Can I help myself somehow? Is there anything else I can do, and most importantly — do I want to do something? Is it worth the effort, are there tangible benefits?
Yes, yes, and yes again.
This post largely discusses issues covered in the book The bipolar workbook. The book can help you identify signs of upcoming mania (or hypomania) and depression, offers strategies for managing them, and suggest how to prevent them from developing. It’s a second essential resource alongside The mindful way workbook, which I mentioned in my previous post. This post will also touch on behavioral therapy, which brings the techniques described in the book into practice.
Medication isn’t everything
Medications for bipolar disorder aim to correct the chemical imbalances in the brain that are typical for those diagnosed with the condition. These drugs either stimulate or inhibit the release and activation of certain neurotransmitters. Therapy, meditation, yoga, and self-development are all valuable supports to medication. However, if the medication isn’t properly adjusted, we might feel disappointed because we won’t experience the benefits of those techniques—or we may find them difficult to apply.
Treatment usually evolves over a person’s lifetime, or at least much of it. That’s why there’s no reason to delay implementing non-drug methods as important support for medical treatment.
Medication alone is often not enough, and without the help of the methods listed above, it’s easy to feel lost. You might not even realize where you are mentally or emotionally. And if we can’t give our doctor accurate information on our state in critical moments, how can they react in time? Usually, it’s already too late. We’re back on the rollercoaster, needing hospitalization or waiting weeks or months to stabilize.
Behavioral techniques and meditation can actually prevent the need for constantly changing medications—because they help stop symptoms from progressing. The bipolar workbook by Monica Ramirez Basco emphasizes that we do have influence—through something as simple as self-observation and a well-matched response. The book also makes it clear: medication can’t fix everything. Our own initiative can truly change our lives.
“Boxes”
Motivation can be hard to find. Denial of the illness, frustration over daily medication, adopting the attitude of “I don’t want anything to do with this,” or simply feeling defeated—thinking, “I can’t do it, I’m not strong enough, this isn’t for me.”
First, there’s classification—“boxes,” or mental categories. These may sound like labels we stick on ourselves, but they can be incredibly useful. Once something is categorized, we can apply the appropriate techniques for that specific state. While this isn’t perfect—our mental states are often mixed and complex—there are certain common trends among people with bipolar disorder. Once we identify the right “box” we pull out a method (often developed with a doctor), and we apply it. This methodical approach is extremely effective. A well-organized mental “dresser” with a few key drawers can be life-changing.
We categorize our states as: mania, hypomania, mixed states, euthymia (a neutral state), mild depression, major depression, and psychosis. Each of these requires several symptoms to be present. Except for euthymia, you should pay attention to how far your symptoms deviate from your neutral state—which is why it’s crucial to identify your personal baseline.
Mania
Manic symptoms include euphoria, irritability, inflated self-esteem, needing little or no sleep, excessive talking (often looping or jumping between topics), racing thoughts, auto-aggression restlessness or agitation, and reckless decisions or behaviors. If at least three of these symptoms (or four if irritability is one of them) persist for several days, it’s time to be seriously concerned.
Hypomania
Hypomania is a milder form of mania. It helps to have personal markers to recognize it early. For me, it’s things like taking turns more dynamically when driving or cycling, or shopping and traveling more often. Catching hypomania early and responding appropriately can prevent mania. In my case (though this is very individual), I notice slight shifts around June—so, with my doctor, we make small adjustments to my meds to avoid a manic episode in the fall. Knowing your own seasonal patterns can be very helpful.
Depression
Symptoms of major depression include sadness, loss of interest or pleasure, changes in appetite and weight, sleep disturbances, psychomotor agitation or retardation, persistent fatigue, feelings of worthlessness, trouble concentrating or making decisions, and suicidal thoughts. At least five of these need to be present for about two weeks to formally diagnose depression—but that doesn’t mean you should wait two weeks to seek help.
Psychosis
Psychosis involves seeing or hearing things that aren’t there, delusions of grandeur or paranoia. In such cases, doctors typically prescribe antipsychotic medications like quetiapine, olanzapine, or haloperidol. These are also sometimes used in manic states or taken long-term for their stabilizing effects.
It’s not easy
Extreme states are usually accompanied by serious sleep disturbances. That makes it difficult to stick with plans, pursue hobbies, or even complete basic tasks at work or in personal life —because just when things are going well, we are sleep deprived, and everything gets thrown off.
When I tell people I have bipolar disorder, they often say, “Oh, so you’re just happy one moment and sad the next, right?” Unfortunately, most people don’t understand the true nature of this condition, which makes genuine empathy hard to come by. Only we know this isn’t just a mood swing—it’s a series of challenges that interfere with our life.
Episodes of hypomania and depression often seem to come out of nowhere, but they can also follow seasonal patterns. External factors like stress, travel, major changes, or significant events can trigger episodes—especially if we don’t know how to recognize or respond to them.
