Coping with prodromes

Monitoring will facilitate the identification of early warning signs—or prodromes—of illness. Although prodromes are idiosyncratic, there is research evidence that bipolar patients report a fairly consistent pattern of prodromes over time (Lam et al., 2001; Molnar et al., 1988). An effective coping strategy for dealing with prodromes is associated with higher social functioning (Lam & Wong, 1997), which, in turn, predicted longer intervals between episodes (Gitlin et al., 1995) or fewer bipolar episodes (Lam et al., 2001). In Lam et al.'s study, avoiding the temptation to seek further stimulation and engaging in calming activities in the prodromal phase of mania were associated with fewer manic episodes during the following 18 months. Likewise, engaging systematically in pleasure or mastery activities, seeking support and reality-testing one's negative cognitions during the prodromal stage of a depression were associated with fewer depressive episodes.

The BAS model suggests specifically that activities should be considered in terms of their potential to reward or frustrate as a means of understanding how they might interact with current mood state. When the BAS level appears elevated, potential sources of reward should be regulated, with a view to avoiding further elevation that may result in hypomania. For example, stimulating social events and work-related challenges could be avoided or reduced. Encouraging realistic appraisal of circumstances or planned actions to incorporate a balanced view of the risks and downsides involved would be one way of dealing with overoptimistic thinking that might lead to unwise actions and further mood elevation. Similarly, when the BAS level appears low, potential sources of reward should be encouraged, while challenges with a high risk of failure should be avoided—for example, through use of graded task assignments. Potential sources of social support could be investigated and, if necessary, instigated, and regular social contact encouraged.

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Letting Go, Moving On

Letting Go, Moving On

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