This is an article in my Catholic Healing Series, where I talk about the most prevalent mental health issues of our time, who the best thinkers are, what the theory is, and how to heal the issue. If you enjoy this, feel free to check out other articles or videos!
The Issue
Bipolar, Cyclothymia, and Mood Disorders are characterized by significant and persistent shifts in mood, energy, and activity levels. Often, there are manic, hypomanic, or partial episodes where a person has heightened mood, energy, and activity. In a heightened state, there often are decreased need for sleep, racing thoughts, and impulsive behavior. Then, there are depressed periods involving feelings of sadness and hopelessness. Very significantly, Bipolar, Cyclothymia, and Mood Disorders are spectrum disorders. On the low end of the spectrum, people are able to manage the conditions effectively with wellness, mindfulness, and dialectical behavioral techniques. On the middle and high end of the spectrum, medication and more intensive therapy programs may be needed. For anyone who has not heard of Cyclothymia, it is related to Bipolar, but people who experience Cyclothymia do not qualify for a full hypomanic or depressive episode.
The Thinkers
Dr. Chris Aiken, MD is a psychiatrist and psychotherapist who became a leader in the field after encountering friends who suffered from depression and mood issues. His personal experience led him on a lifelong journey of helping people with depression and mood disorders to heal. His personality is very telling in terms of understanding what is required to heal from depression and mood disorders. He is very calm and methodical. A lot of what is required to heal these issues involves taking a systematic approach that focuses on what is effective. There needs to be a healthy skepticism of thoughts and emotions in the world of depression and mood. Not all of a person’s thoughts and emotions can be trusted, and in many ways, thoughts and emotions need to be interviewed to see if they are helpful. Aiken favors an approach that is mindful. This approach fosters awareness and also can focus on behavioral activation to help people engage in more effective behaviors—in many ways, less “affective” and more “effective.”
Dr. Marsha Linehan, PhD developed Dialectical Behavioral Therapy (DBT). She is creative, thoughtful, and empathetic. In terms of DBT, she describes it as extremely validating behavioral therapy. It offers people validation and empathy, while also giving them practical tools for effecting change in their lives.
Katelyn Baxter-Musser, LCSW is vibrant, upbeat, and relational. She has a gift for taking the concepts of DBT and making them accessible to clients, even clients who are under a lot of stress due to crisis situations.
Healing Bipolar, Cyclothymia, and Mood Disorders (Actually, Managing Them)
Disclaimer: these are just some of the tools that can be used to heal or manage Bipolar, Cyclothymia, and Mood Disorders. Also, I cannot guarantee healing or benefit. This entire article represents my opinions and applications of the tools, nothing more and nothing less. This article does not constitute medical, psychological, mental health, or other advice.
Locating a Place on the Spectrum
Bipolar, Cyclothymia, and Mood Disorders exist on a spectrum. That means that some people have much milder symptoms than others. It is important to note where on the spectrum someone lies, and that will inform treatment. For example, someone with mild Cyclothymia or Bipolar might not need medication, and might be able to achieve a high level of life function by implementing helpful tools. In contrast, someone who is more on the middle or the high end of the spectrum might need both medication and an Intensive Outpatient Program (IOP).
The Middle and High End of the Spectrum
Many people in the middle and high end of the Bipolar Spectrum benefit from Intensive Outpatient Programs (IOPs). These programs consist of a combination of individual therapy, group therapy, medication management, psychoeducation, coping skills training, family involvement, and relapse prevention.
The Low to Mid-Range on the Spectrum
People on the low to mid range of the spectrum might not need an Intensive Outpatient Program. Most of them benefit from practical tools for managing the condition. Some do benefit from medication.
Regardless of where someone is on the Bipolar, Cyclothymic, and Mood Disorder Spectrum, there are various tools that can be helpful.
