Overcoming Mood Swings
- Defining Mood Swings
- Feelings and emotions are explained by the term mood.
- Event-thought-feeling-behaviour is all connected.
- Your behaviour or reaction to an event will affect to a greater extent your feelings and thoughts.
- Occasionally this series of operations cause a person to go in a downward spiral and become increasingly depressed.
- On the other hand it may result in an upward spiral with increasing elation.
- Bodily processes both physical and biological can be influenced by behaviour, thoughts and mood.
- Mood swings can be a detrimental force on the quality of a person’s life.
- When Are Mood Swings A Problem?
- The features of mood disorders are: mood that continues firmly to be disturbed, also – thinking, behaviour and physical functioning that has an unchanging pattern of alteration.
- Disorders linked to mood swings are:
- unipolar depression (low mood with no ‘highs’);
- bipolar depression – manic depression (mood with ‘highs’ and ‘lows’);
- cyclothymia (unstable mood with milder ‘highs’ and ‘lows’ than bipolar disorder).
- The flow of a person’s life can be intensely interrupted by these disorders.
- The Causes Of Manic Depression
- 1-2% of the population suffers from bipolar disorder.
- Mood swings do not discriminate between men and women and affect individuals of all status.
- An episode of manic depression is likely to first arise around the age of 20-40 years. If there is a family history of mood disorder, it may occur earlier.
- A manic depressive will often suffer from four episodes of disorder during the first ten years.
- According to the stress-vulnerability model some people are susceptible to developing a mood disorder and those ‘at risk’ are likely to develop the disorder when confronted by increased stress factors which can be environmental, emotional or physical.
- A person is more likely to develop manic depression if vulnerability factors are present but these do not cause the disorder.
- Vulnerability factors can be biological or psychological. Biological factors include: genetics, disturbed brain biochemistry and circadian rhythm disruption. Psychological factors play a role in the chances of having a relapse and include the different ways we think, feel, behave and cope.
- Stress factors, whether physical stress, life events or social factors can leave an individual unprotected to susceptibility to an episode of mood disorder.
- Approaches To Treatment
- Treatment aims primarily to lessen symptoms, bring functioning back to its original state, and stop becoming worse after treatment.
- Medication and psychological support together are more effective than either alone.
- Acute mania is treated with a mood stabilizer and an anti-psychotic drug or a benzodiazepine.
- Acute depression is treated with a mood stabilizer and an anti-depressant.
- Repeated episodes are lessened by long term treatment with mood stabilizers.
- It may help to have supportive social contacts, be involved in a self-help group and have access to a mental health professional.
- Understanding Your Mood Swings
- There are four stages in understanding your mood swings.
- To understand your past experiences construct a life chart. Draw the positive and negative y-axis of a graph with the former for high mood and the latter for depressed mood. Draw the positive x-axis and mark on it episodes of highs and lows above and below the x-axis respectively. Mark on it the ages at which the episodes occurred, life events and changes in medication.
- Formulate a symptom profile to acquire understanding of your experiences during different mood swings. Make two columns, one for highs and the other for depression. For each, note your common symptoms, your less common symptoms and mark out the early warning symptoms with a star.
- To understand the factors which cause your mood swings to occur suddenly, compose a risk list. Consider key issues from your episodes and divide them into life events, life situations and personal actions. Next list the high risk events, situations and activities separately.
- Answer the following questions:
- What is the name of your problems?
- What makes your mood swings happen?
- Can you predict your episodes?
- How have mood swings affected your life?
- What can you do to control your mood swings?
- Self-Management
- This involves monitoring and regulating yourself.
- Draw yourself a mood chart with the y-axis from -10 to +10 and the x-axis from 0 to 10. Mark mania at +10, a normal mood state at 0 and severe depression at -10. Label the x-axis from Monday to Sunday. Decide which moods you need to monitor and do so for each day of the week. Your normal day-to-day fluctuations could range from -2 to +2. Consider how your mood would be and what activities or behaviour you would participate in, for each rating.
- For the anchor points +10, +8, +6, +4, +2, 0, -2, -4, -6, -8, -10, note the changes in mood, thinking and behaviour.
