Balance - Developing a wellness lifestyle

Using self-help books to improve your self-esteem and change negative thoughts into positive ones
Enhancing your life with pets, music, and activities that make you feel good
Having a comfortable livingspace where you feel safe/happy Establishing a career or a vocation that you enjoy
Keeping your life calm and peaceful
Taking good care of yourself
Managing your time and energy well
Spend time with positive, affirming and fun people

There are many ways of developing this lifestyle.

Exercise regularly
Those who exercise regularly tend to cope better with stress than those who don’t. Exercise may increase your tolerance to stress and enable you to bounce back more quickly. Fit people who are under stress experience smaller increases in anxiety, muscle tension and blood pressure than unfit people under stress. Thirty minutes fast walking three to four times a week is good exercise, and swimming is an excellent all-round exercise, even for people who are overweight.

Learn to relax
Just as the stress response (when the body gears up for fight or flight) is automatic, so too is the relaxation response; but you need to practise regularly to become proficient. Effective techniques for relaxation include yoga, meditation and massage.

Meditation – how do I do it?

Find a quiet spot that has few distractions. Turn off the radio, take the phone off the hook. Make yourself comfortable, loosen any tight clothing
Focus your attention on your breathing (slowly and deeply), or on an external object such as a candle flame, or repeat to yourself a soothing sound or word (a mantra), such as ‘relax’, ‘peace’
Be passive. Let go of any distracting thoughts which enter your mind. Take your time
Set aside a regular period of time each day to practise, say 20 minutes

Maintain a balanced, regular lifestyle
This includes sufficient sleep and recreation, good nutrition and sustained periods of relaxation.

Change your thought patterns
Emphasise the positive things in your life: when a negative, critical thought comes to mind, distract yourself and think of something positive or pleasant. Know that some feelings are out of all proportion to the situation. Convince yourself that you are overreacting. Wait for time to pass, and do something pleasant and distracting in the meantime.

Face difficult situations
Allow yourself a specified period of time to deal with problems and then do something pleasant for yourself – see a film, go for a walk, read a magazine.

See the humour underlying the situation
Try not to take yourself too seriously. Those all-too-common embarrassing moments and lengthy monologues to friends about your gloom and doom can have a funny side. If you’re feeling low, see a humorous film rather than a heavy, sad one; read that light ‘escapist’ novel instead of a melancholic classic. If you are feeling high, don’t try to save the world today.

Give yourself a lift
Clean hair and colourful fresh clothes can improve flagging self-esteem.

Be assertive
A well-placed ‘No’ or ‘Not yet’ can be a real lifesaver for a frazzled, over-committed ego.

Keep track of yourself with a diary (journaling)
A diary is a form of reflective meditation. It can help put day-to-day occurrences in perspective, and give you insight into your feelings and other experiences. Put special photos, poems, cartoons, pressed flowers in your journal to make it a real haven. It can also be useful for noting down which times of the year you are most likely to be high or low.

Take an hour off now and then
Take regular ‘time out’ to walk, look at the trees and birds, take a relaxing hot bath, go for a swim. If work tenses you up, stop off at the park on the way home (or better still, collect the dog and then walk), or work in the garden for an hour after work. Insist on no distractions: this is your time to unwind.

Plan your recreation
A couple of hours of free time needn’t be spent in bed or in front of the television. With a bit of planning, you could be at the beach, on your way to the nursery to buy some plants, or sitting in the sun with a good book.

Take one thing at a time
For people who suffer from tension or depression, an ordinary day’s work can sometimes seem unbearable. When that happens, remember that the feeling is only temporary. Take the most urgent tasks and work on them first, one at a time, forgetting the rest for the time being. Once you have settled down and achieved something, you will find that the rest of your tasks will be much easier to do. If you feel that you can’t tackle things in this way, reflect. Are you overestimating the importance of many of the things you do? Can the task wait until tomorrow? Can you delegate it?

Be positive to others
Some people expect a lot from others, and then feel frustrated and disappointed when these people do not measure up to their own high standards. Remember that everyone has their own virtues, shortcomings, values and right to develop as an individual. Sometimes people who feel let down by the real or imagined shortcomings of others are really let down about themselves. Instead of being critical, search out the other person’s good points and praise them. This may ease a tense situation, rescue a relationship and, at the same time, help you gain a better understanding of yourself.

