my bipolar disorder

Tag: mindfulness

  • Caring for Relationships

    One of the most important aspects to care for when dealing with bipolar disorder is our relationships with other people, especially those close to us. There are many books that touch on the subject of relationships, and one of them is Nonviolent Communication by Marshall B. Rosenberg. Few books offer such simple and universal tools that can help not only in resolving conflicts in marriage and friendships, but also between groups.

    This post is dedicated to discussing the techniques from that book, as well as the essential thoughts and reflections it contains.

    Principles of Nonviolent Communication (NVC)

    This technique is based on expressing your needs and feelings in difficult conflict situations—or in situations where you feel that what you say might spark an argument. The author even goes so far as to claim that this technique can be applied to any situation where needs—yours or someone else’s—are unmet. The problem is that we are often unaware of our own or others’ needs and instead focus on blaming the other person. We want to force the other person to do or not do something, without actually sharing what we feel or need.

    NVC consists of four sequential steps:

    1. Identify and inform about the situation that is affecting you.

    2. Express how you feel in response to what you observed.

    3. Articulate the need that is the cause of your feeling.

    4. Ask for specific actions that would enrich your life.

    Let me give an example from my everyday life—a situation that remains a puzzle to me—and show how to use this method to handle it.

    When my husband plans an online, hours-long gaming session with his friends in the evening, I feel both angry and sad. I feel overlooked, unimportant, secondary. I don’t like that game and think spending so much time on it is a waste; I feel like he could be doing something more useful. I don’t get angry when he goes to a workout and comes back late—I consider that constructive. When he plays alone, I see it as relaxing. But when he organizes sessions, it seems to me that he’s seriously investing in something I just think is just silly.

    Here’s how I could say it to him using NVC:

    “When you play those online sessions with others, I feel angry. I need to understand and accept why you spend so much time on it and what playing with others gives you. Could you explain it to me in detail and share what it brings to your life?”

    You can go further and ask what your conversation partner feels or thinks in relation to what you said, and whether they’re willing to do what you’re asking.

    NVC in action

    Some time ago, I was walking to the store with someone close to me. Just before entering, a car began reversing slowly and clearly didn’t see us in its path. It kept moving towards us. I stepped aside slightly and pulled on the sleeve of the person I was with so they wouldn’t get hit. But that person reacted by walking up to the car, leaning on the hood—basically lying on it—and started yelling at the driver. From my perspective, it looked very aggressive. I firmly grabbed their sleeve and dragged them into the store.

    Inside, I was trying to figure out how to express the stress, worry, and fear I felt and fearing the situation could repeat. I mentally crafted a sentence based on NVC and, like a robot, without knowing how it might help, I said this after we left the store:

    “When you started yelling at the driver, I felt really scared. I want to feel safe with you—can you not do that again when I’m around?”

    The response surprised me:

    “Oh, I didn’t know. I’m sorry. I won’t do that again when you’re with me.”

    I expected a defensive reaction: “the driver was an idiot, they need to learn how to drive”, etc. But to my surprise, NVC worked. I was understood, and my needs were acknowledged.

    What causes my suffering

    When we begin to honestly express what caused our sadness, we might realize the statement doesn’t actually refer to the person who “caused” the sadness. For example, when I had a friend over and she said her other friend’s house was beautiful, I could say:

    “When you said your friend’s house is beautiful, I felt sad because I thought mine must be ugly. I need acknowledgment for the effort I put into decorating my home. Can you tell me what you like about it?”

    But this doesn’t quite make sense, because that person didn’t actually say anything negative about me. It’s my own thinking— am responsible for feeling bad. And maybe it’s always like that. After all, my husband playing games isn’t malicious, and even yelling at a driver in my presence wasn’t aimed at me. The book emphasizes: we are responsible for our own feelings. The proof is simple—each person reacts differently to the same situation. I know someone who can stay calm and have a dialogue even when being cursed at. What someone else does might trigger a reaction in us, but it’s not the cause of that reaction.

    Judgments, labels, and comparisons

    NVC leaves no room for judging others—either positively or negatively. Judging attitude only leads to conflict. It is destructive to us (when we live with those thoughts) and it damages our relationships. Comparison is a form of judgment—we evaluate ourselves and others. It’s pointless and gives nothing, and that alone is enough reason to drop the habit entirely.

    Acting based on judgment triggers a defensive reaction from the person being judged. If they give in to our demands, it’s often out of fear or guilt. For example, if I said to my husband:

    “I’m angry because you waste so much time on those games—you could be doing something valuable instead, and you’re not even spending time with me.”

    That’s what usually comes to mind first. But in this version, there’s blame, an accusation of wasting time, and a guilt trip. If my husband stopped playing after hearing that, it would be against his will, he’d feel bad, and our bond would weaken.