Tools for Depressive Swings
In the depressive portion of the cycle, it can be helpful to try a few different tools. If people feel like they have control over thoughts, they can try to use mindfulness and cognitive behavioral techniques. What is the thought that the person is having? Will it lead her or him closer to peace or farther away? If farther away, what is the better thought to focus on?
If thoughts feel uncontrollable, then behavioral activation can be a good option. Behavioral Activation focuses on breaking cycles of avoidance and isolation by focusing on positive behaviors. I often think of Pavlov’s dog. Pavlov’s dog was shown meat and it salivated. Then, the dog heard a bell ring and was exposed to meat. It still salivated. Then, after repeated rings of the bell and exposure to the meat, the meat was removed. Only a bell was rung, and the dog still salivated. Behavioral Activation empowers a person to treat herself or himself like Pavlov’s dog. She or he is in control and she or he can focus primarily on a system of punishment and reward that changes behavior in positive ways.
First, a person needs to identify why she or he avoids certain interactions and situations. Often, the reason is that it keeps the person safe from uncomfortable situations or other perceived threats. A key realization is that isolating is effective in protecting the self from uncomfortable situations and perceived threats, but isolation itself causes increased depression and anxiety. Thus, the cost of isolation is too high.
Next, a person needs to push herself or himself into uncomfortable situations. It is important to note that, as a person does this, emotion follows action. A person will feel uncomfortable at first and then during an event or activity, the person will feel increasingly comfortable. It is very helpful for a person to utilize positive reinforcement. On days when a person engages in positive, challenging activities that person should offer herself or himself a reward, like reading an enjoyable book. Also, a person can utilize negative reinforcement by identifying and removing aspects of activities that make them uncomfortable.
DBT Skills One: Mindfulness
Mindfulness helps people to observe, describe, and participate in the present moment. It can help to track how a person is feeling throughout the day on a 10 point scale with 1 being totally calm and 10 being totally manic or totally depressed. It can help to track about four times per day how a person is feeling and why. Over time, a person will get a sense of what triggers are, because triggers will be at places where numbers spike. Also, a person will get a sense of what her or his baseline stress or depression is. That will be the average of all numbers. Mindfulness can also be helpful when considering what things people are doing to improve situations. What are things that the person is doing to improve depression that are effective? What are things that the person is doing to manage mania or hypomania that are effective?
Mindfulness can be very somatic (body oriented) when it comes to DBT. A person can sit and mindfully breathe. She or he can also check in throughout the day with how she or he is doing in terms of body scans. Wherever there is tension in the body, a person can focus on relaxing it. Mindful listening, eating, and even walking can help a person to live and respond to life more effectively and intentionally.
In terms of how a person can interact with the environment, here is a good progression. First, a person can simply observe what is happening internally (thoughts and feelings) and externally (in the situation around the self). Then, a person can describe what she or he is seeing in a non-judgmental way. Third, a person can participate by engaging fully in the present moment. Fourth, a person can acknowledge thoughts and feelings without labeling them as good or bad. Finally, a person can focus attention on one thing at a time.
DBT Skills Two: Distress Tolerance
Distress Tolerance is a productive step beyond the first step of mindfulness. A person is progressing from awareness to response. Victor Frankl famously talked about the space between a stimulus and a response as being the place of freedom. Distress Tolerance helps a person to respond positively and effectively in this place of freedom.
Self Soothing is a good practice for a person to calm herself or himself through sensory experiences. One of the best practices for self soothing is muscular relaxation. There is the noodle, where a person can sit in a hard backed chair with feet flat on the ground. From there, a person relaxes all muscles and goes limp. Sit at rest, just present in one’s body, focus on where there was tension. If a person does that for 30 seconds or more, it is impossible for the mind to stay in fight or flight mode. Another good practice is butterfly tapping. There are many good videos for that on YouTube. Other self soothing practices are taking a bath, listening to music, sucking on candy, and aromatherapy—especially smelling lavender.
