Welcome to Conversations With. My name is Shaila Kukendorn and I live with Bipolar 2 Disorder. Sharing with others is healing both individually and collectively. Sharing our stories will Educate others, bring more understanding, shed more light, and smash more stigma. Our voices need to be heard. Our stories aren't over yet. This is Bipolar. Hi everyone, welcome back to This is Bipolar. I am Shaili Huggendorn, I'm your host. I am a mom and a teacher.
I live with bipolar 2 disorder, and I am a mental illness advocate. And I am really excited today to tell you about my guests. But first, I just wanted to mention that I have subscriptions on Instagram. And what that looks like is that you subscribe there. It is $6.99 a month, and you get extra content. But the most valuable part that people are really excited about is there's a group of us meet once a month.
It is peer support. it's to see someone else and talk to someone else that actually understands what it's like to live with bipolar disorder so you can do that on instagram if you have any trouble with it just message me and i will get you connected and hopefully we'll see you at next month's meeting i know that we tell a lot of stories of lived experience on here and i've had a lot of requests to bring on some bipolar specific specialists.
I know people have talked about therapy and didn't feel fully understood as someone that lived with bipolar disorder. So I have brought on an expert. And let me tell you, I'm going to read her bio just to show you how expert that Dr. Holly Schwartz is.
Okay. Holly Schwartz is a professor of psychiatry at the University of Pittsburgh School of Medicine, the director of the Center for Advanced Psychotherapy and internationally recognized expert in psychosocial interventions, which we're going to talk about today, for bipolar disorder. She's actively engaged in teaching, researching, mentoring, and patient care.
And she is also serving as president of the International Society of Interpersonal Psychotherapy, president of the International Society for Bipolar Disorder, among other things. And one of the things I'm most excited about is her new book, which is called Social Rhythms Therapy for Bipolar Disorder. And so you are a very busy person. Yes, I'm busy, but so, so glad to be here. Thank you so much for inviting me. I'm, really excited to be in conversation with you.
Yeah, I was telling you before we got on here, I felt like I already know you because I was introduced to you by my friend and bipolar buddy, Dr. Andrea Vasiliev. And then some of our subscribers are actually working through your book right now and talking about it in our chat. It's really exciting. I wanted to bring you on just because I think that this is something people are tangible that I can do.
What's something that will just help me in my daily life? I also really want to learn more because it's something that I struggle with. But before we get into that, I'd just love to hear, how did you end up in this profession? What brought you into psychiatry and then specifically working with people with bipolar disorder? Yeah, life is funny, right? So we're all on a journey.
Before I went to medical school, I was actually working in a psychiatric hospital because it was something I was interested in. I wasn't really sure what I was going to do after I finished college. And I just really fell in love with the people that I was working with, the things that I was learning, the questions that were coming up. And so I actually have a very strong memory when I was working in this hospital in Boston.
Meeting a woman who was living with bipolar disorder, and she was coming in sometimes depressed and sometimes manic. She was just a lovely human being, struggling, but trying to figure out, get her head around, and also for me to try to think about what it meant to be a person with really different mood states and how you integrate these experiences into yourself, into your identity.
I was just there for support. So it wasn't like I was treating this person, but it was dramatic and it was raising really important questions and it was really inspiring. And so then I went to medical school and I was like, okay, this is what I'm going to do. And I really haven't looked back, honestly. Wow, that's amazing. That's also really interesting that you got to see this person through both because a lot of people show up at the hospital or to get help in one or the other.
So the fact that you got to walk with this person through both, that must have just been really fascinating. It's really hard to explain to people how opposite the moods can be. And I know I only went for help when I was depressed because I didn't recognize the hypomania. I am curious, can you tell us about the work that you do? Can you break it down? What is interpersonal therapy? What is social rhythm therapy? And just talk us through a little bit of the science behind it. Yeah.
So I've really been interested in psychosocial interventions for mood disorders. Both bipolar disorder and unipolar depression for my, for really for my whole career, because I think they're powerful. I think they can make a difference. They improve outcomes. And the science of it is quite interesting. So we think about it as a verbal pill.
So if we want to test it, if we wanted to see if something stands up to rigorous evaluation in clinical trials, we have to be able to really reproducibly say what we're doing, right? Just like the pill is a pill, we want the psychotherapy to be the same thing more from person to person and across trials and settings.
