Welcome to Bipolar in Focus, I'm Jane Pauley. We all have things that set us off. And for people with bipolar disorder, those same things can trigger mania or depression.
Psychologist Xavier Amador, is with us. They are known as triggers when they are applied to bipolar but they literally are the same things that set us all off and what does happen?
What happens is that the chemical reaction to stress which is stress hormones which includes what's called sympathetic arousal, it' our autonomic nervous system.
It produces adrenalin which in term produces norepinephrine which is a chemical messenger of the brain. Where am I headed? Norepinephrine is implicated in mania; it's also implicated in depression.
So for somebody with a vulnerability to bipolar disorder, these chemicals have a different impact on the brain.
What can constitute a trigger?
There are really at least three types external, interpersonal and internal triggers. The external triggers are typically those things that stress anybody out like a divorce or getting fired or even moving.
So interpersonal triggers like having an argument with your wife or with your teen is one of those external triggers that need to be paid attention to and responded to.
The internal triggers are very different. There are the ways we think about ourselves,
that kind of negative thinking that many people especially with during the depressive episodes of bipolar disorder are struggling with where in simple terms we're beating up on ourselves.
Do you have any control of?
Absolutely. I mean that's the good news. There are two main things you can do. One is learn the things that you can personally do.
Cognitive behavioral therapy, if you've never gone through it, is a really good set of tools that you can learn to manage stress to reduce the chemical impact if you will,
the stress hormones, the norepinephrine et cetera that's created by stress.
Then the other thing is to make sure that your medication for the bipolar disorder itself is where it should be,
that you're in a stable condition because if you're medicated appropriately, you actually are protected. It does protect you from stress, somewhat.
Does it take a person of tremendous insight to recognize their own triggers or is it really pretty obvious?
No, but it takes somebody who is mindful and takes the time to write them down. And I do this with my patients,
"We'll go through, what are your triggers? Let's write them down together and keep the list and look at it."
Learning what your triggers is the first step and then developing strategies for avoiding those triggers if you can, is the second step because oftentimes we think in ways that increase the stress.
What do you mean?
There's an acronym cognitive therapists use. It's "Catch it, Check it, Change it", and what that means is catch the thought.
So let's say I've had a spat with my wife and my thought is, "I'm just a bad husband". And I catch the thought, "Okay, I'm a bad husband. Check it out." "Am I really? What would she say?"
And when I check that out, I'm fortunate. My wife would say, "No, you're a very good husband." And then I change the thought. "Okay, in fact I am a good husband."
This is a very simple technique that you can learn.
Cognitive therapy is a very powerful tool for reducing the stress that's caused by those triggers you cannot avoid.
Dr. Amador, thank you very much and thank you for watching Bipolar in Focus.