- You may have decided that you are hypomanic at +6 and depressed at -6. In this case you may need to take action, to avoid serious difficulties, at +3 and -3. Note your action points.
- Monitor and record your daily activities on a schedule that covers 24 hours a day for 7 days a week.
- Rate your activities for pleasure (P) 0-10 where 10 is a very pleasurable activity, and achievement (A) 0-10 where 10 is very high achievement.
- From the activity schedule you may be able to detect activities that are high-risk or over-stimulating . You may find it useful to monitor these activities on a rating of 0-10. It may be that stimulating activities make you more susceptible to highs.
- Consider your mood and the behaviour associated with it as your mood varies.
- Using three or four activity schedules decide whether they are demanding and organized or not. Develop regular routines for sleeping, eating, social activities, exercise and relaxation and plan your schedule in advance.
- Make sure that your schedule is reasonably demanding and that your daily activities are organized.
- Be realistic and balanced in your daily activities, avoiding excessive use of stimulants and keeping positive experiences.
- Think about how your mood, behaviour and physical state are connected.
- Self-regulation may lessen the chances of a minor mood shift turning into a serious mood disorder.
- Managing Your Time
- Good time management requires being aware of:
- Your needs and strengths – list these opposite each other.
- Your standard procedure – find out how you use your time at present by keeping a record of how you spend your time. From the record you will be able to work out the best way of working. Try to get a balance of work tasks and include breaks.
- Your priorities – identify and rank in order of priority the different areas of your life. Consider the time you allocate to each and what is realistic and necessary. Perhaps others are making demands of you that you need to be more assertive about?
- Setting reasonable goals – keep in mind the important areas of your life when pursuing goals. Clearly define your goals so you know when you have achieved them. Some goals will need to be broken down into more manageable steps.
- Once you know the above you can draw up a new more efficient schedule. Use an organizer and list long-term (within six months), medium-term (within a month) and short-term (within a week) goals. Set aside time each day to organize. Try to do a ‘To do’ list of prioritized tasks every day. Plan flexibly and review every month.
- Delegating – giving over responsibility with authority, to others for appropriate tasks, is part of good time management.
- Good time management requires being aware of:
- Sleep Management
- The length of sleep necessary varies from person to person.
- Worrying will prevent you from sleeping.
- You need less sleep as you get older.
- Sleep is affected by mood, stress, food, alcohol, exercise and medicines.
- In the long-term, sleeping tablets are not helpful and can be addictive.
- You can manage your sleep problems by changing your behaviour rather than resorting to medication.
- Keep a sleep diary for several nights to ascertain if you have a problem. Note the date and anything that might affect your ability to sleep e.g. your activity before retiring. If you have waking episodes, note your activity to restore sleep. Was it helpful? Next day note the number of hours of sleep you managed to get and rate how alert you feel 1-10 (1 is dull and sleepy and 10 is very alert). Rate your performance that day 1-10 (1 is poor performance and 10 is performed well). If you do have a problem the following suggestions might be helpful:
- Analyze your sleep diary to see if poor sleep is due to stress and is likely to get better as this eases; are there behaviours which result in poor sleep that you could change?; identify helpful and unhelpful ways of coping and avoid the latter.
- Introduce pleasant smells into your sleeping environment to help you relax e.g. potpourri or lavender oil.
- Try to relax an hour or two before you go to bed. Keep your daily stress low and seek counselling or the support of friends if you feel the need. Exercise during the day. Avoid caffeine, nicotine and alcohol and try a warm milk drink before bed. Make sure you are not hungry before retiring as this will keep you awake. · Ensure you have a quiet bedroom and a comfortable bed and have emptied your bladder before trying to sleep. Use your bed only for sleeping and set an alarm so you wake regularly each day. Avoid naps during the day.
- If you sleepwalk you are advised to discuss this with your doctor as it can be dangerous.
