Reframe the Way You Look at Your Life

Marc Elliot was born with no large intestine, 4 feet of small intestines, and has Tourette syndrome.  Yet, he has learned to control the symptoms of his disease and have a great life with the classic Cognitive Therapy techniques of Reframing and Challenging Thoughts.

My Psychiatrist says I have Bipolar Disorder. What do I do now?

iStock_000017908199SmallI had two new patients last week who came in for therapy after being diagnosed by their psychiatrist with Bipolar Disorder.  In each case, the patient wanted to spend most of the session expressing his/her relief, sadness, grief, shock, etc. over hearing those words, “you have Bipolar Disorder.”  I often hear, “so this means that I am really crazy.”  Encouraging the patient to learn as much as possible about the disorder is a key part of the therapy at this stage.

The book I most often recommend to patients struggling with a new diagnosis of bipolar disorder (BPD) is Bipolar Disorder Demystified, by Lana R. Castle.  In her opening chapter Ms Castle identifies the following common myths and misconceptions about mental illness.  Patients often find it is helpful to talk about how these myths affect their ability to cope with their BPD.

  1. There is no good reason for the mentally ill to act so crazy.  They just need to learn some self-control.
  2. We all get depressed from time to time.  Positive thinking should be enough to turn things around.
  3. Lots of people think about suicide at times, but don’t actually attempt it.  Those who say they want to kill themselves are just seeking sympathy.
  4. People with mental illness come from bad families.
  5. The mentally ill are immature and self-absorbed.  They just need to grow up and become responsible.
  6. Talking about problems won’t solve them.  It only makes you dwell on them more.  Instead of yammering endlessly in therapy, these people should take action.

Ms. Castle goes on to list 10 more common misconceptions similar to the ones above.  She further points out that the use of the phrase “the mentally ill” reflects the language people often use when making such statements.  She does not (nor do I) condone the use of the phrases “the mentally ill” or ” the bipolar” or “the schizophrenic” .  We both prefer “a person with a mental illness” or “an individual with bipolar disorder” or “my sister who has schizophrenia.”  These phrases help to emphasize the fact that the person and the illness/disorder are separate.  The illness/disorder does not define the person.  The person learns to live with the illness/disorder.


If you have BPD, or love/know someone who does, think carefully about your assumptions and preconceived notions regarding the disorder.  Talk openly about your feelings related to the above myths.  These discussions are key to the process of dealing with BPD.  Some healthy, important steps in  coping with BPD are: 

  1. understanding the disorder – its symptoms, treatments, and possible causes
  2. grieving the impact the disorder has on you life
  3. committing to making adjustments (including medication and therapy) to make your life a long, happy, and productive one.
  4. Recognizing you may have setbacks, along with your major improvements, as you work through this process.

BPD is a difficult condition to deal with; however, the more knowledge and understanding you have of the condition, the better you will be able to manage your life.  I highly recommend Lana Castle’s book, Bipolar Disorder Demystified.

Therapy for Managing Depression, Anger and Aggression

Classic Cognitive-Behavioral Therapy models are based on the assumption that thoughts(cognitive processes) dictate feelings.  Those feelings then dictate behaviors (or actions).

450px-Fire-lite-bg-10Here is a basic example:
A fire alarm goes off in a hotel at night

Person A thinks:  some kids pulled the alarm and now I am awake!
Person A feelsanger at the kids andannoyance about being awake.

Person B thinks: there must be a fire, I must get out!
Person B feelsfear of being trapped in the fire, worry about how to escape

Person C thinks: I remember when my friends and I liked to pull the fire alarm.
Person C feelsunderstanding of kids having fun and comfortable to go back to sleep.

You CAN control you thoughts, which leads to the ability to have more positive feelings.

Christy Motta, MA summarizes a Cognitive-Behavioral approach to dealing with aggression below:

In the case of aggression, the individual must change the perceptions and beliefs that contribute to increased anger. In order to do this, the individual must: 1. Cope with arousal. The first step is to identify (observe) what is happening. The individual must become aware of when they are angry and notice the physical sensations and thoughts that accompany it.

2. Replace problem thoughts with thoughts that are helpful in dealing with PROVOCATION. “This could be rough, but I can deal with it” “easy does it” “Live and let live” “Stick to the issues. Don’t take it personally.”

3. Modify problem thoughts to those that are helpful in dealing with CONFRONTATION. “keep my cool, walk away, take a time out” “I don’t need to prove myself” “There’s no point in getting mad”

4. Change appraisals and reflections AFTER A CONFRONTATION.

a. Unresolved: “They don’t have to agree” “let it go” “don’t take it personally”
b. Resolved. Label (Describe) what happened. Praise self.

People frequently need some external limits in order to identify their aggression as a problem and begin actively working on modifying their thoughts. Probation, the risk of losing housing and the risk of losing important valued relationships are common consequences that get people thinking about their aggression.