Keeping Your Balance

Keeping Your Balance

Keeping Your Balance
Module 8
Coping with Psychosocial Stressors& Self-Management

Coping with Psychosocial Stressors

2

Coping Resources Worksheet

4

Problem Solving

5

Problem Solving Worksheet

7

Self-Management

9

Self-Management Plan

10

Module Summary

12

The information provided in this document is for information purposes only. Please refer tothe full disclaimer and copyright statements available at www.cci.health.gov.au regarding theinformation on this website before making use of such information.

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COPING WITH PSYCHOSOCIAL STRESSORS
Research with people who have bipolar disorder suggests that stressful life events can play asignificant role in the development of symptoms, and that the prevention of depressive andmanic episodes can be partly achieved by controlling stress. People with bipolar disorder may
have problems in a number of different areas, including family, work, health, finances and soon. One important way of controlling stress is to develop skills in identifying and addressingproblems that arise on a day-to-day basis.

Cues to Action

Identifying and defining problems requires an awareness that problems exist. There are various internaland external cues that can be helpful for recognising problems as they occur. Internal cues include physicalbodily changes, such as muscle tension, headaches, changes in breathing, tightness in the chest. Thesephysical changes can act as signals of stress, and a cue that unresolved problems need attention. Emotionalchanges (eg, feelings of hopelessness, anxiety, worry) can also act as a cue that problems exist. Otherpeople’s behaviour is also a useful indicator that difficulties exist. Family members, friends, and significant
others are often good observers, and may be able to identify problems earlier than the person concerned.
Unfortunately, it can often be hard to welcome the observations and comments of other people,
particularly if they are perceived as criticisms or complaints. Although comments from others may at times
be unjustified, they are useful because they indicate that something might be wrong.

Identifying and Prioritising Problems

It is common for people with bipolar disorder to experience significant problems following an episode ofmania or depression. For example, financial problems can develop from loss of employment caused bytiredness and low motivation during depression. Likewise, financial extravagance and poor judgement
during an episode of mania can lead to financial problems that have to be dealt with afterwards. The feelingsof frustration, hopelessness, and being overwhelmed can make it seem impossible to address the difficulties,
or even know where to begin.
Having a clear procedure for identifying and addressing problems as they arise can help to minimise thesense of hopelessness and feeling of being overwhelmed. So, once it has been recognised that problems
exist, it is useful to work through the following steps:
1. Prioritise the Problems
Often, people are faced with a number of difficulties and it is not clear which needs the mostimmediate attention. To begin the process of resolving problems, it is necessary to identify a few
problems to work on, beginning with those of greatest urgency and importance. A useful way todo this is to make a list of all the issues that have consumed a lot of physical, emotional, andmental energy in recent times (eg, over the past week). The next step is to order the items on
the list according to the amount of energy that they have consumed. Then, prioritise theproblems in terms of their importance or urgency. Ideally, the greatest amount of energy should
be given to problems that are highest in priority and importance. If this is not happening, it may
indicate that a lot of time and energy is being spent doing things that are less important or urgent,and would be better spent on high priority difficulties. The items that are ranked as highest inpriority or urgency should be selected as the first difficulties to address.
2. Identify Coping Resources
Coping resources refer to aspects of yourself or the environment that can help in overcoming thedifficulties you have identified. External resources include assistance from others, such as family,
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Keeping Your Balance
friends, therapists, and work colleagues. External resources can also include support
services/agencies, financial assets, access to transport, and any other aspects of the environmentthat may help to overcome identified difficulties. Internal coping resources can include:• Assertiveness• Energy• Intelligence• Creativity• Sensitivity• Confidence• A sense of humour• Ability to seek out and accept help
from others• Time• Perseverance• Organisational ability• Resourcefulness
3.

Identify Barriers to Effective Coping
Several internal and external factors can interfere with successful coping, and it is important torecognise potential barriers to resolving problems, so that they can be minimised as much aspossible. External barriers to effective problem solving can include a lack of information about theproblem, lack of time, irregular schedules, deadlines, other demands, and insufficient resources(eg, money, work). Internal barriers can include a lack of solutions for solving the problem,symptoms of mania (eg, impaired judgement) or depression (eg, emotional distress, fearfulness),or unhelpful beliefs surrounding the problem and about your ability to solve the problem.

