Behavioural Strategies for Mania

Keeping Your Balance

Keeping Your Balance
Module 7
Behavioural Strategies for Preventing Mania

Behavioural Strategies for Preventing Mania

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Weekly Activity Schedule

4

Organising and Prioritising Ideas/Projects

5

Organising the Ideas List

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Module Summary

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BEHAVIOURAL STRATEGIES FOR PREVENTING
MANIA
Behavioural Changes in Mania

One of the hallmarks of bipolar disorder is the distinctive behavioural changes that take place when apatient begins to experience hypomania and mania. Activity levels and libido increase and hours spent insleep decrease. This cycle of increased activity and decreased sleep (or physical rest) can itself perpetuateand escalate the mania.
These changes in activity levels usually begins slowly and builds over time. As such, activity levels can beused as a measure for tracking the progression of the elevation in mood. When you recognise that yourmood begins to be elevated, it is important to begin monitoring your activity levels. If your activity levels
begin to consistently and progressively increase, your early intervention strategies should be activated toprevent a full-blown episode of mania. Here are two strategies you can incorporate into your earlyintervention plan.

Preventing Sleep Disruption
Research has shown that sleep deprivation can be both a trigger to, and a consequence (symptom) of,
mania. Some patients find that with little or no sleep, they become exhausted, but cannot slow down
enough to fall asleep. These symptoms may escalate into a full blown episode of mania and possibly
psychosis. Other bipolar patients may enjoy the increased energy and vigour, but find that this level ofenergy and activity cannot be sustained without negative consequences, such as irritability and paranoia.
The best strategy for coping with sleep disruption is to prevent it. If it is possible, try to forecast or
identify times when your normal sleeping habits are likely to be disrupted (eg, when having to rush for adeadline, travelling, going on holidays, etc.)
Here are some good sleeping habits to maintain, so that you can prevent a hypomanic or manic episode:





Going to bed and waking up at the same times each day
Avoid napping if it causes night-time insomnia (or don’t take too long a nap)
Try to minimise sleep disruptions (eg, share night-time responsibilities, bring favourite pillow onholiday, use ear plugs or eye shields, or medications)
Avoid overstimulation (eg, too much physical activity before bedtime,caffeine)
Avoid thinking too much at night (do some relaxation exercises or calmingactivities)

Limiting Your Activities
Besides pharmacological intervention, there are some strategies you can implement to prevent mild or
moderate mood elevation from becoming a full-blown manic episode. The key principle for any behaviouralintervention for preventing mania is to limit activity and to keep activity levels to a “normal” level. It isrecommended that while you are well, use a Weekly Activity Schedule (provided on the next page) to planand organise your regular week, and ensure that there is a balance of responsibilities, pleasant activities, andtime for sleep and/or rest. Then, when you begin to suspect that you may be hypomanic, use a separate
activity schedule to monitor your activity level and compare it to your “normal” and balanced schedule. If
you find that your activity levels have increased significantly, try to get yourself to slow down and return toyour normal weekly schedule. You could also ask a friend or family member to help you do this.
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Behavioural Strategies for Mania
So remember …
Preventing mania is all about slowing yourself down, relaxing, and having enough rest. These are things youcould easily do once you recognise some of your early warning signs. For example, if you realise thatyou’re beginning to feel a little keyed up and restless or more energetic, you could take a slow and relaxing
walk somewhere nice or take a nice long bath. These strategies are recommended not to stop you fromfeeling happy but to prevent your good mood from escalating toward mania. Many bipolar patients havesaid they love it when their mood is slightly elevated but do not enjoy the experience of full-blown mania.
This is where you can learn to better manage your moods so that you can prevent them from escalating tofull-blown episodes.

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Behavioural Strategies for Mania
Weekly Activity Schedule
Use the schedule below to plan your activities for the coming week. Make sure you balance
responsibilities, pleasant activities, and time for sleep and/or rest.