A person is aiming to achieve Radical Acceptance. Radical Acceptance is a sense of “it is what it is.” That is to say, a person might not like what is happening or think it is a good thing, but a person can come to an acceptance of the fact that it is happening. Certain skills help with this. The STOP Skill helps a person to Stop, Take a step back, Observe, and Proceed mindfully. Also, TIPP is an acronym for Temperature, Intense exercise, Paced breathing, and Progressive muscle relaxation. Going through these progressions helps a person to process through challenging emotions and experiences.
DBT Skills Three: Emotional Regulation
Emotional Regulation Skills help a person to continue to process through challenging emotions. This involves identifying and naming emotions. Things should not just feel “good” or “bad.” Also, a person can identify where in the body the emotion is felt. It is helpful to trust the primary thought and emotion and to not engage a secondary thought and emotion. For example, a person might have a negative emotion due to someone else hurting her or his feelings. A secondary thought and emotion often discounts the first thought and emotion. The primary thought and emotion should be focused on because it is the valid thought and emotion.
Also, increasing positive experiences is crucial. If a person is having positive relationship connections and is experiencing joy, she or he is less likely to get overwhelmed when negative emotions arise. Finally, a person can build a sense of mastery by journaling, or even by reflecting at the end of the day on what is good and what is bad (an Ignatian Examen can be a great way to do that). Whatever went well with emotional regulation should be repeated. Whatever did not go well presents an opportunity to experiment with a new technique. If a person stays with this over time, she or he will encounter long stretches where there is more good than bad and confidence will increase significantly.
DBT Skills Four: Interpersonal Effectiveness
Interpersonal Effectiveness completes the relationship loop in a lot of ways. Once a person becomes aware of what is happening, accepts it, and processes through the emotions, it is time for that emotion to drive the person to effective action.
Interpersonal Effectiveness begins with good Communication Skills. A person can begin with a soft start up. The person can use I statements and then empathize with the other person. Then, the person can share her or his feeling and a proposal for what can be done in a situation. For example, a person can say, “When you said _____, I felt disrespected. In the future, I would like you to say _____ instead. How does that sound to you?” Not only does this statement share an emotion and request a need, but it also invites a collaborative discussion. Many people struggle with being assertive enough to state the need in the first place, and when they do, many struggle with stating it appropriately. In the world of DBT, this is both an art and a science. A person needs a good sense of template and things to focus on, but then a person needs to understand how to apply it creatively in the moment. Good Communication Skills lead to a healthy assertiveness, problem solving, and conflict resolution.
In addition to Good Communication Skills, Boundary Setting is a key component of DBT. Setting healthy boundaries involves communicating your needs and limits while honoring the needs and limits of others. Prior to interacting with someone else, it is important for a person to reflect on her or his own needs. Then, they need to be communicated effectively using the Communication Skills already mentioned. Then, very importantly, boundaries need to be enforced. If a person crosses a boundary, it is important for a person to reassert the need and let the other person know the negative consequence of crossing that boundary. If the other person continues to cross a boundary, the boundary setter needs to make sure that the negative consequence is experienced. Some people do not speak the language of empathy, but far more people speak the language of consequences. This is a really important part of Interpersonal Effectiveness.
Wellness
Practicing great wellness does amazing things when it comes to managing mood disorders! This begins with diet. Of course, if a person has unique dietary needs, that person should consult a nutritionist or dietitian.
In general, the following really help with gut health and in turn predispose a person to overcoming anxiety.
1 spoon of fish oil daily
1 spoon of olive oil daily
Daily Multivitamin
Yogurt, kombucha, kefir, or probiotic supplement daily
At least 4 to 6 portions of fruits and vegetables daily
Another really important area of focus is eating a high protein diet. This diet gives a person large amounts of tyrosine, an amino acid that helps the body to produce dopamine, which gives people with mood issues a healthy boost.