- To cope with disturbing dreams you could try:
- Constructing a positive ending to your disturbing dream and mentally practicing this alternative ending several times before sleeping;
- Practicing beforehand what you might say if the dream occurs;
- Keep water and a towel by your bedside to wash your face with if you wake up sweating - this will help you re-orientate;
- Keep a notepad and pencil within reach so you can record your dreams but beware of reading too much into their interpretation.
- Relaxed Breathing Method:
You could try the following method of relaxed breathing to ease tension and promote sleep:- Ensure you have some time to yourself and push your worries to one side;
- Sit or lie comfortably and close your eyes with your arms by your side;
- Concentrate on breathing naturally;
- Place your hands on your stomach and breathe in deeply and hold for a few seconds feeling your stomach rise. Breathe out and feel your stomach contract. Repeat and as you breathe out think of a relaxing image or sound. Continue doing this until you feel thoroughly relaxed;
- Count back from 10 then open your eyes and feel how relaxed you are now. Slowly get up and resume normal activities.
- Taking Your Medication
- About half of all people on long-term medication stop taking them at least once and many are uncertain about taking medication.
- Reasons for not taking medication include: treatment issues such as insufficient knowledge about treatment; lifestyle issues such as chaotic lifestyles leading to forgetting to take medication; attitudes and beliefs such that treatment will not be of help or is not the correct approach.
- Approaches to improve medication adherence include:
- KNOWLEDGE – ensure that your treatment method is understandable (i.e. it fits together coherently), acceptable (i.e. the side effects are reasonable) and manageable ( i.e. it is simple to remember which treatment to take);
- PRACTICAL STRATEGIES – reminding yourself to take the medication and getting others to remind you to take the medication, monitoring and regulating yourself and making a written treatment plan for the medication you plan to take, the benefits and barriers of this approach and how you might overcome these barriers;
- COGNITIVE STRATEGIES – be clear about the facts of your mood disorder as opposed to your personal beliefs or the views of others. TOC’s are task-orientating cognitions and are thoughts that encourage adherence. They tend to occur when you think about your goals and aims in life and you should list them as they arise so that you can use them to counter TIC’s which are task-interfering cognitions that are a form of negative automatic thoughts occurring when you are about to take medication.
- Do a cost-benefit analysis listing all the advantages and disadvantages of taking medication and the advantages and disadvantages of not taking medication. Challenge negative automatic thoughts by recognizing and recording your negative automatic thoughts about taking medication. Rate your belief in the thought 0-100% and your emotional reaction 0-100%. Review the negative thought – What is the evidence both for and against this idea? What are the pros and cons of this idea? Are there alternative ways of thinking about this situation? Respond by re-rating your belief in your original thought and your current emotion.
- If you are unable to keep taking your medication make sure that your doctor is aware, reduce the medication slowly and monitor your symptoms while you are off medication.
- Dealing With Depressive Episodes
- Managing depression involves comprehending detrimental behaviours such as:
- avoidance of fulfilling activities;
- withdrawal from supportive social situations;
- procrastination – putting off doing tasks or being unable to finish them.
- You may find it helpful to plan your day using 24hr weekly activity schedules as described in 6) Self- Management. Keep it simple and set realistic and balanced targets. Try to list activities you can do on your own or with others, in particular activities that are enjoyable. Include one social interaction for each of the first few days then increase to two towards the end of the week. Be specific about your planned activity and become aware of changes in your mood. If an activity does not have the desired effect, think about how you can alter it so that it is more successful next time. Acknowledge your successes by rewarding yourself for completing activities.
- Approach tasks and problems step-by-step – list your tasks in order of difficulty then break down the easiest task into manageable steps and work your way down the list to the most complex task. For each problem list all the alternative solutions and consider the pros and cons of each then choose the most promising solution; if it is unsuccessful move to your next choice of solution.
- Identify and record your automatic thoughts – write down the situation and your automatic thought, rating your belief 0-100% and your emotion 0-100%. Review your automatic thought by considering and noting the evidence for and against the thought. Next think of alternative views and note them. Re-rate your belief and emotion 0-100% for the original automatic thought. Write down an action plan or outcome.