    Feelings

    Recognizing feelings is a challenge, also common in mindfulness (which I wrote about in another post). Most people don’t have this skill. It’s very difficult. It helps to download a list of possible emotions and keep it handy, trying to identify your feelings often. You can practice it through short (3–5 min) meditations during the day (3 times or more). In these meditations:

    1. Assume a posture of dignity (close your eyes).
    2. Become aware of your surroundings and what you’re experiencing.
    3. Acknowledge your current thoughts.
    4. Name what you feel.
    5. Focus on your breath (for a while).
    6. Focus on your breath and your body as a unified whole.

    Practicing this regularly builds the skill of recognizing feelings, so when a crisis hits, we’re more likely to express what’s really going on inside us.

    Empathy

    When we can express our feelings in a way that connects with our needs, it becomes easier for others to show empathy. In the gaming example, I connected anger with a need for understanding—but maybe frustration or even aversion would have been more accurate.

    To recognize our own feelings and needs, we need self-empathy—but we can also show empathy to others, even when they don’t use NVC and are overwhelmed by sadness or rage, shouting insults, using verbal aggression, or showing disrespect.

    In those moments, we still follow the four steps, only this time we guess the other person’s needs—and even if we guess wrong, just trying helps defuse the situation.

    In lighter moments, when someone expresses sadness, we might think giving advice or encouragement is empathy—but it’s not. For example, this morning I saw my husband was tired and said:

    “Maybe just take it easy today—when I’m tired, I slow down and do less.”

    Now I see how unempathetic that is. I hate when people say that to me, yet I do it myself. According to NVC, I could’ve said:

    “I see you’re really tired. Maybe you’re feeling overwhelmed? Maybe you need relax after work? Is there something I could do to help you with that?”

    You can apply the same approach to someone reacting with anger or unable to manage their frustration.

    Listening for others’ needs is an act of empathy that can effectively heal relationships. When we can’t show empathy because we’re sad, angry, etc., we can still use the four steps of NVC (expressing our feelings and needs to the other person).

    Violence (lack of empathy) can also be directed inward—and it’s common. The book says that words like “I must” or “I should” are forms of self-violence. Focusing on our needs is the key to using “I want.” We are trapped in patterns of doing things for rewards. This leads to self-discipline, expectations, and forcing ourselves. But if we find joy in everyday tasks and want to do them because they meet our needs and feel good, it comes with a relief.

    Being disconnected from our needs and feelings can lead to self-criticism and even depression. Deep listening and compassion toward ourselves can be trained through mindfulness.

    I often have flashbacks of past mistakes. I feel shame, anger, and immediately aversion—I don’t want to feel those emotions. But thanks to meditations (focused on working with aversion), I suddenly listened to my feelings, felt them in my body, and unexpectedly felt sorrow and care—for myself. Compassion. That helped me cope with those memories.

    NVC in Practice

    When using NVC (observation → feelings → needs → request), we can speak slowly and give ourselves time to form our thoughts into words. If we don’t give ourselves enough time, even if we’re thinking about the steps, everything might suddenly pour out of our mouths — and not in the way we would like.

    Sometimes we might think, “I’m so angry, I don’t care about this NVC stuff, I just don’t have the energy for it!” But try following the process a few times in less intense situations, and you’ll probably never want to handle things any other way. That’s because it’s incredibly effective.

    To use NVC effectively, you need to deeply understand each step and have the right intention while applying it. We can’t just wrap our words in NVC language if, deep down, we are judging, demanding, ignoring others’ needs, and blaming them for our suffering.

    Arguing

    The book emphasizes the importance of focusing on the present moment — the feelings and needs that exist right now — instead of explaining who said what and who did what in the past. I often find myself stuck in conversations like: “But when I said this, you said that, and I didn’t say this before that.” Then I hear: “No, I didn’t say it like that at all,” and I go: “I don’t remember exactly what you said, but I meant this…” This can go on forever, and 100% of the time, neither of us remembers exactly what was said or how it was said 5–10 minutes ago. On top of that, everything is clouded by the emotions of the present moment. That’s why we should talk about what we feel and need right now — because that’s all that really makes sense. Plus, bringing up past events is usually perceived as criticism, which triggers a defensive response. It’s pretty clear that this leads nowhere.

    Summary

    I highly recommend reading the entire book from cover to cover. This post is an essence — in my opinion — of what I’ve read there. Other parts of the book may resonate with you more deeply. What struck me the most is how magically it works — and not just in conflicts. Thanks to tuning into the needs of others in everyday conversations — whether about flowers, weather, sleep, or illness — my relationships have significantly improved. I’d even say they’ve transformed into something different, better, and more fulfilling.

    – Agnieszka

    *The information and comments in this post do not constitute medical advice. The author takes no responsibility for any use of them.

