John,

Thanks for sharing this with us.  It is a really good example of mindfulness and making correct choices that come from experience.

Mindfulness is something that has to be developed or experienced and as you have said meditation is a tool that can help you realize the potential of mindfulness within yourself. 

Sometimes these negative thoughts can be so engrained in your subconscious, arising automatically in situations, over a very prolonged period, that you do not recognize the thought, only the emotional reaction. 

Did you remember to practice your meditation?

I am a practicioner and I believe in its benefits.  As far as mindfulness, let me share a meditation experience that illustrates witness consciousness or mindfulness.  When I meditate I use the position savasana or corpse pose.  I must set an intention to remain conscious and alert.  I have fell asleep before.  One time I was deep in meditation and I began to drift into unconsciousness.  This time was different.  As I drifted off I began to dream but I was watching my dream, my thoughts and was aware I was dreaming.  I watched for awhile and then came back out of the dream and into yogic sleep.

Sometimes, during the beginning of a meditation period, thoughts may try to intrude.  Somtimes, these thoughts can be some of the ruminating thoughts and with mindfulness they can be identified.  Meditation also takes you out of your thinking center and can give you relief from anxiety and depression.  Through the practice of meditation you can become more mindful and be more aware of your thoughts, as you have done and shared with us.

John McManamy, Health Guide

7/13/09 6:04pm

Hi, Knowthyself. I'm pretty bad at practicing meditation, but with this sciata reducing me to lying flat on my back, I now have ample opportunity. :)

Depression and CBT

I guess this was the point I was trying to drive home last week, in that if you are having a chemical depression going on...these methods rarely work. Why do I say that? In Johns case, he is not describing a chemical depression but and environmental low that even a sane person would be feeling after being hit on a few fronts.

Lets take a aka normal person and toss in a sciatic nerve pain that is there causing sever pain and lack of sleep , having a weekend where past negative feelings are brought to the forefront by family members and it being miserably hot outside causing one to retreat indoors if your lucky enough to have an air conditioner.

I can speak from personal experience in that after I was labeled bipolar...any low or high I exhibited was somehow related to my illness verses having normal feelings...especially from family members. Even when there were things going on to cause the lows and highs...it would be suggested that should I contact my therapist and psychiatrist.

But hey, we are just as bad when we label these normal feeling to our illness instead of recognizing them for what they really are and that is being human. Guess what...we are allowed to feel bad or good about events shaping our lives. If were in pain and there is a lack of sleep...were going to feel down, short tempered and a few other feelings just like anyone else in the same boat.

Go poll a bunch of people with lower back problems or ones that have constant pain and ask them where they would rate their moods. The environmental issues that John has presented can be treated with cognitive thinking to a point and tend to go away once the pain quits for the sciatic, the weather cools off for the heat and you quit speaking with family members for a week.

I guess what I am trying to say is that just because we are bipolar, dosen't mean that we don't have the same feeling as everyone else in the same situations. It also doesn't have to equate to rushing off to our therapist or psychiatrist for increased medications to solve it when these hurdles present themselves. The real things to watch for is when there is nothing going on and you go either direction to a point of causing problems.

I still cycle on medications and I know they will pass. I take advantage of the times of feeling good to complete the big tasks and leave the smaller less important ones for when I dip down. This is part of my chemical illness and not environmental.

John McManamy, Health Guide

7/13/09 6:00pm

Hi, Eric. Your interpretation of how I described my condition is totally inaccurate. I clearly stated I was in a depressive trough that was part of cycling, in which case this is part of my biology. Also, I made it clear that as of the time I was writing the piece I was miserable but not depressed.

 

My other stuff - environment, but there is little point making a practical distinction, as biology and environment are inextricably linked. Environmental stress can set off a clinical depression - the research is loud and clear on that.

 

A further complication: Environment is mediated by biology and vice-versa.

 

In a "normal" person, once the environmental situation resolves, the brain tends to reset back to normal. This is hardly the case with our population. When environmental stressors pile on, we reach overload far quicker than "normal" people and our brains tend to take much longer resetting to normal.

 

Thus, environmental becomes biological before we know what hit us. Which means we need to treat every one-alarm fire in our brains as if it were a nine-alarm fire. In my case, I spotted a perfect storm of converging events, each with a cascading effect. The events could well have overtaken me, in which case none of my cognitive tricks would have helped.

 

Fortunately, right now, I'm still miserable but not depressed. My cognitive tricks may have had something to do with it, or I may have gotten lucky. Tomorrow, for all I know, the bottom may fall out. But right now, even though I am writing this on my back, I am feeling in control. And here is the point of CBT: How does it FEEL to be in control? A hell of a lot better than not being in control, thank you very much.