4. Address and Overcome Barriers to Effective Coping
Once you have identified your barriers to coping effectively, it is important that you address themand challenge any unhelpful thoughts or beliefs surrounding your circumstances. Remember that
it is alright to ask for help or advice.
Use the worksheet on the next page to work through this process.

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Coping Resources Worksheet
In the first column on the left, write down possible sources of stress, problems in the recent past, or anticipatedstressors (remember positive events may be stressful as well). Then, in the ‘Coping Resources’ column, list thestrengths and qualities you have that may help in your coping with problems. Also, identify any external coping
resources, such as, friends, family, doctor, etc. Then, identify factors that might interfere with effective coping.
These barriers may be internal, eg, beliefs and attitudes, or external, eg, unemployment, heavy workload, tightdeadlines, etc. How can you overcome these barriers? Remember to use strategies that we have discussed in
the previous modules. Write these down in the last column.

Psychosocial
Problems & Stressors

Coping Resources

Barriers to
Effective Coping

Strategies for
Overcoming Barriers

Current:

Recent Past:

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Problem Solving
Sometimes, it is not enough to just cope with the problems – they need to be solved.
Most people engage in problem solving every day. It occurs automatically for many of
the small decisions that need to be made on a daily basis. For example when making adecision about whether to get up now or sleep in for an extra 10 minutes, the possible
choices and the relative risks and benefits of obeying the alarm clock or sleeping latercome automatically to mind. Larger problems are addressed in a similar way. For
example “I have tasks that need to be done by the end of the week. How am I going toget them all done on time?” After considering the possible strategies, one is chosen andimplemented. If it proves to be ineffective, a different strategy is tried. People who candefine problems, consider options, make choices, and implement a plan have all the basic skills required for
effective problem solving. Sometimes following a step-by-step procedure for defining problems, generating
solutions, and implementing solutions can make the process of problem solving seem less overwhelming.
The following are step-by-step procedures for helping people to solve problems.

1.

2.

Problem Identification and Definition•

State the problem as clearly as possible (e.g., I don’t have enough money to pay the bills)•Be specific about the behaviour, situation, timing, and circumstances that make it a problem (eg,I need to pay the phone and gas bills, and I don’t have enough money to cover both this month)

Generate Possible Solutions••

3.

List all the possible solutions, don’t worry about the quality of the solutions at this stage
Try to list at least 15 solutions, be creative and forget about the quality of the solution. If youallow yourself to be creative you may come up with some solutions that you would nototherwise have thought about

Evaluate alternatives•

The next step is to go through and eliminate less desirable or unreasonable solutions••

Order the remaining solutions in order of preference
Evaluate the remaining solutions in terms of their advantages and disadvantages

4.

Decide on a Solution•

Specify who will take action•

Specify how the solution will be implemented•

Specify when the solution will be implemented (e.g., tomorrow morning: phone the gas
company and negotiate to pay the gas bill next month)5.

Implement the Solution•

6.

Implement the solution as planned

Evaluate the Outcome••

Evaluate how effective the solution wasDecide whether the existing plan needs to be revised, or whether a new plan is needed tobetter address the problem

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Keeping Your Balance•If so, return to step 2 to select a new solution or revise the existing solution, and repeat theremaining steps

Use the worksheet provided over the next 2 pages to work through this process.

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Problem Solving
1.

Identify and Define Problem Area/Issue

Try to state the problem as clearly as possible; be objective and specific; describe the problem interms of what you can observe rather than subjective feelings.
Try to identify what is maintaining the problem rather than just what caused it.
Set realistic and achievable goals for resolving the problem.

Problem Definition

2.

Maintaining Factors

Goals for Problem
Resolution

Generate Potential Solutions


List all possible solutions without evaluating their quality or feasibility
Eliminate less desirable or unreasonable solutions only after as many possible solutions have been
listedBearing in mind your goals for problem resolution, list the remaining solutions in order of preference

List of Possible Solutions

Preferred Solutions
1.
2.
3.
4.
5.

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3.

Evaluate AlternativesEvaluate top 3 or 4 solutions in terms of their pros and cons.

Advantages

Disadvantages

Potential Solution #1

Potential Solution #2

Potential Solution #3

Potential Solution #4

4.

