10 ways to manage anxiety when you have bipolar disorder

Some days are harder than others.

Even in the best of times, many of us feel anxious at some point. But people with bipolar disorder and anxiety may have an especially hard time during the COVID-19 pandemic.

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Your guide to Generalized Anxiety Disorder

Right now, anxiety is an all-too-common occurrence as we collectively worry about the future, our health, and the health of our loved ones. And although anxiety can be on a spectrum from feeling anxious to having a diagnosable disorder, either one can trigger mood episodes, such as mania and depression, in people with bipolar disorder, the National Institute of Mental Health (NIMH) explains.

“For individuals with bipolar disorder, sometimes high levels of stress and anxiety can make it that much harder to maintain a stable and good mood,” Trisha Chakrabarty, M.D., assistant professor in the department of psychiatry at the University of British Columbia, tells SELF.

Some days are harder than others, but you can try to manage anxiety so your emotions don’t become overwhelming, explains Mona Potter, M.D., medical director at the McLean Anxiety Mastery Program. Ultimately, the following strategies won’t eliminate your stress, but they can make anxiety easier to handle when you have bipolar disorder.

1. Find a mentally consuming distraction.

Anxiety can make you jump from point A to point Z very quickly, according to Rachel Guerrero, Ph.D., clinical psychologist at NYU Langone Health. Let’s say you read a story about the high number of COVID-19 cases in your state and start worrying that you’ll get sick.

You might start to think that your entire family will get sick. From there, you might wonder if everyone you know will get severely sick. Catastrophizing, or thinking about the worst possible outcome, only introduces more stressful scenarios. “It puts you at risk for a mood episode,” Dr. Guerrero tells SELF.

When anxiety-provoking thoughts run through your head, Dr. Guerrero recommends distracting yourself with a task that requires some focus. Depending on how you do it, this can actually count as mindfulness. “People often have the assumption that if I’m doing mindfulness I’m sitting calmly—that is a misconception,” she explains.

You can be mindful while riding a bike, taking a shower, painting your nails, or any number of activities that you enjoy, she explains. If you take a shower, for instance, think about how the soap and water feel on your skin. Notice if you prefer the sensation of warm or cold water on your face.

2. Do your best to follow a routine.

“For people who struggle with anxiety, you want to reduce the multitude of decision points in a day by creating structure,” Dr. Guerrero says. She recommends that, to the best of your ability, you designate times to do things like eat, sleep, exercise, and enjoy yourself.

Hammering all of this out can help you feel more in control at a time when control is generally lacking—a classic anxiety coping mechanism. But this kind of self-care routine can also make it easier to maintain habits that help you avoid mood episodes.

For example, poor sleep increases your risk of mood episodes, especially mania, which is why experts typically advise people with bipolar disorder to try to go to bed and wake up at the same times every day, says Dr. Guerrero. “For someone with bipolar disorder, this is treatment,” she says.

3. Schedule 15 minutes a day to write down your worries.

Speaking of routines, Dr. Guerrero recommends giving yourself 15 minutes a day to write about your stresses. To avoid spiraling while you do this journaling, you can focus on writing worry statements instead of ruminations, SELF previously reported.

A worry statement includes a beginning and an end, whereas rumination goes around in a circle. For example, worry statements might be something like: I’m worried about losing my job because of the pandemic.

If I lose my job, then I won’t be able to pay rent. If I can’t pay rent, then I’ll have to move in with my family. Rumination sounds more like: I’m worried that I’ll lose my job, and if I lose my job, then I can’t pay rent. If I can’t pay rent I don’t know what I’ll do. I just cannot lose my job. How will I pay rent?

It’s helpful for some people to even write out possible solutions to their worries, too, Dr. Guerrero says. Either way, designating this worry time might mean that when you notice an anxious thought taking hold in your brain, you can more easily stop yourself and say, “Nope, it’s not time for that now.

I’ll think about this later,” Dr. Guerrero says. “The more you do this the better you get at redirecting your mind away from that spiral of anxious thoughts,” she says. You can even set a timer to keep yourself on track.

4. Learn to relax your muscles.

Sometimes people notice that their necks or shoulders tighten up when they feel anxious. This is just one of the ways your body reacts to stress, according to the University of Michigan Medical School. If you identify with this feeling, then trying out progressive muscle relaxation can help relieve bodily tension. The practice involves first tensing a muscle or group of muscles while focusing on your breathing.

Some people prefer to clench one big muscle at a time, while others like to focus on several muscles at once or start at their toes and move up their body, says Dr. Potter. The main thing is you want to breathe in and tighten your muscles at the same time. Try to do this slowly so the entire process takes about 5 to 10 seconds, Dr. Potter explains.

Then breathe out and relax your muscles at the same time. It might seem counterintuitive to make yourself feel tense in order to relieve stress, but the practice can help you be more mindful of physical sensations as you release tension and notice the differences between feeling relaxed versus tense, according to the Mayo Clinic.

