Hi! I believe I can be of help with this issue.
First let me say that I can imagine how frustrating and worrisome this situation must be for you. YOur question is whether what you're experiencing is a physiological problem or a life/spiritual problem. And the answer is that the divide between the two is rather artificial. There are more and more studies showing the interaction between our emotional/spiritual selves and our physical health and behavior. And the brain is so complex that it is really the meeting place between our lives and our lives' complexities and problems and dreams and hopes and our physiological, chemical makeups. So I urge you not to treat them as either/or situations but as two sides of what's going on in your life.
And this is actually the key to my answer to you that you need to think about and consider and act on. Your symptoms are severe enough that I think we need to discuss psychotherapy to help as well as self help efforts. I will also at the end of the posting give you a technique you can use on your own as well for when you are in the throes of anxiety and phobic fear and worries.
Let's work on five ways you can begin to build a behavioral program for yourself: diet, exercise, spiritual life, motivational reading and psychotherapy. The first four are to help you feel more involved and in control of yourself and what's going on inside. The psychotherapy can actually teach you skills and give you tools for managing your symptoms. This is serious for you as you need to reprogram your thinking about yourself. Spiritual life, diet and exercise are great ways to begin such a reprogramming.
Diet: cut out coffee, sugar, white flour. That may be tough. But you will see results as some of the newer research shows. And lean meats only. No fast food restaurants, no fatty foods. See what I mean about getting involved in controlling what's happening? With diet changes you are treating your problem with respect: you are acknowledging you need to make changes to get your body feeling better.
Vitamins can be useful for moods. A good quality daily vitamin, for example. One of the most important supplements is Omega 3 fatty acids, either in fish oil or capsules or in flax seed oil. Buy good quality. The clinical dosage is 800 to 3,000 mg daily. STart with the middle of that range. All these things you should get at the biggest and most frequented health food store and ask them for the best brands they trust in terms of quality.
Exercise: 5 days a week moderate exercise, to include 3 days of strength training as you get more used to it. Pretty amazing isn't it? I told you it would require work, but what you put in to it you will get out of it. Your doctor will verify the research results showing the benefit. YOu are a young man so you will most likely need to ramp up the intensity here.
Spiritual life: the medical literature is now rather overwhelming about the benefits to so many different areas of physical health of regular religious and spiritual practice. Going to church, meditation, etc. are all shown to produce benefits to the physical body. What about our mental health? Well, you will see that meditation is now a regular part of psychotherapy interventions. I don't know if you're a religious person or not. But if not, this may be a good time in your life to tune up your spiritual life. If you do not believe in G-d, that's not a barrier to your own spiritual life. Just thinking about the meaning of your life, of life in general, and studying spiritual texts and practices will help with the anxiety. And that will help with the phobic and panic reactions.
Then along with exploring the spiritual part of life, I want you to get really into motivational videos and books. Here's a simple YouTube search I put together for you on "motivational speakers":
Some like Tony Robbins are the classic big guys. Some are newer. Watch them all. Get inspired. Buy a book or two. Here are some possibilities, but they are only suggestions as there are so many good ones.
The first book is the father of all these type of books. How to Win Friends and Influence People by Dale Carnegie. There are classes in these books now! It was written in the 1930s and still has something to say to us today that is very worthwhile.
I think very highly of the second book on my list, which is a real classic: The Seven Habits of Highly Effective People by Stephen Covey. It is the book that has helped more people than probably any other.
The third book is by Anthony Robbins. He's one of those speakers who fills up huge auditoriums. For a reason. He's a terrific speaker and writer. The particular book (if you like it, try his others): Awaken the Giant Within.
Don't underestimate the wonderful benefit of this type of self work.
Now for psychotherapy. This is a very sensitive area. Many psychotherapists say they work with BD and if they use standard CBT therapy, it will be of some help. But you need to be working with someone who is using a CBT therapy that is modified especially for BD. So, if your therapists are not doing this, it may be time to seek someone who is experienced in these therapies. In my practice, I use the resources with people with BD from Mary Ellen Copeland. I have found her work easy for people to use and easy to keep with him . The biggest problem is forgetting to keep to the plan when times are good and then something happens! Copeland also had BD and was hospitalized. She's a therapist and developed a BD treatment protocol called Wellness Recovery Action Plan (WRAP). First let me cite one of her books for you.