- If you cannot overcome your hopelessness you should seek additional help and support. See ‘Overcoming Depression’ in the Forward Counselling Advice Service.
- Managing depression involves comprehending detrimental behaviours such as:
- Dealing With Hypomanic and Manic Episodes
- Managing highs includes comprehending detrimental behaviour such as:
- being easily distracted;
- taking risks;
- being impulsive and disinhibited;
- being irritable.
- There are two basic behavioural interventions which need to be employed before a manic episode to be effective:
- Keeping safe - make a simple and predictable activity schedule that you can use when you are high and thus avoid exposing yourself to risky circumstances.
Avoid difficult tasks - complete each activity and have a break between each one. If you have a complex task use a step by step approach and get the support of a friend.
Avoid stimulating substances and circumstances - try to keep to your schedule and if you feel you have excess energy, disperse it by exercising in a safe place. Review your plan after a week to see if you need to include more exercise to calm and dissipate your excess energy.
Learn to relax - you could try sitting in the dark and listening to relaxing music. If you feel you cannot resist excitement, try finding safe alternatives and only expose your self to these for half an hour a day and do calming activities afterwards. Avoid even these safe alternatives if you are becoming manic.
Avoid social situations involving large gatherings - if you do participate in social interaction, ensure you spread them out over the week and that your schedule is predictable. In any social situation try to sit upright in a chair controlling your breathing, before you start conversing. Talk calmly and slowly. - Maximizing self-control – control that which is in your power to control and delay and avoid behaviour you are unable to control. Record your ideas in a notebook and evaluate them when you are better. Others will be more convinced by your idea if you are your normal self. Do not make any major decisions when you are high – delay these decisions till you are better by noting then in your notebook. Use the 48-hr delay rule to approach situations, in particular impulsive expenditure. When you are your usual self decide on two people whose judgement you trust and turn to them for third party advice when you are high.
- Keeping safe - make a simple and predictable activity schedule that you can use when you are high and thus avoid exposing yourself to risky circumstances.
- Identify unhelpful automatic thoughts: You may overestimate gains or underestimate losses; you may be overly focused on yourself; you may make overoptimistic predictions.
- Useful cognitive strategies for modifying these unhelpful automatic thoughts include:
- Active Distraction – when you feel like acting on an idea, distract yourself actively by strongly focusing on perhaps relaxing scenes or bad outcomes of the past. You could also try repeating phrases such as ‘Stop, its harmful’ or ‘There’s no need to do anything now’.
- Considering the Pros and Cons – Write your idea at the top of the page then make two columns. In one note each reason for acting on your idea and for each note in the other column reasons for not acting on your idea. Consider how your idea might harm others and its potential for destruction and losses. Write down a conclusion and use the 48-hr delay rule and third party advice.
- Reframing - List situations that frustrate you even when you are your usual self and avoid them when you are high. Reframe ‘should’ statements as ‘I would prefer it if …’ to reduce the intensity of your reaction. Think about the disadvantages of acting on your negative thought. If you still have control over your high you could identify, review and modify your thoughts as in Dealing with Depressive Episodes. Many of your automatic thoughts may be linked to anger or irritability due to perceived criticism. When you recover from your high examine the evidence for these comments and find alternatives. Write down the situation, your angry thoughts, initial automatic thoughts and initial reaction. Note your response and decision. Rate the perceived criticism and perceived sensitivity each 0-100%.
- Get used to employing these techniques when you are your normal self and set them in action in the early stages of a manic episode as they will be hard to implement when you are high.
- Managing highs includes comprehending detrimental behaviour such as:
- Stress Awareness Training
- You need to monitor your stress and become familiar with what sets it off and the feelings, thinking and actions associated with the anxiety. You can do this by keeping a diary. When you feel anxious note the date and time. What was the event? Rate your distress 1-10 (1 is no distress and 10 is extreme panic). What caused your anxiety? What was your response to cope with the problem? Re-rate your distress.
- After two weeks of monitoring your stress levels you should become aware of what triggers your distress, your bodily feelings and thoughts when distressed, how your distress levels vary with different situations, what you tend to do when distressed and what is the best way for you to cope with your distress.
