Cognitive Strategies for Mania

Keeping Your Balance

Keeping Your Balance
Module 6
Cognitive Strategies for Preventing Mania

Cognitive Changes in Mania

2The Cognitive Behavioural Approach to Preventing
Mania

4

An Example of a “Balance” Sheet

5

The “Balance” Sheet

6

Module Summary

7

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Cognitive Strategies for Mania

COGNITIVE CHANGES IN MANIA

The onset of mania or hypomania can often be a pleasant experience for people with bipolar
disorder. Positive changes in mood can be quite dramatic, and people often feel energised,excited, and optimistic. On the other hand people sometimes find that mania andhypomania begin with irritability and agitation, or that they experience both feelings ofdysphoria and euphoria at the beginning of a manic episode. For those who experience
mixed episodes, quick changes can occur between being in a good mood and extreme irritability.
The symptoms of mania, hypomania, or mixed episodes usually emerge over a period of days to weeks.
Often people become aware of a pattern in the development of their symptoms, for example, hypomania
or mania may begin with one symptom such as insomnia, and then progress to other symptoms (e.g.,increased sexual interest, feelings of euphoria). Changes in the nature of people’s thoughts, orpreoccupation with certain ideas can also be part of this progression. Some people learnto recognise these changes in their thinking and can say, “It’s happening again. I always
start thinking that way when I’m getting high.” This recognition can be a critical step forintervening early to prevent a full-blown manic episode.

Cognitive Symptoms of Mania & Hypomania
The cognitive changes associated with mania or hypomania include changes in the way people or situations
are viewed, and changes in the amount and quality of new ideas. These changes can act as a signal that amanic episode is developing, and that action needs to be taken to prevent the symptoms from getting
worse.

Increased Optimism & Grandiosity
When people are manic or hypomanic, the most common symptom is the development of an unusually
positive view of self, the future, and the world at large. When people are becoming manic, they often findthemselves feeling particularly self-confident and experiencing a general sense of well-being. This is often
accompanied by beliefs that include overestimating their abilities, an optimism that causes them to view theworld as particularly helpful, or an underestimation of the negative consequences of their behaviour.
Sometimes this self-confidence can progress to the point where the person’s thinking is grandiose anddelusional.
When people are becoming manic or hypomanic they may develop a wealth of new ideas and plans that
often have the potential to be successful. Unfortunately, when people are manic, it can be difficult todistinguish between good ideas and grandiose delusions. The other thing that often happens during amanic episode is that a person’s ability to concentrate and follow through with plans is impaired(particularly when they are overactive or not sleeping much). All of these factors, together with little or noplanning, can cause even the best ideas to fail.
During a manic or hypomanic episode, people may forget to consider the potential negative consequencesof their behaviour. There is a tendency to rush into an activity or make a decision without carefully
considering the pros and cons associated with each choice. They may also be feeling so optimistic that they
dismiss the potential negative consequences anyway.
Some people may think they have special powers, particularly in the areas of creativity and personalinteractions. These beliefs are maintained when people focus only on events that appear to confirm thebelief, while ignoring evidence to the contrary.

Paranoia

Early in the development of mania or hypomania, paranoid thinking is often evident, and may manifest as
suspiciousness of others. This suspiciousness is often based on very real events and a history of bad feelings
between the person experiencing mania, and the target of his or her paranoia. The paranoia is often
maintained by focusing on evidence that confirms the paranoid thoughts. Interactions with the targetforCentrelinical
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Cognitive Strategies for Mania
person are likely be tense because of the suspicion involved, and the target person is likely to react in some
way to the tension and hostility. This reaction can then be read by the person as confirming their paranoia.

Increased Fluency of Ideas
During mania and hypomania, there is often a flood of new ideas and interests. People with hypomanic
symptoms frequently overestimate how much can be accomplished in a given day and underestimate thetime it takes to complete tasks. The increase in mental activity that accompanies mania acts to distract
people from these tasks they have started doing, making it even more difficult to complete activities.

Thinking Errors in Mania
Social judgement can be impaired in hypomania and is usually quite impaired during manic episodes. People
with bipolar disorder often experience a decreased sense of self-awareness during their interactions withothers. They may say or do unusual things, or fail to notice the impact that their words or actions have onother people.
On the next page, we will discuss some strategies for preventing a full-blown episode of mania.

