A Bipolar Wellness Plan is exactly what it sounds like – a system to help you identify resources and implement strategies to help you stay well and prevent relapse into episodes of mania or depression.
It is a highly individual and customized road map based on principles of
- personal responsibility
- education about your condition, and
- support from people you trust.
An effective Wellness Plan requires self-awareness and self-direction.
If you begin by mood charting, you will be better equipped to prepare a truly powerful, personal Bipolar Wellness Plan. This is a self-help technique that depends on you – your understanding of yourself and your condition.
Nobody else can do the job of creating the Plan for you!
Don’t worry – it isn’t all that tough! The insights you will gain from mood charting, and the templates and guides prepared by bipolar disorder experts make this a very “do-able” process.
The steps are as follows:
- Monitor your state of mind and health
- Identify symptoms as they begin to develop
- Use the strategies you have mapped out in advance in your Wellness Plan to stop symptoms from escalating into a serious episode of mania or depression.
PLEASE NOTE: Just like a Bipolar Mood Chart or a Treatment Contract, your Bipolar Wellness Plan is a tool you can use to play a more active role in your own recovery. It is designed to be used in combination with medication and professional medical care – NOT as a replacement.
Wellness Plan vs Mood Chart
What is the difference between the Bipolar Wellness Plan, the Mood Chart, and the Treatment Contract?
The Mood Chart is used every day in order to gain insight into how you are doing, the things that act as triggers and stressors for you, the things that help you stay well, and the results you are getting from your medication and diet and exercise program, or other strategies you may be using.The Wellness Plan is used when you detect the first signs of symptoms in order to help you stay well and protect you from a full-blown episode of mania or depression.
Wellness Plan vs Treatment Contract
The Treatment Contract is a safety net you put in place before an episode develops so that your loved ones, medical team and other supporters have a clear and shared understanding of what should happen to get you well again as soon as possible, and limit any damage that may result from serious mania or depression.
Bipolar Disorder Wellness Strategies
Stay well strategies are unique to each individual.
Discuss the ones you will include in your own personalized Bipolar Wellness Plan with your doctor or spouse, family member or friend.
Before including a strategy in your plan, consider these questions:
1. Is it safe?
2. Is it simple enough that I can use it even if I am becoming unwell?
3. Is it effective for ME?
The following lists of common triggers, warning signs, and “stay well” strategies are not complete or universal. Some may apply, but others will not. Everyone is different and it is essential you develop your own personal lists!
Then you simply transfer the contents of your own lists over to your own Bipolar Wellness Plan, as shown in the sample Wellness Plan at the end of this page.
Common Depression Triggers
Common triggers for an episode of bipolar depression include:
- Alcohol or drug use
- Change in seasons
- Loss of relationship
- Loss of employment
- Conflict with others
- Discontinuing medication
- Any disappointment or negative life event
- Lack of exercise
- Poor diet, especially if lacking in B vitamins or folic acid, or if excessive sugar is consumed
- Social isolation
- Unhelpful thinking styles such as negative self-talk, self-blame, and self-recrimination
- Nightmares or other distressing dreams
- Any draining or debilitating physical illness. This could be as serious as prolonged, chronic pain or as “ordinary” as the common cold
- “Feeding” ordinary, normally transient feelings of sadness with sad or negative movies, books, music, and conversations with negative people
- Feelings of stigma about having a mental health condition.
- Fill in your own ________________________
Common Mania Triggers
Common triggers for an episode of bipolar mania include:
- Lack of sleep
- Change of seasons
- Drinking alcohol or using recreational drugs
- Taking inappropriate medication such as certain stimulant ADHD drugs or SSRI antidepressants which may trigger mania in people with bipolar disorder.
- Taking “natural” treatments such as SAMe or St John’s Wort which have been shown in clinical studies to trigger mania.
- Stressful events at home, in the workplace or at school
- Financial stress
- Travel, especially if it involves jet lag
- Changes in routine such as moving house or changing jobs
- Stopping your bipolar disorder medication, even though it is working effectively as a mood stabilizer
- Changes in smoking habits
- Relationship break-ups or conflict in personal relationships
- Engaging in highly stimulating activities with an “addictive” component such as gambling, online gaming, Internet chat, day trading or Forex
- Physical illness, especially thyroid malfunction or diabetes
- Poor diet and exercise habits, especially consuming excess sugar or caffeine or being physically inactive.
- Fill in your own: _________________________
If you really are not sure about your own triggers, start Mood Charting!