- Make two lists – one of short-term only coping strategies and the other of long-term coping strategies. You can refer to these when you feel stressed. Try to incorporate more of the long-term strategies into your set of coping techniques and attempt to gradually abandon your short-term methods.
- Avoid turning to stimulants such as alcohol, caffeine and nicotine as coping methods. These have unpleasant effects in the long-term.
- Study your diary to determine what drives your cycles of distress. Is it bodily, psychological, behavioural or social?
- Dealing With Bodily Experiences: Controlling Your Breathing
- Hyperventilation – faster breathing occurs in response to exertion and stress. In the long-term this can be uncomfortable and cause unpleasant physical symptoms which trigger more anxiety and more hyperventilation. Another cycle of stress is set up and can result in a panic attack.
- You can rectify hyperventilation by learning to control your breathing.
- First practice lying down and later sitting or standing. Place one hand on your stomach and the other on your chest. Breathe in slowly through your nose until your lungs are full then exhale slowly through your nose. Breathing in and out counts as one breath – aim to take 8-12 breaths a minute.
- In order to be effective you need to practice this exercise repeatedly.
- Dealing With Bodily Experiences: Relaxation
- You need to develop relaxation into a skill you can use when you feel muscular tension due to stress.
- Try to develop a routine and practice your relaxation exercises. Start by lying down and later you can try sitting or standing. Control your breathing.
- Record your experiences noting the date and time. Rate your distress before the relaxation exercise, 1-10 (1 is tense and 10 is very relaxed). Which exercise did you use? Rate your distress afterwards. Make notes of the sort of day it was, your preoccupations etc.
- Below are three exercises – only move to the next one when you are fully relaxed after a routine.
- Progressive Muscular Relaxation (PMR) – Breathe slowly and regularly as you focus on different parts of the body: feet – tense your feet then relax and repeat; legs – straighten your legs then relax and repeat; abdomen – tense your abdomen then relax and repeat; back – arc your back then relax and repeat; shoulders/neck – bring your shoulders up and in and press your head back. Relax and repeat; arms – stretch out your arms and hands. Relax and repeat; face – tense your face and bite hard then relax and repeat; whole body – tense your whole body then relax and repeat.
After the routine if you still feel tense then repeat it then when you are relaxed think of something calming to relax your mind. Get up slowly and gently.
You should practice PMR twice a day until you feel relaxed after the exercise. - Shortened PMR – You can miss out the tensing and go straight to relaxing the different muscles. When you have achieved this you can progress to using the routine at other times and places.
- Simple Relaxation Routine – Identify a word, object or scene you find calming. Sit comfortably and close your eyes. Be aware of your breathing as you inhale through your nose. As you exhale, think about your calming mental image. Continue this until you feel relaxed. You should practice this exercise frequently.
- Progressive Muscular Relaxation (PMR) – Breathe slowly and regularly as you focus on different parts of the body: feet – tense your feet then relax and repeat; legs – straighten your legs then relax and repeat; abdomen – tense your abdomen then relax and repeat; back – arc your back then relax and repeat; shoulders/neck – bring your shoulders up and in and press your head back. Relax and repeat; arms – stretch out your arms and hands. Relax and repeat; face – tense your face and bite hard then relax and repeat; whole body – tense your whole body then relax and repeat.
- When you have learned to relax using the three exercises you can start to use the skills throughout the day. Use something to remind you regularly to relax. Apply your relaxation skills whenever you need to use them in response to physical tension.
- Dealing With Psychological Aspects: Distraction
- A cycle of mounting anxiety is set off by alarming thoughts and images. You can break this cycle by distracting yourself.
- Physical Exercise – If you keep active you are less likely to be preoccupied by worrying thoughts.
- Refocusing – Distract yourself by focusing on things around you e.g. listening to others’ conversations or studying how someone is dressed.
- Mental Exercise – Formulate a phrase, picture or mental exercise that distracts you e.g. redesign your home, imagine your dream home in detail or recite poetry.
- Develop a set of distraction techniques for different occasions that are suited to your needs e.g. If you get stressed at interviews then physical distraction will not be helpful.
