The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder

1. Understand Bipolar Disorder: A Spectrum of Mood States

Bipolar disorder is a biological illness that causes unusual shifts in your mood, level of energy, and ability to function in different aspects of your life (for example, working or going to school, taking care of yourself, and maintaining relationships).

Bipolar disorder is complex. It involves fluctuations between extreme mood states, including depression, mania, hypomania, and mixed episodes. These mood shifts can significantly impact a person's ability to function in daily life, affecting relationships, work, and overall well-being.

Key characteristics:

• Depression: Persistent low mood, loss of interest in activities, changes in sleep and appetite
• Mania: Elevated mood, increased energy, decreased need for sleep, impulsive behaviors
• Hypomania: Similar to mania but less severe and without psychotic features
• Mixed episodes: Simultaneous experience of both manic and depressive symptoms

Treatment approach: Bipolar disorder is a lifelong condition that requires ongoing management. The cornerstone of treatment is typically medication, often combined with psychotherapy and lifestyle modifications. Understanding the nature of the illness and recognizing personal patterns of mood shifts are crucial for effective self-management and prevention of episodes.

2. Practice Mindfulness to Increase Self-Awareness and Emotional Control

Mindfulness has been defined as purposely paying attention, in the present moment and without judgment (Kabat-Zinn 1994).

Mindfulness is a powerful tool. By practicing mindfulness, individuals with bipolar disorder can develop greater awareness of their thoughts, emotions, and physical sensations. This increased self-awareness allows for earlier detection of mood shifts and better emotional regulation.

Benefits of mindfulness:

• Reduces anxiety and stress
• Improves sleep
• Enhances focus and concentration
• Decreases rumination and negative thought patterns
• Increases ability to tolerate uncomfortable emotions

Mindfulness techniques: Start with simple practices like focused breathing, body scans, or mindful observation of everyday activities. Gradually increase the duration and frequency of practice. Remember, the goal is not to eliminate thoughts or emotions, but to observe them without judgment and learn to respond rather than react.

3. Develop Wise Mind: Balance Emotion and Reason for Better Decision-Making

Wise mind results when you are able to think from both emotion mind and reasoning mind together (Linehan 1993b).

Cultivate balanced thinking. Wise mind is the integration of emotional experience and logical reasoning. By developing this skill, individuals can make more effective decisions, even in the face of intense emotions or challenging situations.

Three states of mind:

1. Emotion mind: Dominated by feelings, often leading to impulsive actions
2. Reasonable mind: Focused on facts and logic, but may overlook emotional needs
3. Wise mind: Balances emotions and reason for optimal decision-making

Developing wise mind: Practice recognizing which state of mind you're in throughout the day. When faced with decisions, consciously strive to incorporate both emotional and logical perspectives. Use mindfulness techniques to create space between thoughts and actions, allowing for more balanced responses.

4. Master Distress Tolerance Skills to Survive Crises Without Self-Destructive Behaviors

The purpose of this chapter is to help you to learn new coping skills that won't have unhealthy, self-destructive consequences. These skills will not get rid of your emotions, nor will they solve the problems you're currently dealing with. They will simply help you to survive the crisis without making things worse (Linehan 1993b).

Develop healthy coping mechanisms. Distress tolerance skills are essential for managing intense emotions and urges without resorting to harmful behaviors. These skills help individuals survive crises and prevent long-term negative consequences.

Key distress tolerance strategies:

• STOP skill: Stop, Take a step back, Observe, Proceed mindfully
• Distraction techniques: Engage in activities that redirect attention
• Self-soothing: Use the five senses to calm and comfort yourself
• Improve the moment: Find ways to make the current situation more bearable
• Radical acceptance: Acknowledge reality without fighting against it

Implementing distress tolerance: Practice these skills regularly, even when not in crisis. Create a personalized crisis survival kit with reminders of coping strategies and items that provide comfort or distraction. Remember, the goal is to get through the difficult moment without making the situation worse.

5. Recognize and Validate Emotions to Reduce Emotional Intensity

Validating your emotions basically just means giving yourself permission to have them. It doesn't mean you like to feel that way or that you don't want the feeling to change. It simply means acknowledging the presence of the emotion and allowing yourself to have it.

Embrace emotional experiences. Validation is a powerful tool for reducing the intensity of emotions and preventing secondary emotions (feelings about feelings) from escalating the situation. By acknowledging and accepting emotions without judgment, individuals can create space for more effective responses.

Steps for emotional validation:

1. Identify the emotion
2. Acknowledge its presence without judgment
3. Recognize the emotion's function or message
4. Allow yourself to experience the emotion
5. Respond to the emotion's message in a healthy way

Overcoming invalidation: Many people struggle with self-invalidation due to past experiences or societal messages. Practice catching self-invalidating thoughts and replacing them with validating statements. Remember, all emotions serve a purpose and provide valuable information about our experiences and needs.

6. Implement Radical Acceptance to Decrease Suffering and Increase Peace

Radical acceptance is about accepting something with your body, mind, and soul—accepting it completely rather than halfheartedly. Accepting it with all of yourself, rather than just with your mind. This is why it's radical—because you're doing it with your entire being (Linehan 1993b).

Embrace reality to reduce suffering. Radical acceptance involves fully acknowledging the reality of a situation, even when it's painful or undesirable. This skill helps reduce emotional suffering by eliminating the struggle against unchangeable circumstances.

Key aspects of radical acceptance:

• Acknowledging reality without approving of it
• Recognizing what is within and outside of one's control
• Letting go of attempts to change the unchangeable
• Focusing energy on effective action within the given circumstances

Practicing radical acceptance: Start with small, less emotionally charged situations. Notice when you're fighting reality and turn your mind towards acceptance. Use coping statements like "It is what it is" or "I can't change what's already happened." Remember, acceptance is an ongoing process that requires patience and persistence.

7. Cultivate Assertiveness for Healthier Relationships and Self-Esteem

Assertiveness is expressing your thoughts, feelings, and beliefs in a direct, honest, and appropriate way. It means that you demonstrate respect for yourself as well as the person you're communicating with, and you try to ensure that you're getting your own needs met while also trying to meet the needs of the other person as much as possible.

Foster effective communication. Assertiveness is a crucial skill for maintaining healthy relationships and building self-esteem. It involves expressing oneself clearly and respectfully while considering the needs and feelings of others.

Components of assertive communication:

1. Describe the situation objectively
2. Express thoughts and feelings about the situation
3. Clearly state what you want or need
4. Consider the other person's perspective
5. Be open to negotiation and compromise

Developing assertiveness: Practice using "I" statements to express feelings and needs. Set clear boundaries and learn to say "no" when necessary. Recognize that assertiveness is a skill that improves with practice. Start with low-stakes situations and gradually work up to more challenging interactions. Remember, assertiveness is about mutual respect and finding win-win solutions whenever possible.

Last updated: October 18, 2024