  • Anchoring – routines

    And here comes yet another method of coping with bipolar disorder. Sometimes it feels like there’s no end in of it. No end in terms of how we can help ourselves, and no end to our personal growth. I’d put it this way: it’s a steep, massive mountain with no visible summit, but the view just keeps getting better while we climb.

    In this post, I’ll focus on introducing routines into daily life and their beneficial impact on people living with bipolar disorder (BD).

    Interpersonal and Social Rhythm Therapy

    IPSRT (Interpersonal and Social Rhythm Therapy) is a therapeutic method dedicated to individuals with bipolar disorder. It focuses on increasing awareness, understanding the illness, supporting pharmacological treatment adherence, and—most importantly—introducing daily routines aimed at improving quality of life and achieving remission. The therapy is based on the assumption that vulnerability to manic/depressive episodes is genetically linked to sensitivity to disruptions in circadian rhythms and a heightened susceptibility to neurotransmitter system imbalances. Hence, introducing routine helps stabilize the system, as studies have shown [1].

    Additionally, maintaining a daily routine and observing its effects gives patients a sense of control over the illness, motivating them further, as they feel it’s not just about taking medications. Routine also clearly improves the quality of life for those with BD—and the benefits extend to other groups as well, like the elderly.

    The Power of Routine

    At first, I thought routine would help me catch subtle changes in mood—if I do the same thing at the same time every day, it’s easier to spot a shift. And that’s true. But it turned out that routine is even more powerful than that. Since we perform the same activities regardless of our mood, they bring us back to balance. In other words, they anchor us, form a base, and restore equilibrium.

    It’s not entirely clear how this happens. Take my own example. I dedicate up to an hour a day to physical activity. On off days or after a sleepless night, I’ll at least go for a walk. Walking makes me feel better physically – I feel the blood flow. Especially in the forest, it calms me down. Recently, I was feeling really low and couldn’t find anything to boost my mood. But I kept my routine and went for that walk. It brought me back to default settings. I returned home feeling slightly better and satisfied that I fulfilled the routine. This applies to every habitual task—even brushing your teeth. My morning routine, ending with a five-minute meditation, really wakes me up, no matter if I’m anxious, sad, or agitated.

    Routine in Treating Depression

    The book The Mindful Way Workbook [2], which I mentioned in another post, also emphasizes the importance of daily routines. It offers a system for recognizing mood decline and managing it through routine tasks. It distinguishes between two types of daily activities: those we enjoy and those we are skilled at (which give us satisfaction). It sounds simple, but without a structured set of routine tasks, motivation can be hard to maintain.

    Pleasure that requires little effort could mean a bath (it is a part of the daily routine) or yoga—not buying something, eating chocolate, or drinking beer. An activity we’re skilled at might be cleaning or cooking. We know how to do it, it’s not hard, maybe not fun, but completing it gives us a sense of satisfaction and brings us closer to balance. This mainly applies to depressive states, but these same tasks can help calm us or ground us when we’re overstimulated (in hypomania).

    Well-Being

    Research on improving the lives of people with bipolar disorder highlights four key factors [3]: a regular daily rhythm and meaningful activities, overcoming stigma through social connection, reclaiming a positive identity—especially through work and better understanding of the illness to support self-management.

    Here, we focus mainly on the first aspect. The research emphasizes the importance of a fixed daily schedule—especially concerning meals, taking medication, and sleep. It also suggests that having a job is a good motivator for patients.

    From a mindfulness perspective, I don’t fully agree with that last part. If someone replaces a job with another routine, it can work just as well. Thinking that job is the only path to meaning or purpose in life may feel like a trap for some people. The article, based on interviews, suggests that constantly staying busy to avoid thoughts is a good thing. I disagree again. Mindfulness teaches us something else entirely: how much we can discover by simply doing nothing, and how comfortable we can become with ourselves through awareness practice (like meditation or mindful everyday tasks).

    Routine also creates a sense of safety, stability, and certainty—something people with BD frequently emphasize. They say they can manage and ease their symptoms better through regular practices like meditation, yoga, walking, or cycling.

    An examplary Daily Routine

    As with everything, building a routine should happen gradually. Too many expectations at once (a rigid, packed schedule) can quickly kill motivation. Your routine must suit your unique needs and our body—and that’s something you learn over time. It’s important to match expectations to what’s realistically doable, not what we imagine is ideal. Every day is a new beginning. Falling out of routine due to travel, a bad mood, or illness should not mean we abandon our routine but that we keep working on it.

    People on medication often struggle with getting up. A morning routine—a sequence of actions—can help. An example could be: meds → coffee and relax → refresh → tidy up → meditate. It’s helpful if your routine includes something you look forward to, even the night before—it makes waking up easier. Once the sequence is complete, you feel awake and ready for the day. Similarly, an evening routine helps wind us down, for example: bath → yoga → meditation → reading.