- Make two columns – in one write down the situation causing anxiety and in the other your chosen distraction method.
- Practice your distraction techniques when you are not anxious and try to catch your anxiety at an early stage.
- Problem-Solving
- Problems of any sort can cause distress to a person with mood swings.
- The problem-solving approach can be useful in these cases. You learn to focus your thinking and find solutions to your problem instead of becoming frustrated. There are six steps in problem-solving:
- Define the Problem – Be specific and try to break the problem into more manageable tasks. Do one task at a time. Choose your task and specify your goal.
- List Solutions – Try to write down as many ideas, to solve your problem, as you can.
- Evaluate the Pros and Cons of Each Solution – Consider your solutions and reject the unsuitable ones. List the remaining solutions in order of usefulness.
- Selecting a Solution and Planning Action - Choose your first solution and decide how you will put it into action. Rehearse your task and make sure you have a back-up plan in case your task does not go as planned.
- Do it - Attempt your solution.
- Review the Result of the Solution – If your solution is successful try to understand why it was so. If your solution is unsuccessful try to comprehend why it did not work. Praise yourself for having tried and choose your next solution from your list.
- Dealing With Interpersonal Relationships
- Interpersonal relationships may have caused the mood swings or may be preventing you from recovering – in any event interpersonal relationships will be affected by mood swings.
- You need to understand your personal relationships and be able to deal with them effectively.
- Draw interpersonal maps – one for before you developed mood swings and the other for afterwards.:
- How your interpersonal relationships are at present;
- How your interpersonal relationships might be now if you did not suffer from your emotional problem;
- How your interpersonal relationships will be in 10 years if you continue to suffer from your emotional problem;
- How you would ideally like your interpersonal relationships to be.
- These will summarize all your relationships and allow you to recognize any changes you may desire.
- List all your important relationships and put yourself in the middle of the map in a circle.
- Place each person’s name in a circle on the map, around you in the middle – the closer the relationship to you, the closer the circle to you.
- Join these circle’s to you in the middle with an arrow outward if it is you mainly giving; an arrow inward if you are mainly receiving; a two-way arrow if giving and receiving is balanced; a question mark if you are unsure.
- You could also draw maps for how you would ideally like your interpersonal relationships to be; how your interpersonal relationships might be now without mood swings; how your interpersonal relationships will be in 10 years if you still have mood swings.
- Examine these maps noting any differences and set yourself goals to make any desired changes to your relationships.
- For each relationship ask yourself:
- who initiates and terminates contact;
- are you happy with how often you see this person? ;
- who decides what to do or what to talk about? ;
- is there a balance between giving and receiving? ;
- do you want to alter the relationship in any way?
- Consider questions such as:
- who could I confide in and get advice from? ;
- who would be there for me if I fell ill? ;
- who would lend me money at very short notice?
- Next time you have contact with each person, examine the relationship – participate and observe. Were your predictions correct? – If not, what was different?
- When you have a complete picture of your relationships, think about how you maintain them and in what way you want to change your relationships.
- Two important reasons for making changes are:
- A balanced and supportive social network is necessary for your well-being;
- By altering your relationships but avoiding being controlling, you may increase your sense of control.
- Start by making small changes and monitoring progress. You could also try discussing what you have learned about the relationship with the individual.
- Removing The Obstacles To Intimacy
- Record and examine closely the things that prevent you from achieving intimacy with someone. Note your thoughts and reactions when you distance yourself from a friend or end a relationship and make an analysis e.g. are you overgeneralising?
- Social inadequacy can be an obstacle to intimacy. Apply your assertiveness skills to your social and work life and observe how socially skilled people handle situations in particular difficult ones. Rehearse your social behaviours so that you are comfortable with them.
- Try to grasp your anxious thoughts, examine them closely and if required, challenge them. What are your anxious thoughts? Is your outlook biased – are there misjudgments? Consider the evidence to support and discount your thoughts.
- See ‘Overcoming Social Phobia’ in the Forward Counselling Advice Service.