Be kind to yourself
Some people expect too much of themselves and get into a constant state of anxiety. They try for perfection in everything – an impossible task. Do the best you can, and don’t be too hard on yourself if the result isn’t perfect. Pat yourself on the back for the things you do well, but don’t set yourself impossible standards and targets for everything you attempt.

Counselling and talking treatments
Various forms of psychological therapy and counselling can help in a number of ways. They may be able to reduce emotional and relationship problems that can trigger mood swings. They may be able to help us work out better ways of dealing with the stressful events that can lead to highs and lows. They may be able to help us identify habitual ways of thinking that make us more likely to become depressed or manic and help us to organise our lives more effectively. Some talking treatments, psychotherapies, focus more on talking about feelings. Others, cognitive therapies, focus more on ways in which we think about ourselves, our experiences and other people, and which may underlie our emotions and responses. Both of these, together with more general counselling, offer an opportunity to talk frankly about our thoughts, feelings and life, in a way that might be difficult with friends and family who are close to us, and can help us develop a different perspective on our problems. As with medication, different treatments suit different people and it is advisable to find out as much as possible about any particular talking therapy.

Interpersonal and social rhythm therapy suggests that stressful life events influence the course of bipolar disorder by disrupting daily routines, social patterns, and sleep-wakefulness habits. Individuals with bipolar disorder are guided to regulate their social rhythms when stressed and to address interpersonal problems linked to the onset and persistence of bipolar episodes (Joyce and Mitchell 2004).

Recurrent episodes of illness can place a strain on your relationships. Family therapy or professional relationship counselling may be helpful for you and your partner. Professional counselling may also help you to develop strategies to handle stressful situations more effectively. Your local Relationship Services centre may be helpful.

Complementary therapies
Increasingly, people are turning to complementary therapies for the relief of physical and emotional problems. There are many types of complementary therapy available: creative therapies (like art, dance, music therapy); physical (touch) therapies (like massage, aromatherapy and reflexology); exercise/postural therapies (like relaxation, yoga and Tai Chi); and dietary/herbal therapies. Most people use these therapies as well as, not instead of, more conventional approaches. They have been described as helpful in promoting relaxation, alleviating distress, focusing the mind, taking control, self expression, and feeling peaceful. Complementary and self-help treatments for depression with the best evidence of effectiveness are St John’s Wort, exercise, bibliotherapy involving cognitive behaviour therapy, and light therapy (for winter depression). There is some limited evidence to support the effectiveness of acupuncture, light therapy (for non-seasonal depression), massage therapy, negative air ionisation, relaxation therapy, S-adenosylmethionine, folate, and yoga breathing exercises (Jorm et al. 2002).

Light therapy
Seasonal Affective Disorder (SAD) commonly known as the winter blues is a particular form of depression (or bipolar depression) that affects people to varying degrees during winter. It can be a problem in up to 10% of the population (USA and UK). SAD is recognised by the DSM-IV, a manual that assists with the diagnosis of illnesses like depression. Symptoms often begin in late autumn or early winter and cease in spring.

Typical symptoms are:

Changes in sleep patterns, particularly difficulty in waking, or reduced quality of sleep
Changes in eating habits, particularly weight gain and a craving for sweet or starchy foods
Depressed mood
Irritability
Decreased energy levels
Decreased socialising
Decreased sex drive
Decreased concentration

Light treatment has been shown in many studies around the world to be effective in alleviating or completely curing the effects of SAD (Golden et al. 2005). Light levels need to be between 2500 and 10000 lux (much higher than standard room lighting of 500 lux). It can be used instead of, or in conjunction with, drug therapy and has many advantages over other treatments:

It is non-invasive, benign, and cheaper.
It has only occasional mild and temporary side effects which might include a slight headache, nausea, sore eyes or feeling agitated.
It is fast acting – benefits are typically noticed within 4 days (although it can be up to three weeks).
It has a high success rate (typically 50-80% of SAD sufferers respond dramatically).