Early Warning Signs – Bipolar Mania
Mania/hypomania early warning signs:
- Decreased need for sleep
- Begin to get lots of thoughts and ideas
- Feel “better than well”
- Increased energy
- Increased irritability
- Heightened senses – colors seem brighter, music more compelling
- Increased sex drive
- Different sexual thoughts and feelings, for example attractions to people who I have never noticed before or are “not my type”, or interest in sexual practices that are not usually appealing to me
- Feel more loving and expansive towards others – unless they disagree with me in which case I am disproportionately annoyed
- Compulsion to keep talking, “pressured speech”
- Jumping from thought to thought
- Jumping from project to project
- Aggressive or fast driving
- Impulse purchases
- Interest in speculative financial ventures or dubious “investments”
- Increased interest in risk-taking activities such as gambling
- Feeling impregnable, ‘bullet proof”, endowed with special powers or qualities
- Impatient, unable to wait in lines, frustrated by the “slowness” of others
- Unusually sociable, talking to strangers
- Paranoia, feeling people are talking about me behind my back, criticizing me, “ganging up” on me
- Argumentative, picking fights
- Taking on unusually large or ambitious projects that are impractical.
Early Warning Signs – Bipolar Depression
Depression early warning signs:
- Avoiding or withdrawing from others, refusing invitations or accepting invitations but not showing up
- Abandoning activities you usually complete and consider worthwhile, for example going to the gym, walking the dog, going to Church, reading books, “date night” with your spouse, playing with the kids
- Don’t go out, even if it is something you would usually consider “necessary” such as a trip to the bank, post office or grocery store
- Don’t answer your phone or reply to emails
- Find it harder to get up in the morning
- Changes to sleep pattern such as difficulty sleeping, getting up later or earlier than usual, sleeping more than usual, taking more naps
- Harder to get going
- Stop eating, or eat too much, especially “junk” or “comfort” food
- Pay less attention to personal appearance, hygiene and grooming
- Feel slowed and sluggish
- Feel hopeless
- Feel down and sad
- Feelings of guilt
- Having little interest in sex
- Feeling tired
- Feelings of agitation
- Feel irritable
- Feel numb
- Feel just can’t be bothered or motivated
- Not interested in things
- Not able to enjoy
things as much
- Thinking is slowed and more difficult
- Hard to concentrate
- Self talk is critical and blaming
- Difficult to think things through and make decisions
- Lots of worrying thoughts
- Ruminating thoughts – thoughts that go round and round
- Thoughts of self harm
- Thoughts are negative about self, others or future.
Wellness Strategies for Bipolar Disorder
- Regular sufficient sleep
- Medication compliance
- Using “talk therapy” in conjunction with medication
- Regular consultations with psychiatrist
- Promptly scheduling additional appointments if early warning signs appear and following suggestions for medication or dosage changes
- Abstain from alcohol and recreational drugs
- Avoid over-committing to too many work-related or other activities
- Avoid known stress triggers, especially if they have triggered episodes in the past
- Maintain a consistent daily schedule
- Eat regular meals, including plenty of protein, minimal simple/refined carbohydrates and saturated fat, and plenty of omega-3s/fish oil, vitamin B12 and folic acid
- Daily exercise that you find enjoyable
- Avoiding overly stimulating environments
- Getting regular physical checkups and treating any common co-morbid conditions such as thyroid imbalances and diabetes
- Learning self-talk techniques and reality checking your thinking, especially if it is very “all or nothing”, “catastrophic” or unusual.
Sample Wellness Plan
This is a condensed version of my own Bipolar Wellness Plan. I developed it with my spouse and although it sometimes requires painful honesty from both of us, it has been the foundation for many years of stability and a wonderful marriage.
Trigger: Jet lag
Early Warning Sign: N/A
Stay Well Strategy: Travelwith sleep aid meds such as Ambien and extra mood stabilizers. Schedule down
time for immediately after travel.
Trigger: Disrupted sleep
Early Warning Sign: Difficulty getting to sleep or staying asleep.
Stay Well Strategy: Use
sleep aid medication short term until stable again. Increase exercise.
Trigger: Stress about work, money or family issues
Early Warning Sign: Irritable, paranoid, argumentative.
Stay Well Strategy: Increase exercise. Follow The Bipolar Diet rigorously. Get “thought checks” and “reality checks” from spouse.
about work, money or family issues
Early Warning Sign: Impulse spending and financial extravagance.
Stay Well Strategy: Share complete truth with spouse. Avoid Internet banking. Stop carrying credit cards and avoid stores.
Bipolar Wellness Plan vs WRAP
A Wellness Recovery Action Plan (WRAP) is a similar tool to what has already been described above.
This is more often today known as an APRP – an Action Plan for Recovery and Prevention. This, to me, is an excellent name because it focuses on the 3 critical factors – ACTION, RECOVERY and PREVENTION. The principles are the same as we have already covered but the APRP/WRAP tool is used for conditions other than bipolar disorder.
The key take away is simple – use your periods of wellness to the work of defining/refining your own triggers and early warning signs. Then make a crisis plan so that mood swings can be recognized and headed off before you lose your stability.1