Sometimes, it’s our loved ones who first notice something’s wrong—but by then, it’s already too late. That’s why it’s the subtle, seemingly minor changes in mood, sleep, or energy that serve as early warning signs. Catching these signals ourselves is essential. Tools like mood journals help. A great free app for this is “Dalio”—it’s user-friendly and visually pleasant.
Journaling is another valuable habit. Writing regularly forces self-observation, increases self-awareness, and helps you analyze and learn from your patterns. Apps like “Stoic” for Apple devices, or even a physical journal, can work great.
Even when you’re doing everything right, the illness can still surprise you. But the fact that you’re on alert helps you recognize when something’s not right.
What do I do with all this?
The book lists many symptoms of mania and depression that you can relate to. In practice, it’s helpful to come back to the book often, and pair it with meditation (which I covered in a previous post).
First, check whether you do anything that might be making things worse—like skipping medication, overexertion, rumination, or overstimulation from noise, light, crowds, or malls.
The book emphasizes recognizing emotions and bodily tension. These are key elements in mindfulness. The author recommends a scale to help decide when to observe, when to act on your own, when to contact your doctor, or when to go to the hospital—depending on symptom severity. The book helps you build a custom plan that matches your personality, capabilities, and specific condition. It includes exercises for deeply understanding your disorder. The idea is: read, apply, read, apply—on repeat.
Acceptance
In the first few years post-diagnosis, when medication stabilizes you and you enter a neutral state, many people feel like they’re no longer themselves. They miss the elevated mood and see the neutral state as negative. Of course, in hypomania we’re sharp, social, and full of energy—but does that truly define who we are? Or are our values more important—values that aren’t dependent on our state?
Motivation
You could definitely say the book is a user manual for the illness. Reading it—and doing the exercises—is the first step to a better life with bipolar disorder. As with most things, it all looks great on paper, but real progress comes only from your own effort, brick by brick.
The book is practical and includes exercises—but often, we read it, feel inspired, and then forget about it weeks later. For those lacking motivation or follow-through, behavioral therapy is a natural continuation of the book. For others, it becomes clear that therapy is the next step.
Just like with medication, your behavioral therapist (emphasis on behavioral) should be well-reviewed or personally recommended. Timing is important—forcing therapy at the wrong moment can backfire and close you off to it in the future.
Behavioral therapy
This post is less scientific than the last two, because the book already covers most of the topic. Most academic articles focus on neurotransmitters, meds, or mindfulness—but I found one valuable, on behavioral therapy: Cognitive-Behavioral Therapy for Bipolar Patients by Mario Francisco P. Juruena (2014).
The article argues that therapy’s first goal is helping the patient stick with their medication. As I mentioned earlier, the biggest early win in therapy is acceptance of the illness—and with that, acceptance of treatment. Other goals include early symptom recognition, stress and lifestyle management, addressing coexisting conditions like panic attacks, social anxiety, or addiction, and managing depressive episodes.
The author suggests that each new episode (mania, depression, mixed states) is an opportunity for growth—if we don’t seek them out, but use them to learn and improve. Therapy isn’t just for the individual. Family members are encouraged to attend one or more sessions, which helps them respond with more empathy. For example, when a loved one sees the patient isn’t sleeping, they may try to force them to sleep out of concern. But this often backfires—causing guilt and frustration. In the U.S., Family-Focused Therapy (FFT) is a common practice. Full family involvement ensures proper support. Don’t hesitate to invite someone close to attend a few sessions with you.
The article also explains that many patients regret things they did during mania or hypomania for years. They may struggle to forgive themselves or lose important relationships. Therapy also helps with this.
As with many illnesses, patients often want to avoid learning about their condition—they minimize it or reject it, which can be self-destructive. This, of course, is heartbreaking for families. Therapy’s role is to break that wall and show that it’s not as scary as it seems.
The article outlines therapy goals such as teaching patients to respond effectively to symptoms without always needing med changes. Behavioral therapy operates on multiple levels: doing exercises in sessions, completing homework, and having real conversations with the therapist. You build tools for stress, problems, decisions, addictions—and learn how to take care of yourself in any situation. It’s all about changing thought patterns and utilizing new tools.
Summary
The book, paired with behavioral therapy, opens eyes to a whole new world—a world of possibility, growth, and belief in change.
Daily routine is also very effective in self-observation, early symptom detection, and overall stability. When we repeat certain activities, it’s easier to notice shifts over days or weeks. This can be a morning routine before work, consistent workout days, or even a full daily schedule. In the next post, I’ll focus on the powerful role of routines and healthy habits in everyday life.
– Agnieszka
*The information and comments in this post do not constitute medical advice. The author takes no responsibility for any use of them.