    I’ve noticed I’m more easily thrown off balance without my morning and evening routines. Sometimes, news or emotional events would disrupt the peace I’d built. But starting over with the routine helps bring me back to abalanced state.

    You can begin by building a short morning and evening routine, and then add things like regular meals and daily physical activity. Weekly recurring tasks like shopping or cleaning can follow.

    A clean, simple app called “Structured” can help. You can enter specific tasks, set their durations, and arrange them throughout your day, with colorful icons and a timeline. A nice touch is being able to check off completed tasks. And it’s free.

    Is Routine Boring?

    You could say that doing the same things over and over makes life dull. People with BD often crave change. In hypomanic and manic states, our neurotransmitters thrive on novelty. But is that really good for us? That’s something to consider while euthymic. Changes can overstimulate us and make things worse.

    Over time, you can learn to maintain a routine while occasionally mixing in events like travel or late nights out, without disrupting the whole routine. You can adopt a minimalist version of your routine—for example, while traveling: take your meds, brush your teeth, wash your face, and get dressed—in the same order. Before a night out, you could do part of your evening routine (e.g., bath, yoga, meditation). Big life changes like pregnancy, changing a job, or hospitalization can be supported with smaller, adjustable routines that don’t overwhelm you.

    Personally, I don’t feel bored with my routines anymore, because the activities I choose are interesting, slightly stimulating, and enjoyable. Like trail running—you can change the route, intensity, or type of workout. While playing the piano, each time I can learn something new or improve a piece. And meditation often considered passive—is actually one of the most intense experiences – thoughts race, emotions rise, tears or profound joy and peace.

    Sleep Inertia

    A scientific article on sleep inertia in people with bipolar disorder [4] identifies it as a comorbidity. Sleep inertia means lingering grogginess and disorientation for hours after waking. One strategy for managing it is the “RISE-UP” routine, which involves: resisting the snooze button, increasing physical activity (light stretching/exercise), splashing cold water on the body or face, exposure to sunlight, listening to upbeat music and performing a simple task.

    It’s a bit demanding. Personally, I don’t think I could follow such a strict routine daily—it feels like military training. But it’s generally known that skipping snoozing and getting some light movement in the morning does help.

    For people with BD, this routine might be too intense. Easy to suggest, hard to do. So I encourage more compassion to ourselves and customization to own needs. If giving up snoozing feels like having the covers ripped off you and is deeply uncomfortable, allow yourself to keep it. Try shortening it, or limit to three snoozes instead of ten. If cold water feels like punishment, skip it. Take a warm shower and do light stretching instead.

    I once tried placing my alarm in the shower to force myself to get up and take a shower right away —it didn’t work, I just went back to bed. Eventually, I found a blog where someone described how having a detailed morning routine helped them wake up. Once you start the first task, you’re already with the current and it’s easier to keep going.

    RISE-UP has shown effectiveness in bipolar disorder (though long-term studies are lacking), so if you like it—go for it.

    Summary

    Routine can truly work wonders. It’s another tool—among many I’ve discussed on the blog. Most of them support one another. For example, routine can make taking medications, automatic, reducing the stigma of being sick. And in the spirit of mindfulness, routine can even become a meditative act that restores a neutral or even pleasant emotional state.

    There is a time for everything, and there’s no need to try everything at once. I started with medication, then moved on to behavioral therapy, followed by mindfulness practice. I gained additional skills through various books (some of which I mention on the blog), and eventually, I began implementing routine. The results have been incredible—especially according to my loved ones. I don’t have the distance to see all the changes myself, but I’m glad they notice and appreciate it, as it makes their relationship with me easier.

    – Agnieszka

    *The information and comments in this post do not constitute medical advice. The author takes no responsibility for any use of them.

    [1] Frank E., Halastala, S., Ritenour, A., Houck, P, Ming Tu, X., Monk, T.H., Mallinger, A.G., Kupfer, D.J. Inducing Lifestyle Regularity in Recovering Bipolar Disorder Patients: Results from the Maintenance Therapies in Bipolar Disorder Protocol. 1997.

    [2] Teasdale, J., Williams, M., Segal, Z. The Mindful Way Workbook: An 8-week Program to free yourself from depression. 2014.

    [3] Jupille, J., Harscoet, J.A., Duval, M., Grall-Bronnec, M. Moret, L., Chirio-Espitalier, M. “What makes you well?” Supports of well-being in bipolar disorder. A qualitative study. 2023.

    [4] Kaplan, A.K.,Talavera, D.C., Harvey, A.G. Rise and shine: A treatment experiment testing a morning routine to decrease subjective sleep inertia in insomnia and bipolar disorder. 2018.

  • In search of a guidance

    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.