In terms of exercise, regular exercise also helps with mood disorders a lot! It releases endorphins, stimulates GABA production (GABA is a neurotransmitter that helps to calm the brain), generates serotonin in the brain, improves sleep, reduces muscle tension, activates the brain, builds resilience, improves concentration, and boosts self-esteem. Integrative exercising is extra helpful, because it aids connectivity in the brain. Examples of integrative exercises are SoulCore and pilates.
In terms of sleep, it helps to reorganize brain connections and restores the prefrontal cortex, which helps with emotional regulation. Also, it lowers cortisol levels, improves cognitive function, and emotional resilience. Sleep helps to ward off sleep deprivation, which drastically increases anxiety. Good sleep tips include to aim for about 8 hours of sleep per night, to be early to bed and early to rise, and to practice good sleep hygiene, which involves staying away from screens and exercise in the evening, using a weighted blanket, and having good lighting for sleep. When it comes to mood disorders, it is important to consider scope. Sometimes, 8 hours of sleep is not realistic. But it is important to practice good mindfulness around sleep to get sleep levels as high as possible.
Of course, as Catholics, prayer is the most important wellness category of all! If we can trust God and surrender to Him, then we can find peace amidst the storm of mania and depression. Turning to Mary gives us the graces that we need to be successful, because she is full of grace! If an apple a day keeps the doctor away, a Rosary a day keeps the anxiety (and the devil) away.
Medication
In the case of Cyclothymia, Bipolar, and Mood Disorders, it is sometimes possible to manage symptoms well without medication. However, sometimes medication is essential and helpful. I have had multiple clients who credit medication with dramatically improving their mental health. Lithium provides a great help for certain types of mood disorders. Antipsychotic medications and Antidepressants are sometimes prescribed, as well.
What do these medications do? It depends on the type. An Antidepressant will focus more on boosting serotonin levels and helping with depressive symptoms. An Antipsychotic will focus on boosting dopamine levels and can help with mania. Lithium and mood stabilizers can impact serotonin, dopamine, and norepinephrine. They can help with mood and depressive symptoms.
As one can tell, there are a wide range of medications with a wide range of side effects that are prescribed across a wide spectrum of disorders. This means that a person should have a good psychiatrist to prescribe. I do recommend a psychiatrist over any other type of prescribing doctor, because that expertise is very helpful.
In terms of finding the right psychiatrist, I think that is a really important piece of things involving medication. I recommend that people approach psychiatrists as customer service providers. A great psychiatrist is collaborative, cares, and accepts input from clients/patients and any family members involved. If a person meets with a psychiatrist and the psychiatrist demonstrates those qualities, it could be a good fit. If a person meets with a psychiatrist and the psychiatrist does not demonstrate those qualities, I recommend trying a different psychiatrist until a fit is established.
A key thing to focus on when taking medications is side effects. If bad side effects show up immediately, it is important to discontinue use and reach back out to the prescribing psychiatrist. Also, some medications take 4 to 6 weeks of daily use for their effectiveness to show. It is helpful to be aware of that.
Conclusion
One of the best things about the skills involved in addressing Cyclothymia, Bipolar, and Mood Disorders is that we all can benefit from these skills. We all need to come to Radical Acceptance that “it is what it is” in life. Also, we all need to get good at processing through difficult emotions in difficult situations. Finally, we all need to respond with Interpersonal Effectiveness. This is a journey where Pope Saint John Paul II says that love transforms fear. This is a journey that gives rise to maturity, and that maturity can give rise to the flourishing of mental health and the creation of heaven on earth.
Katelyn Baxter-Musser has good resources for DBT on her website:
https://www.innerawakeningscounseling.com/
Looking for therapy regarding Bipolar, Cyclothymia, and Mood Disorders? Reach out to The Catholic Healing Institute and Tom Weishaar for a specially trained approach from a Certified Mood Disorder Professional!
www.catholichealinginstitute.com
Tom Weishaar, MA LPCC CCTP-II CMDP is the President and CEO of The Catholic Healing Institute. He lives in Steubenville, OH with his wife and three children.