Financial issues
Many people who have an episode of mania spend lots of money during this episode and may face large debts when they recover. This can be disastrous for families and spouses, whose own life savings may also go down the drain. If this is a pattern, it may be necessary to protect large sums of money from manic sprees. Here are some ideas:

Put money in accounts that require some notice before withdrawal is possible – such as short-term investment accounts needing three months’ notice.
Limit the number of credit cards one has – especially bankcards and store credit cards
Put property in the names of more than one person so that there is a potential veto when one person becomes manic
Avoid joint accounts

Some people with bipolar disorder also find it difficult to continue to work when depressed. Talk to your employer about the options if you become too unwell to work for a significant period of time (i.e. longer than your sick leave allocation). Work and Income Services may be able to assist financially.

Self care for family and friends
Sustaining an appropriate level of involvement with an ill child, parent, sibling, spouse or friend is extraordinarily difficult. It is very important that family and friends apply the self care or the principles of keeping well within their own lives. Pain, powerlessness, shame, guilt, confusion, fear, disappointment, exhaustion, and frustration are common emotions among friends and families. It may be useful to think in terms of the wisdom of the 4 Cs, ‘I didn’t cause it, I can’t control it, I can’t cure it so all I can do is learn how to cope with it’.

Family and friends must somehow negotiate the issue of how to maintain closeness and distance when someone they love has bipolar disorder. This is the puzzle of how best to draw the line between themselves and the person who is unwell. Eventual recognition that a family member’s illness may continue well into the future may provoke feelings of sadness, but also anger and resentment. These feelings need to be dealt with. In the extreme case, family and friends may have to be reconciled with hating someone they also love (Karp 2001). Family and friends need to take good care of themselves to be able to care for their loved one. Family and friends cannot take responsibility for the decisions or actions of the person with bipolar disorder. Learning to accept the things that can be changed and to let go of the things that cannot is important.

Peer support groups
‘What is Peer Support? Peer support is not like clinical support, nor is it just about being friends. Unlike clinical help, we don’t really think of each other as sick and in need of constant professional help, but instead, we understand each other because we’ve “been there,” shared similar experiences and can model for each other a willingness to connect. In peer support we come together with the intention of changing our patterns, getting out of “stuck” places, building relationships that are respectful, mutually responsible, and potentially mutually transforming. Instead of taking care of each other and thinking of each other as “sick,” we support and challenge each other and build mutually responsible relationships … the primary goal of peer support is to fully respect the individual process of change, yet responsibly “challenge” one another when we feel like we’re incapable and stuck. This means validating each other for our “personhood” rather than our “patienthood,” and leads us to see each other’s behaviour through the lens of personal experience rather than through the lens of illness.

Finally, peer support offers a culture of health and ability as opposed to a culture of illness and disability (Mead 2005).’

Not everyone wants to talk about their experiences, especially when they are well. However many people find it helpful to attend a support group to share their own feelings and to listen to, learn from and support others.

The groups in Christchurch and Dunedin got going when a few patients and family members who had attended education courses at the local psychiatric hospital advertised in the newspaper for other interested persons. Groups were formed out of which self-help support groups were set up and started meeting regularly. A separate group for family members/friends was also started. In our experience, membership of a support group for this disorder can fluctuate considerably. Some people will attend only once or twice.

If you would like to find out about support in your area contact Balance NZ – Bipolar and Depression Network as they work to encourage the development and growth of bipolar and depression support groups in New Zealand. They can be contacted at http://www.balance.org.nz/ or Tel: 03 366 3631. The mailing address for postal enquiries is PO Box 13266, Christchurch 8141.

Check with your local community mental health services for a list of any support groups they can identify. If there is no local support group near you, you might consider starting one yourself. Look for any local mental health consumer groups that you might be able to gain the support of, or work with, to start a group.

If there are no local mental health consumer groups, it may be easier to keep a group going if help and continuing support can be obtained from a mental health professional even though these people need not be involved in the group itself. There may be an education course at the local psychiatric unit – a good starting point. The group might be able to meet in hospital-owned premises.

The use of a room in a building where other activities are taking place would avoid loading the responsibility on to one person to be available at every meeting to open up premises and lock up afterwards.

A letter to the editor of the local newspaper or advertisements could make known your wish to set up a group, or inform others of its existence.

Advise the Citizens Advice Bureau in your area of your group’s existence, giving a contact, and also tell local mental health professionals (inpatient, outpatient and community mental health services, GP practices) who would be willing to tell people about the group.

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