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Cognitive Strategies for Mania
The Cognitive Behavioural Approach to Preventing Mania
The cognitive behavioural approach to managing the cognitive and behavioural changes associated withmania or hypomania include:
1.

Recognising subtle mood, cognitive, and behavioural changes to allow for early intervention

2.

Evaluating and changing distorted or unhelpful thoughts and beliefs, or ideas such as suspiciousness orgrandiosity

3.

Organising and scheduling of activities, ideas, or plans with the aim of limiting and containing overlystimulating activities.

In this module, let’s look at how you can learn to manage your thoughts to prevent mania. First, you needto learn to recognise what sorts of thoughts you get when you are beginning to get high. When you are inan elevated mood, thoughts that are overly positive might not be helpful to you because they could cause
your mood to spiral upwards toward mania. Just like negative thoughts are considered to be unhelpfulwhen you are depressed, thoughts that overly positive are also considered unhelpful when your mood iselevated.
On the next two pages, a worksheet called ’The “Balance” Sheet’ is provided, together with an example.
This worksheet is for you to record those thoughts that might be overly positive when you are in a mildly
or moderately elevated mood. You might not know whether or not they are helpful and that’s why it is agood idea to write them down. You might find that some of your thoughts seem a little grandiose and arequite different from how you would normally view a situation, and these would be considered unhelpful toyou. The next step is then to develop a more balanced thought in place of the initial unhelpful thought.
Here are some questions you can ask yourself to help you develop a balanced thought:•••••

What evidence do I have that my thoughts are true?
What facts or details might I have ignored or overlooked?
What other ways are there of viewing the situation?
If I were not feeling high, what would I be thinking?
What is a balanced view of this situation?

It is probably very helpful if you practise this exercise before you start feeling high. Remember thatpreventing a full-blown episode of mania is all about EARLY recognition of the warning signs andintervening quickly before they escalate. Recognising early warning signs of mania is essential because
cognitive behavioural therapy might not be very effective once a person is in a full-blown manic episode.
On the next page is an example of how you can complete the worksheet. Then, turn to page 6 and try out
the exercise for yourself!

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Cognitive Strategies for Mania
An Example of a “Balance” Sheet
When I am feeling euphoric, Ioften think:

An Alternative, Balanced View

Ask yourself:· What evidence do I have that my thoughts are true?
· What facts or details might I have ignored or overlooked?
· What other explanations could there possibly be?
· Are there other ways of viewing the situation?
· What is a balanced view of this situation?

Wow! I’m feeling reallycreative and energizedright now. Everyone else
seems so uninspired!

Hmm … I think my mood might begetting a little elevated. While it feels
good to be creative and energized, it
might be a good idea to keep a lid onthings. Anyway, it’s not really fair tosay that everyone seems uninspired –they’re all working really hard at
finishing this project …

Shopping seems like areally good idea to me!
I want a new pair ofboots and a new jacket!

Hmm … do I really need those newthings? What are my finances like rightnow? Not all that good, I reckon.
Anyway, it’ll be spring soon – I might notneed a new pair of boots or a new jacket
right now...

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Cognitive Strategies for Mania
A “Balance” Sheet
When I am feeling euphoric, I
often think:

An Alternative, Balanced View

Ask yourself:· What evidence do I have that my thoughts are true?
· What facts or details might I have ignored or overlooked?
· What other explanations could there possibly be?
· Are there other ways of viewing the situation?
· What is a balanced view of this situation?

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Cognitive Strategies for Mania
Module Summary•
•
•
•
•
•

•
•

The symptoms of mania, hypomania, or mixed episodes usually emerge over a period of days
and may have a pattern in their development
Cognitive changes associated with hypomania and mania include increased self-confidence andoptimism, and an increase in creative ideas and interests
Sometimes, paranoid thinking might be present and is demonstrated through suspiciousness ofothersJudgement can sometimes be impaired when mood is elevatedJust like negative thoughts are considered to be unhelpful when you are depressed, thoughtsthat overly positive are also considered unhelpful when your mood is elevated.
It is important to be aware of these thoughts, to write them down and develop a balanced
view of the initial thought. The ultimate purpose of this is to prevent a full-blown episode ofmania
Try to practise this exercise before you actually start feeling highPreventing a full-blown episode of mania is all about EARLY recognition of the warning signs
and intervening quickly before they escalate

Coming up next …

In the next module, we will discussbehavioural symptoms of hypomania
and mania, and identify specificstrategies you can use to prevent fullblown episodes.

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