MonTues

WedThurFriSatSun

8 to9am
9 to
10
10 to
11
11 to12pm
12 to1
1 to 2

2 to 33 to 44 to 55 to 6

6 to 77 to 8
8 to
10
10 to
12 am
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Organising & Prioritising Ideas/Projects
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. They underestimate thetime it takes to complete tasks and underestimate the costs involved in implementing certain ideas.
Coupled with the optimism and increase in self-confidence, patients in an elevated mood may take on too
many (and perhaps, risky) projects, thus making it more likely that projects are not completed or are notsuccessful. In addition, they run the risk of becoming exhausted from doing too many things.
When you begin to realise that your mood is becoming elevated and you begin to have many creative ideas,
it is important that you begin organising and evaluating these ideas. The purpose of this exercise is to help
you take a step back and to slow down a little. It also helps you keep a record of your creative ideas andto set yourself up to succeed in doing some of these projects (be they small or large) because you will havethought through some of the important details before you start doing anything. Use the worksheet in thenext few pages to do the “Organising Your Ideas List” exercise.
First, write down all the ideas for activities or projects that you have. Then, evaluate ALL your ideas,
projects, or actions by asking yourself:What are the costs and benefits of trying out this idea, or embarking on thisproject, taking on this new responsibility, or carrying out this action?

What resources do I need?

What are the steps I must take to carry out this idea/project successfully?

It is important that you do this for every idea, project, new responsibility or action that you have in mind.
After you have evaluated your ideas, list them in order of priority. Also, for each idea or project, youmight want to set a deadline for yourself as to when the project should be completed. Then, carry out theidea or project that you placed as the TOP priority. Remember, before you begin carrying out a
new idea or project, you must have completed the previous one. In this way, you can ensure thatyou limit your activity levels, while focusing your energy and resources on one important project at a time,
thereby increasing your chances of success. This will also help you prevent a full blown episode of mania,
likely hospitalisation, and total exhaustion.
By doing this exercise, you will not only slow yourself down, you will also have a record of all your creativeand interesting ideas, and ensure that some, if not all, of these ideas will be carried out successfully.

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Organising the Ideas List
List of Ideas, Projects and/or Actions

Evaluating New Ideas, Projects or Actions
For each idea or possible project, or action, ask yourself: What are the costs & benefits of trying out thisidea (or embarking on this project)? What resources do I need? What are the steps I must take to carryout this idea/project successfully?

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Costs

Benefits

Resources

Specific Steps

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Behavioural Strategies for Mania

Idea or Project:
Costs

Benefits

Resources

Specific Steps

Costs

Benefits

Resources

Specific Steps

Idea or Project:

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Behavioural Strategies for Mania

Idea or Project:
Costs

Benefits

Resources

Specific Steps

Prioritised List of Ideas, Projects, or Actions
When you have evaluated a number of ideas and/or possible projects, list them in order of priority. Also,
you may want to set a deadline for yourself regarding when the project should be completed.
Remember:

Before you begin carrying out a new idea or project, you must have completed the previous idea orproject.

Ideas or Projects in order of PRIORITY

Deadline for Completion

1.
2.
3.
4.

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Module Summary•
••••
••

•

When bipolar patients begin to experience hypomania and mania, activity levels and libido
increase, and hours spent sleeping decrease
This cycle of increased activity and decreased sleep/rest can perpetuate and escalate themanic episodeSleep deprivation can be both a trigger to, and a result of, mania
The best strategy for coping with sleep deprivation is to prevent it
Good sleeping habits include: sleeping and waking at the same times each day, avoiding naps,
minimising sleep disruptions, avoiding overstimulation, avoiding thinking too much at night
The key principle for any behavioural intervention for preventing mania is to limit activity or
to slow down and to keep activity levels to a “normal” level
With the flood of new ideas and interests that often come with hypomania or mania, bipolar
patients may underestimate the time it takes to complete tasks and the costs involved in
implementing certain ideas
With the dual purpose of slowing yourself down and ensuring the success of any project, try
to evaluate all your ideas for projects, taking into account costs and benefits of the idea,
resources needed, and steps for implementation

Keep Going ...

In the next module, we will discuss
the types of psychosocial stressors
you might face, identify ways ofcoping with these stressors,
discuss strategies for effective
problem solving, and focus on ways
you can better manage your illness
and life in general.

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