5. List five things you can see.

Turn your focus outward and list five objects you can see the next time your mind becomes overwhelmed, Dr. Chakrabarty suggests. Then acknowledge four things you can touch, three things you can hear, two things you can smell, and one thing you can taste. This 5-4-3-2-1 practice can help you focus on the present instead of any anxious thoughts, according to the University of Rochester Medical Center.

You can do this even in the most ordinary environment, like your bathroom. For example, you might say, “I feel the cool tiles under my feet, but if I shift to the right I now feel my old bath mat instead. Wow, I never noticed how plush the rug feels under my feet.”

6. Create a self-soothe kit in a less anxious moment.

Dr. Potter likes for her patients to create a self-soothe kit full of calming techniques. She calls this the “cope ahead” method because you’re thinking about how to manage your emotions before anxiety sets in. It might be helpful to think about using strategies that bring attention to each of your available senses, she says.

If listening to Destiny’s Child triggers happy memories, then you can create a playlist with their songs, and other mood-lifting music, on your phone. Or maybe you always think about baking cookies with your family whenever you smell vanilla.

You could carry a vial of perfume or essential oil reminiscent of the nostalgic scent. It’s a good idea to include as many strategies as possible. “If you try something and it doesn’t work, then you’ve got other choices,” Dr. Potter tells SELF.

7. Challenge anxious thoughts with facts.

Challenging anxiety-inducing thoughts can be tough but ultimately really helpful sometimes. Maybe you’re worried that brain fog is negatively impacting the quality of your work, and you can’t find a way out from this line of thinking. “Sometimes no matter how much you try to challenge a thought you can still find a counter challenge,” Dr. Potter says.

If that happens, try looking for proof that a certain outcome you’re worried about will actually occur. If you're spiraling and thinking, I suck at work, and I might lose my job. I’ll never find another job again because I’m not employable, then you’re catastrophizing.

Stop and ask yourself what proof you have to support those thoughts. Maybe it’s asking yourself a few questions like, “Has my boss said that I’m doing a bad job? What proof do I have that I’ll never, ever find a job?” You can also ask yourself if these anxious thoughts are helpful. Returning to the work example, stressing about making mistakes at work will only create more anxiety, which can lead you to making more mistakes.

Instead, Dr. Potter suggests thinking about what you can control in a given situation. For instance, you can talk to your boss about how you’re feeling, if you’re comfortable with that. Or you might ask for feedback and direction on a specific project, or experiment with different kinds of to-do lists so you don’t forget about important tasks.

8. Share your cope-ahead plan with someone in your inner circle.

After months of physical distancing you may be getting Zoom fatigue, but that doesn’t mean you should stop connecting with other people entirely. Dr. Guerrero says consistent social interactions are especially important for people with bipolar disorder who are prone to depression.

“You have to be intentional about it because it’s so easy to not do it,” she says. This doesn’t have to be a video chat if you’re really over those—it’s more about the consistent connection than the form that connection takes.

Dr. Potter says it’s even more helpful if you confide in a very close friend about your mental health. Ideally, you’ll share your cope-ahead plan with this person, so they can remind you of your strategies when you need them.

It’s best if you can be concrete about what you want them to do when you ask for help. “Oftentimes we keep it kind of vague,” Dr. Potter says. If you know that sleeping less and ruminating triggers your depressive episodes, then you might ask this person to encourage you to contact your therapist when this happens.

9. Limit your alcohol consumption.

Drinking may feel like a good way to dull your worries, but alcohol can directly trigger bipolar episodes, according to the Mayo Clinic. If you are worried about being seriously tempted to drink, you may want to avoid keeping alcohol in the house.

If that’s not realistic for you for whatever reason—maybe you know you’re still going to buy alcohol, or you live with someone who drinks a lot—it might help to look for more specialized support if possible, either by talking to your therapist if you have one or checking out support groups, like Tempest, a membership-based sobriety group that can connect you with others who may have similar experiences with alcohol.

10. Know when to ask for help.

You might need to use a few different strategies from your self-soothe kit to ground yourself. “Sometimes the emotion is really big, so it’s going to take a few different things [to calm down],” Dr. Potter says. She recommends trying three different skills to manage your anxiety.

If you still feel anxious and are worried about triggering a mood episode, then you might want to reach out to your psychiatrist or psychologist if you have one. They could suggest changing your medication, trying a new medication, or incorporating more therapy sessions, depending on your situation.

We can’t ignore the fact that getting help isn’t easy right now. People are struggling financially, but there are a few potentially more accessible options, like reduced-fee therapy sessions. (You can find a therapist who offers sliding scale sessions on Open Path and Thero.org.)

Alternatively, the Health Resources & Services Administration database lists federally funded health centers that offer sliding scale or free care. Even joining an online support group, which connects you with others who can understand your specific concerns, may help you through this time. You can visit the Depression and Bipolar Support Alliance for a list of groups in the U.S. These groups aren’t a replacement for professional help, but they can help you feel less isolated.

“We’re all experiencing loss and grief on some level, in addition to fear and anxiety,” Dr. Guerrero says. “There are a lot of intense emotions.” And you might have an easier time dealing with this intensity with a little support.

Original article appeared on SELF | Author Melissa Matthews