"I am afraid that I will do something I will regret when I am manic. Are there strategies that have helped other people avoid negative things from happening?"
Your mood can influence your judgement so that you are more likely to make risky decisions. You can learn a great deal from your past experiences that will help minimize the chance of this happening. Here are some questions you can ask yourself to help you with this process:
Based on your past experiences, what are the particular risks for you or what behaviour tends to become more tempting as your moods change?
What did you do that you now look back on and regret?
How did your hypomania or mania 'trick' you into thinking everything was okay and that you did not have to take precautions?
Are there some things that you can now remind yourself of so you are less likely to be mislead by the high of the mania?
What are some of the valuable lessons you have learned as a result of going through the mania or hypomania episode?
Based on your answers to these questions, what strategies are you willing to try so that you can lessen the chances of doing things you will regret?
Examples of strategies others have found helpful to help prevent risky behaviours
Implement rules that you have established beforehand with yourself and trusted others. For example, give your credit cards to someone else to hold or avoid having alcohol in the house.
Pick your battles. You can avoid some situations where confrontation is likely. See the Anger Management Wellness Module for more information on coping with irritability.
No big decisions rule. Avoid irreversible decisions.
Two person feedback rule. When you have a new idea, test out the plan with at least two people you trust. This can help you distinguish between an idea that 'feels' like a good idea with one that actually 'is' a good idea. An idea is more likely to be truly useful if two people you respect think it to be reasonable.
Sleep on it. You can use a 48 hour rule where you wait at least 2 full days with 2 nights sleep before acting on risky decisions.
Review your decision to avoid a tempting, but risky, behaviour. List cost and benefits of tempting behaviour when you are feeling well. Write this out on a flashcard to use as a prompt when you are feeling tempted.
Use imagery to foresee possible negative consequences of an action.
Use caution when acting on strong feelings. Remind yourself that even though a feeling may be very intense, it does not necessarily last very long. You might be able to wait it out.
How can I get other people to help me?
The support of family and friends can be a very valuable part of your treatment plan. You will need to decide how they can best help you. This is something to think carefully about when you are NOT experiencing symptoms.
You want to develop a set of instructions stating ways in which you and your support providers can be helpful in preventing and managing your flare-ups in symptoms.
Once you have decided on the strategies or plans you feel comfortable using, your plan can be communicated to the people you trust and that you feel will help you implement your strategies. This may include giving someone else permission to intervene or to help you when necessary. It is important to spell out your wishes in clear terms (e.g., If I have not slept more than 4 hours a night for three days, I give you permission to call my physician).
Examples of contracts for self and others can be found at:
Mary Ellen Copeland: Mental health recovery and WRAP website: www.mentalhealthrecovery.com
Massachusetts General Hospital Bipolar Clinic and Research Program website: www.manicdepressive.org
About the author
The Mood Disorders Association of BC is a member of the BC Partners for Mental Health and Addictions Information. The organization is dedicated to providing support, education, and hope for recovery for those living with a mood disorder or other mental illness. For more, visit www.mdabc.net or call 1-604-873-0103.