The Depression Workbook: A Guide for Living with Depression and Manic Depression by Mary Ellen Copeland. Amazon: http://www.amazon.com/Depression-Workbook-Guide-Living-Second/dp/157224268X/ref=sr_1_1?ie=UTF8&s=books&qid=1284317815&sr=8-1-catcorr
Now here's a YouTube search I've put together on the WRAP program. I want you to look at the videos and see what you think:
The video with Mary Ellen is a bit strong but worthwhile. Here is the web address for Psychology Today's therapist directory. You can sort by zip codes and when you see someone who seems like they might be helpful look at the listing and see if they list BD or mood disorders as something they work with and perhaps if they accept a sliding fee if he has no income. I'm assuming if you can't fund his therapy fully.
Good Therapy is a non profit directory. Same idea as the one above:
I believe from my experience that it is SO important for you to not just take the meds and expect them to do everything. YOU have to take charge of managing your BD. And having a strategy like the WRAP program is a coherent way to do this. So that you can regulate your moods as they cycle. Here's what I mean:
Most people are like cars with automatic transmission. They tool around the day going from a little sad and then they feel a little glad and if they get to too high a gear, the emotional transmission just automatically sends them back to a lower gear and if the low gets too low, the transmission clicks into a higher gear. Rarely are they thinking about it. They are usually within their normal range.
You with BD are like a car with a manual transmission. You start having a racing mood and unless you downshift manually, you're going to be out of control soon until you can't maintain that and you cycle down and then get too far down, etc. So you have to continually use the clutch and manually adjust the emotional gear.
That's what a program like the WRAP plan is about. It gives you the tools to notice what's going on and to make adjustments. So that is why I'm stressing it for you. I hope it allows you to safely reduce your meds with your doctor so that you are functioning more optimally.
I wish you the very best!
Now, I want to give you a tool to use for when the worry and panic is overwhelming. Here are instructions on a therapeutic protocol called Progressive Muscle Relaxation (PMR). It's really quite easy to do almost anywhere. My patients suffering from depression or anxiety, when I teach them PMR at first are amazed how simple it is and that it is a psychological protocol. It was first used in the 1920s! Since then, of course, it has been refined and many studies have been done showing its effectiveness. You will practice PMR at first when you don't wake up with an attack so that you will be familiar with it. I want you to practice the PMR at least 5-6 times before an attack or feeling acute anxiety. Why? Because when you're in the throes of anxiety, you will only remember to do something you are very familiar with it. So practicing 5-6 times is really a minimum.
I want to stress the importance of breathing as well. Part of the physiology of what is happening to you in anxiety states is that your breathing is getting shallower. This reduces the oxygen in your blood to your brain. That increases the anxiety reaction, which strengthens the attack and you are in a vicious cycle! Not good. So breathing is the primary tool. I have found in my practice that learning breathing techniques can be helpful. But some of my patients are not interested in learning more than one thing at the beginning, so I have found that just reminding you to BREATHE deeply at the same time you are doing PMR is almost as good. If you are willing to take a yoga class and learn breathing techniques, that's the best. But, breathing deeply with your PMR will help.
So, we're ready for learning PMR. I want you to print my instructions below my signature and have a copy in each of the rooms of your home where you may be when you have an attack. And again, you need to practice this easy technique at least 5-6 times as soon as you can. It needs to become as natural to you as breathing. Ah, remember breathing?
- After finding a quiet place and several free minutes to practice progressive muscle relaxation, sit or lie down and make yourself comfortable.
- Begin by tensing all the muscles in your face. Make a tight grimace, close your eyes as tightly as possible, clench your teeth, even move your ears up if you can. Hold this for the count of eight as you inhale.
- Now exhale and relax completely. Let your face go completely lax, as though you were sleeping. Feel the tension seep from your facial muscles, and enjoy the feeling.
- Next, completely tense your neck and shoulders, again inhaling and counting to eight. Then exhale and relax.
- Continue down your body, repeating the procedure with the following muscle groups:
- entire right arm
- right forearm and hand (making a fist)
- right hand
- entire left arm
- left forearm and hand (again, making a fist)
- left hand
- entire right leg
- lower right leg and foot
- right foot
- entire left leg
- lower left leg and foot
- left foot
- for the shortened version, which includes just four main muscle groups:
- neck, shoulders and arms
- abdomen and chest
- buttocks, legs and feet
Quickly focusing on each group one after the other, with practice you can relax your body like ‘liquid relaxation’ poured on your head and it flowed down and completely covered you. You can use progressive muscle relaxation to quickly de-stress any time.
What You Need:
- A comfortable place.
- Some privacy.
- A few minutes.