- It is possible to become over-intimate and make ourselves vulnerable to exploitation. Trust can be given in a series of stages and you can fluctuate as to how much you trust someone.
- Communication is necessary for all relationships. Record the feelings which threaten your relationship (e.g. jealousy) and grasp the automatic thoughts. Analyze them and find alternative ways of dealing with the situation.
- Assertiveness Training
- The aim of assertive behaviour is to stand up for your legitimate rights and face others without putting yourself or them down.
- Assertiveness training teaches you to increase the number and variety of situations in which you are assertive.
- There are three types of interpersonal behaviour:
- Aggressive - you may be forceful in expressing your opinions, feelings and wants.
- Passive - your opinions, feelings and wants may be withheld completely or partly.
- Opinions, feelings and wants are stated with respect for the rights of others.
- Make sure you are aware of your fundamental rights which include: asking for what you want; saying 'No' without guilt; not being perfect; being ignorant about something; being responsible for your actions; having your own perspective and emotions; being indecisive; choosing whether or not to deal with others' difficulties; expecting privacy, independence and success.
- There are five steps to being assertive:
- What do you want? ;
- What is fair? ;
- Be clear in asking for it;
- Contemplate and be ready for the risks;
- Stay calm
- Practice your arguments in advance and repeat yourself to get the message across. Be prepared to negotiate.
- Think about situations in which you are not assertive and how you could change this and be assertive.
- Write out a detailed description of problem scenes - note when and where the problem occurs; who is involved; what your difficulties are; how you handle it; your fear of what will happen if you are assertive; your goal.
- To deal with a problem situation:
- Consider your rights and wants.
- Unless spontaneous action is required, arrange a mutually convenient time to discuss your problem with the other person.
- Define the problem as specifically as possible.
- Describe your feelings using 'I' messages, to give the other person an understanding of how important the issue is to you.
- Make your request in one or two simple but firm sentences.
- Give positive reinforcement to get what you want e.g. we'll be able to spend more time together. If this will be ineffective try negative reinforcement, describing the alternative way you will look after yourself if your wishes are not met.
- You need to arrive at a workable compromise. Agree to review this after a specified length of time and if you are not both satisfied you can renegotiate.
- Avoid being manipulated - techniques include:
- 'Broken Record' where you choose a concise assertive statement to say over and over to get your message across.
- Delay responding to a challenging statement until you are more prepared.
- Inviting criticism may reveal what is troubling the other person.
- When someone puts you down, acknowledge something you can agree with in their criticism and ignore the rest.
- You can change the focus, from discussing the topic to analyzing the interaction between the two of you.
- In instances where you lack time you could use the short form assertiveness technique. Consider:
- Your thoughts - state the facts as: 'I think…'
- Your feelings - express as 'I' statements: 'I feel…'
- Your wants - specify behaviour change as: 'I want…'
- You need to develop assertive body language. Practice the following basic rules in front of a mirror so that you learn how to apply them to problem situations:
- Maintain eye contact and an erect body posture.
- Speak clearly and firmly.
- Emphasize what you are saying with gestures and facial expressions.
- Learn to listen assertively:
- Make sure you are both ready to listen.
- Listen giving the other person your full attention and ask them to clarify if necessary.
- Let the other person know you have heard what s/he has expressed to you.
- Practice being more assertive in problem situations and consider how it makes you feel.
- Role-playing is a good way to improve your assertiveness in a safe environment before trying it out in real life situations.
- Conclusion
- Relapse prevention includes:
- Identifying and recording triggers such as high-risk events or behaviour and early warning symptoms – decide how often you need to check for these;
- Write out an action plan – monitor, manage and medicate yourself. Set up support systems and get in touch early, with mental health services.
- Summarize the above on a flashcard to have close at hand.
- Practice recognizing triggers and early warning symptoms and implementing your action plan.
- Looking forward with confidence requires overcoming low self-esteem (See ‘Overcoming Low Self-Esteem’ in the Forward Counselling Advice Service), overcoming a negative self-image, forming strong relationships and developing realistic life goals.
- Relapse prevention includes:
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