Decide on a Solution

Decide on one or two solutions.
Specify actions and who will take action.
Specify how and when the solution will be implemented.

Action Steps

5.

WhenImplement Solution
6.

WhoImplement the solution as planned.

Evaluate the Outcome

Evaluate the effectiveness of the solution
Decide whether a revision of the existing plan or a new plan is needed to address the problem
better.

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Keeping Your Balance

Congratulations! You’ve reached the end of this info-pack! If you have read and worked through all themodules in sequence, well done! If not, we encourage you to go back and work through the bits you might
have missed. Most importantly, you should now begin to actually implement some of the things you’ve
planned and to keep practising what you have learned or worked through! This means that all of the usefulskills and insights about yourself that you have gained through this information package need to keep beingapplied. In this way, the concepts and skills you have learned can begin to become more like habits that
integrate nicely into your lifestyle.
On the next page is a worksheet entitled “Self-Management Plan” for you to summarise all the important
things you have worked through in this information package. We encourage you to complete thisworksheet in detail and to keep it close at hand so that you can refer to it when necessary. You might also
want to give a copy of it to a family member or a close friend.
As with life, there will be ups and downs. Here are some important things to remember about maintaining
the gains you might have made over the course of working through this information package:
Expect Slip-Ups: Slip-ups in progress can happen at any time and are to be expected. Try not to fall into
the trap of believing that you are ‘back to square one’ as this will only make you feel worse. Use your skillsof challenging your thinking to help when this situation occurs. It might be useful to remind yourself thatmost people have ‘down days’ or days where life’s hassles are harder to deal with –its part of being human! Also, you can use setbacks as a way of learning something
new about yourself to help avoid similar problems in the future.
Social Support: It is wise to find someone with whom you can sit down and have agood talk. This doesn’t mean a therapy session where you pour out your heart but
rather just a chance to talk through what’s going on in your life, what your goals areand generally just to ventilate with someone you trust. Social support has been found to be very importantin preventing relapse. Often problems seem bigger than they really are when a person tries to deal withthem on their own. Hearing yourself talk through something can help you put it into perspective.
Research has shown that bipolar patients often experience relapse and episoderecurrence. However, research has also shown that if you stick to your medication
regimen and see your doctor or mental health practitioner regularly, look out forearly warning signs and intervene early, you can help protect yourself from becoming
extremely unwell.

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Self-Management Plan
What are the signs that tell me I am becoming unwell (depressed ormanic) and need to do something about myself?

What can I do to prevent myself from becoming unwell?

What situations are potential problems for me?

What are some things my friends and/or family may say to me if I am becoming unwell?

How can I respond to what they say?

What strategies/techniques have I found most helpful and would continue to practise?

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Thought Management:
Common unhelpful thoughts
when my mood is depressed

What I can say to myself in response(balanced thoughts)

Common unhelpful thoughts
when my mood is elevated

What I can say to myself in response(balanced thoughts)

What are my support options?
GP/Psychiatrist:
Counsellors/Agencies:
Friends:
Family:Other:

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Module Summary•••••••••

Stressful life events can play a significant role in the development of symptoms in bipolar
patients
The prevention of depressive and manic episodes can be partly achieved by controlling
stress
It is important to be aware of signals or cues that problems are occuring and to clearly
identify and define them
Having a clear procedure for identifying and addressing problems as they arise can help tominimise the sense of hopelessness and feeling of being overwhelmed
The steps to better coping with psychosocial stressors are: prioritise the problems, identify
coping resources, identify barriers to effective coping, address and overcome barriers toeffective coping
Sometimes, it is not enough to just cope with the problems – they need to be solved
Problem solving involves: identifying and defining the problem area or issue, generating
potential solutions, evaluating alternatives, deciding on a solution, implementing thesolution, and evaluating the outcome
As ups and downs are a fact of life, expect that you might have slip ups now and then. It
will also help greatly for you to organise some social support for yourself through family
members or friends
To better manage your illness, it is important to stick to your medication regimen, see
your doctor or mental health practitioner regularly, look out for early warning signs, andintervene early

A Final Word
We hope you have benefited fromworking through this information
package. If you have any concerns orquestions about the material you have
read, do see your doctor or mental
health practitioner. For now, it’s
goodbye from us at CCI. Take care!

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