Stress has such an impact on our minds, bodies, and spirits that it exacerbates mental illnesses such as bipolar disorder. Stress is a significant trigger for episodes of bipolar disorder. Obviously, people who don’t have bipolar disorder get irritable, impatient, and short-tempered when faced with chronic stress, but for people with bipolar disorder, uncontrolled stress can lead to dangerous manic or depressive symptoms. The degree of stress we have in response to environmental stressors is partly genetic but can be controlled when we learn behaviors that minimize its impact on our psyches, relationships, and bodies.

Both human and animal studies have found links between emotional sensitivity and response to stress, and the predisposition toward mood disorders (Bale 2006). A Swedish twin study found that the relationship between stressful life events and mood disorders was due to a combination of environment and genes. Researchers found that some people with mood disorders tended to be drawn to high-risk environments (Brostedt and Pedersen 2003).

High levels of stress and limited access to social support, such as family and friends, are linked with recurrence of bipolar episodes, particularly in cases of people diagnosed with bipolar I disorder (Cohen et al. 2004). The stress related to a death in the family and other major life events was found to be associated with increased risk of first admission with bipolar disorder (Kessing, Agerbo, and Mortensen 2004). This means that major stress relates to the onset of a bipolar episode severe enough to potentially result in a hospitalization.

Coping with stress has to do with our response to our environments. Having bipolar disorder can be very stressful and creates anxiety that reinforces symptoms. But with psychotherapy and medications that reduce anxiety, those of us who have bipolar disorder can learn how to live in the present moment without worrying as much what might happen if we have an episode. When in the midst of an episode, we may feel anxious that it might result in a hospitalization. Though we may feel we have no control over whether or not that happens, learning to cope with our stress in a healthier way helps us focus more effectively on managing our symptoms, which reduces the likelihood of being hospitalized or having a severe episode.

The Stress Response

Our reactions to stress are both common and unique, in that many people share responses to stress, such as increased heart rate, sweaty palms, headaches, and other common symptoms, but we each have our own unique combination of responses. Our stress response is not always a bad thing. For example, the rush of adrenaline you feel during a job interview may keep you sharp and focused, and help you present your best self. Other people may react to that same type of stressful situation with sweaty palms and an inability to focus or concentrate, causing them to fail the interview. We all have stress reactions, but the key is to learn healthy ways to cope with stress rather than engage in unhealthy behaviors that may trigger manic or depressive episodes

Coping with Stress

So how do you relieve stress? Coping with stress requires that you identify and understand the source of your stress and then make a plan for how to reduce the impact of that stressor on your life. The next set of action steps will give you some tools to help you identify stressors, become more aware of your reactions to these stressors, and learn how to cope with triggers so you can reduce the impact of stress in your life. Let’s start on a positive note by identifying how you can reduce your stress.

Action: Name Your Stress Reducers

1. Think of five activities you’ve done from time to time that have brought you peaceful feelings. These may include time spent at the beach, relaxing with your family, reading a book in your favorite coffee shop, taking a nap, or engaging in a hobby, such as knitting or swimming laps in a pool. Open your journal to a blank page and draw a line down the center, dividing it in half.
2. On the left-hand side of the page, list the top five situations that make you feel relaxed.
3. On the right side of the page, list how often you engage in these activities using the following categories: daily, several times per week, several times per month, once a month, and less than once a month.
4. Notice the patterns of your own anti-stress behaviors and take note of what behaviors you may want to increase to bring more peace and calm to your life.

excerpt from Bipolar 101: A Practical Guide to Identifying Triggers, Managing Medications, Coping with Symptoms, and More by Ruth C. White, PhD, MPH, MSW and John D. Preston, PsyD, ABPP