed.
4. Get out the door.

Once she was out in the fresh air and on her way to the tennis court, the probability of her going back to bed was low. Encourage your teen or patient to create a routine and make it a habit. Using numbers or some type of sequence can facilitate breaking steps down to help teens get moving and begin to beat the blues. Talking or singing to themselves can be helpful because action is the name of the game. Teens that are not in treatment for bipolar disorder can get help from healthy friends, community groups, or trusted ministers.

Learn to master procrastination: Many depressed people procrastinate because their motivation and energy are low, but they can move toward creating positive energy by getting things done that they don't want to do. The trick is to set aside some time for the completion of unpleasant tasks. Wendy didn't like her history teacher, and she often arrived late to class. It was her first class of the day, so it was easy to sleep in longer. She would imagine how boring the class would be and think, "Well, I'll be on time tomorrow," but her tomorrows became a string of yesterdays, and she had a D average by the middle of the semester.

So, Wendy was to start her day by imagining how good she would feel with a B in the class. She was to schedule "History at 9 a.m." on her iPod and get to class regardless of her mood. If she was depressed, tired, anxious or unmotivated, she was to get up and go anyway. Taking charge of this problem and other aversive tasks gave Wendy positive energy and a sense of empowerment because she was taking care of business. Learning to push through lethargy is a habit that can gradually transform your world.

Bipolar II is a challenging condition, but it is treatable. Knowing the early symptoms of this condition can increase the probability of an accurate diagnosis in your teen, your patient or yourself. You can do something about bipolar, and you can get well. Remember, you are not your illness, you have an illness, and I encourage you to form mood management habits for a fulfilling life. Although social stigma may still cause considerable shame about coming forward with bipolar symptoms, you can be one of the people who seek help, and help can make all the difference in the world. Remember there is hope, there is help and it can be just a phone call away.