MrsLKR

7/16/09 10:16am

An excellent response, John.  My husband saw a therapist who did not practice CBT for 3 years for his depression and had several manic episodes that were devastating. When he started seeing a new therapist trained in CBT, the effect was remarkable.  He has been able to control the extreme lows and has not had a manic episode in over 2 years.  As you point out, the environmental issues that a person without bipolar disorder would be able to recover from can cause him to spiral out of control.  But by being mindful of his feelings, he has been able to prevent the negative thoughts from taking over. 

 

I commend you for recognizing what was happening to you and seeking advice from your doctor, who gave you suggestions that helped you stay on track.  To anyone who believes that CBT isn't helpful, I would recommend trying a different CBT therapist. Doctors have different levels of skills in teaching and using the technique.  And there are also very good books available that help a patient understand and apply the technique outside of the doctor's office. 

 

Thank you for sharing your story and showing how CBT has made a difference in your life.

KB

7/16/09 2:42pm

I think both John and Eric have valid points.  Everyone has moods and would be affected by pain, environment, etc.  It seems that sometimes those with Bipolar need more "treatment" for the same thing that is actually normal. So while one would have a normal down day, the person with Bipolar has a trigger to thow them into something bigger.  It makes me a bit annoyed when my mood is dismissed as "its one of those times", similar to "its her time of the month" as if its not real and can be dismissed.

 

On the other hand, pain affects sleep.  Sleep depravation can cause mood swings.  "Normal people" wouldn't be affected the same way.  Bravo for John for recognizing the oncoming storm.  My own obsessive traits mean that I watch myself constantly and ask for feedback from people.  What/how would a "normal" person react in a similar situation.

 

I am currently in southern FL and recently unemployeed.  The heat is devestating and I find myself isolating.  I have a Rodney Yee video and really like it.  I know I need to meditate more.

 

Thanks to all of you for sharing!

Hopefulness

7/17/09 6:32pm

How did you prevent the sleep deprivation from sending you manic or hypomanic ? AS we know sleep loss in someone without Bipolar Disorder is more likely to make them feel low and irritable, but in someone with Bipolar it has the opposite effect and can qickly trigger mania and hypomania with euphoria, or dysphoria, irritability, and aggression, but with a decreased need for the sleep the longer it continues. IT is a very strange phenomenon. This is the opposite effect it would have in a " Normal " mood individual. How did you counteract this ? Do you think it had a slightly elevating effect as you went from depressed to miserable. Are you on the way up do you think , and are you able to spot your hypomanic signs when they emerge? My partner can not at all and refuses to consider he might be going hypomanic at any stage. He has been extremely hypomanic and most aggressive and highly irritable and activated for over 5 weeks now. This usually lasts 3-5 months in him and is not at all a leasant time for those around him, and he is very agitated whe severly hypomanic but does not quite make mania. I am tired and frustrated reading some researtch and literature playing down hypomania , its presentation and impacts,and saying it is a pleasant or short lived time. This is completely innacurate for many people especially rapid cyclers.His hypomanic episodes are just as destructive as mania and last many months, significantly underdiagnosed and undertreated,though I am disbelievd,as the symptoms are not picked up properly by his mental health team whom he manages to fool that he is well when he sees them, but they do not witness how he is behaving outside of the consultation room. This dillema is well researched and documented in some of the better more up to date research, but many websites still churn out the same old stuff and have not moved beyond old concepts and out dated research on hypomania. Apparently CBT is rarely effective for the hypomanic or manic phase as it requires insight which is generally lost during the hypomanic or manic phases but not generally actual insight is not lost in depression unless very severe or in psychotic depression.

I have manias, and like me you experience trouble with your depressions when you have what I call a "convergence" - a lot of factors at once. Your post has given me some clues about better handling my own problem.

You need to have someone at least look at that sciatica - maybe a cortisone shot? It's a terribly debilitating condition. - I've known other people that have had it.

You are handling things but obviously it's no picnic.

Hi John, I'm sorry to hear you have been having a hard time. Even when times are tough for you, you come through with help, support and reflection for the rest of us. My husband had back surgery 20 years ago and the sciatica never went away. He now has another bulging disc but surgery is not an option and he wouldn't have it unless he was bedridden for a long period of time. We have been through it all, with and without insurance. Without insurance, we could not afford the treatments suggested here. With insurance, he has found that resting and staying off his feet has helped just as much if not better than anything else. I hope you are feeling better sooner better than later. I have a very bad case of fibromyalgia, sleep apnea, insomnia and several other health problems along with the bipolar disorder. I am disabled and have been mostly housebound for about 10 years. I don't have friends anymore, I'm too much of a burden for everyone. I have never been taught CBT and don't know much about it. I have taught myself to think in a more positive way, accepting that this is just how it is, and knowing I'm doing the best I can. Little things like changing my sign in name from queenofpain to serenity helps. For the most part I can keep from spiraling down. I have found that the people closest to me affect me the most. I seem to mirror their moods. How does using CBT deal with that?