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Section 12
Kindling of Life Stress in Bipolar Disorder

CEU Question 12 | CE Test | Table of Contents | Bipolar
Social Worker CEUs, Counselor CEUs, Psychologist CEs, MFT CEUs

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On the last track, we discussed the three types of treatments that clients may take in addition to therapy:  psychotropic medications; non-medicinal treatments; and hospitalization.

As you know, clients who suffer from a mental disorder are extremely sensitive to stress or stressful situations. 

On this track, we will examine how stress affects those with bipolar disorder and how clients can monitor their stress:  kindling; short-term and chronic stress; and stress symptoms.

3 Ways to Monitor Stress

1. Kindling
The first topic we will discuss is kindling.  As you may be aware, kindling occurs when a client’s body becomes sensitized to stress.  A stress trigger that initiates a mood episode leaves the client more vulnerable to additional stressors later on in life.  To explain it more comprehensibly to clients, I use this analogy.  When you sprain an ankle or any other part of your body for that matter, that joint becomes more susceptible to sprains later on. 

Geraldine, a 48 year old bipolar client of mine, had her first encounter with severe stress at the age of 23 when her mother died.  During that time, Geraldine remembered having her first depressive episode during which she gained approximately twenty pounds from overeating.  After this initial trigger, Geraldine became more and more sensitive to every day occurrences.  Such minor stressors as bills became a life and death situation for her and would send her into a depressive state. 

Finally, after twenty five years of this type of kindling, Geraldine would fall into a depressive state without any noticeable stressors. Geraldine stated, "It was as though I could just think about stress and I would become depressed. That feeling of not knowing what to do is terrifying." As you can see, Geraldine had fallen victim to kindling. To prevent kindling, some researchers promote the use of mood stabilizers such as lithium which seem to block the initial stages. Anticonvulsants such as valproic acid appear to affect kindling later on.

2. Short-Term and Chronic Stress
To help Geraldine and other clients like her, I emphasize the positive values of some stressors.  To do so, I separate stress into two categories: short-term and chronic.  Short-term stress, such as a near collision while driving a car, can actually help the immune system. During short-term stress, small amounts of adrenaline and cortisol are released.  I explain to my clients that cortisol can help maintain blood pressure; slow the immune system’s inflammatory response; balance the effects of insulin, affecting energy; and regulate protein, carbohydrate, and fat metabolism. 

However, during a depressive episode, high levels of cortisol are produced all day long, which negatively affects the cerebral cortex’s ability to process crisis and stressful events. This type of stress falls under the category of chronic stress. This type of stress relegates normally non-stressful circumstances to a crises. This can almost be called a chicken-or-egg type of question.  While chronic stress can instigate depression, depression can also worsen chronic stress.

3. Recognizing Stress Symptoms

In addition to kindling and short-term and chronic stress, the third topic we will discuss is helping a client recognize their stress symptoms. Often, when bipolar clients become distracted by their lives, they don’t realize that their bodies are actually telling them to slow down and take a break. If left unnoticed, these stressful symptoms will escalate into full-on depression or mania.

Checklist of Symptoms
Because I knew that Geraldine’s episodes occurred after encountering stressful situations, I gave her a "Checklist of Symptoms" that I asked her to place somewhere around her house where she would see it every day. Geraldine chose her bathroom mirror. On this checklist were several symptoms that indicated a body was undergoing stress.
These symptoms included:
1. Anxiety and nervousness
2. Appetite and weight changes
3. Avoidance and procrastination
4. Concentration and memory problems
5. Constipation or diarrhea
6. Dizziness, faintness, or weakness
7. Headaches
8. Irritability
9. Muscle
pain or tension
Whenever Geraldine began to feel these effects or any other symptoms that she equated with stress, she would be reminded that these symptoms were signs that her body needed to slow down.

Technique:  Me Day
To help Geraldine relieve her stress, I suggested she make up a plan to give herself a "Me Day".  I explained to Geraldine that a "Me Day" was a day in which she took off work and her other responsibilities to pamper and indulge herself.  Several of the mood relaxing ideas to try were massage, manicure, exercise, shopping, or a long hot bath.  I found it important to emphasize to Geraldine that her "Me Day" should be designed to fit her own tastes and wishes. 

To plan out some ideas for her Me Day, Geraldine wrote "Sleep in until at least nine o’clock. Go for a morning bike ride if weather permits. If it’s cloudy, try some yoga.  Fix a large breakfast of eggs, toast and bacon.  Go to the hair salon and get hair done.  Do some scrap booking. Watch favorite comedy.  Call up some friends and go to a concert that night. Go to a coffee shop and read a book.  At night, make myself an ice cream sundae." 

After writing it out, Geraldine stated, "Just thinking about all my favorite things to do relaxed me.  I actually can’t wait to have a "Me Day". It’s nice knowing that when I do get stressed, there’s a positive awaiting me." As you can see, by taking the time to listen to the body’s needs, Geraldine could better handle her stress and not face it with a fatalistic attitude.

On this track, we discussed how stress affects those with bipolar disorder and how clients can monitor their stress:  kindling; short-term and chronic stress; and stress symptoms.

On the next track, we will examine the several types of substance abuse most common in bipolar disorder clients:  alcohol, illegal drug abuse, and nicotine.

Peer-Reviewed Journal Article Reference:
Johnson, S. L., Tharp, J. A., Peckham, A. D., & McMaster, K. J. (2016). Emotion in bipolar I disorder: Implications for functional and symptom outcomes. Journal of Abnormal Psychology, 125(1), 40–52.

Mneimne, M., Fleeson, W., Arnold, E. M., & Furr, R. M. (2018). Differentiating the everyday emotion dynamics of borderline personality disorder from major depressive disorder and bipolar disorder. Personality Disorders: Theory, Research, and Treatment, 9(2), 192–196.

Weiss, R. B., Stange, J. P., Boland, E. M., Black, S. K., LaBelle, D. R., Abramson, L. Y., & Alloy, L. B. (2015). Kindling of life stress in bipolar disorder: Comparison of sensitization and autonomy models. Journal of Abnormal Psychology, 124(1), 4–16.

Online Continuing Education QUESTION 12
What occurs when a bipolar client becomes sensitized to stress? To select and enter your answer go to CE Test.


CE Test for this course | Bipolar
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