And so learning how to do that and then testing these therapies to see if they helped, how they helped, who they helped, has been the quest that I've been on with colleagues for a long time. And I started out with interpersonal psychotherapy. So interpersonal psychotherapy. Is a now well-tested psychotherapy for unipolar depression.
And it focuses on understanding the links between mood and relationships, both relationship difficulties and positive changes in relationships and communication and interpersonal functioning. And so that was one area that I started out in. And then I actually came to Pittsburgh where I have been for over 25 years now to work with Ellen Frank, who developed interpersonal and social rhythm therapy.
So what Ellen Frank did, she's now retired, but very much alive and well and involved still with the field. She took interpersonal psychotherapy and added to it what we now call social rhythm therapy, a circadian-based behavioral intervention, specifically targeting underlying disturbances in the circadian system that we know are part of bipolar disorder. And this interpersonal and social rhythm therapy then was tested as a treatment
for bipolar disorder. And I had the opportunity to learn from her and participate in her clinical trials. And then later I've taken just the social rhythm therapy part of it, pulled that out separately and have over the last maybe 10 years, been looking at social rhythm therapy to see if that alone might be effective for some people with actually mood disorders, bipolar disorder, as well as depression.
Yeah, yeah. I just found that, find it all so fascinating because of course I've heard of routine and words like that that seemed... Constraining to me, but I like the language of rhythms and social rhythm therapy. For someone that's just being introduced to the science behind this and just being introduced to some of these terms, could you explain what circadian rhythm means? Yeah, no, that's a great question, right? So the word circadian comes from Latin, actually.
So circa means about, and dia, day, means day, 24 hours. So it's like about a day. And these are rhythms in our bodies that run on approximately 24-hour cycles. And if you start paying attention to it, you'll notice it in yourself pretty easily. So when you are hungry, when your energy is high, when your energy is low, when you're sleepy, when you're alert, when you're physically stronger versus less physically activated. And so these are things that are moving on a roughly 24-hour cycle.
There are also processes that are happening inside our bodies. So things like our blood pressure, hormones that circulate on a cycle throughout the day, throughout the 24-hour cycle. And so these are all circadian rhythms and they control lots and lots of aspects of our biology. But the thing that's really key about this is it's about 24 hours. So this is a clock that kind of gets off track unless somebody reminds it when it is, right? It's about 24 hours, but it,
Just get off track. So we're constantly needing input to remind our brains when we are. And this is useful because we have to readjust to different environments. So it allows us to be flexibly adaptive to time changes, to moving across time zones, to the changing in the light-dark cycle across seasons. And it allows our bodies to interact with these environmental cues so that we're in sync with our environment. But it can also get off cycle. The rhythms can lose the beat.
And then we can get into trouble. And that sometimes happens with bipolar disorder. Yeah, definitely. I love the language you used, lose the beat, because how I would probably describe it is the beat gets really fast or there's a very quiet beat depending on which end I'm at or in the middle. I think that was a really good way to explain it. Thank you so much. I also really appreciate how you talk about it as a full body experience.
One of the things that I'm always trying to explain to people that don't live with bipolar disorder or don't study bipolar disorder is that we tend to think it's all because it's a mental illness, that it's all up in our heads.
And my experience and the experience of many people that I have interviewed is that it is full body like different different things in my system like I can feel it in my body when things are changing and yeah it almost feels it almost takes over kind of thing and as we go further I just wanted to speak to people listening this is going to possibly sound easy but also I know that this is also not very easy, especially for those of us that live with bipolar disorder, because we know
that it's a sleep disorder. Energy disorder, all of those things that tie into what you're talking about. And so I'd love to hear more about how these rhythms affect our brain and what kinds of things indicate or tell our bodies that it is time to do certain things in that 24 hour period. Yeah. So we can definitely talk about that. I just want to go back to your comment. It sounds like this is easy, but it's not easy because yeah.
So the gist of this is behavior change. So it's learning to do things at the same time every day. And it sounds super simple, but as you said, it's not. It's like when someone says, eat healthy. Yeah, that sounds easy, but it's not, or exercise more. It sounds easy, but it's not. And so this is one of those things that I think the principles are pretty straightforward.
Implementing it can be challenging. The basic idea here is, remember I said that the circadian system gets input from the environment. And the most potent factor helping to set our body clocks, our circadian rhythms, is the rising and the setting of the sun. and that helps tell us when we are in time. But as you point out, we're not just a brain floating in space, right? We're connected to all sorts of bodily functions.
And so there are sensors actually in every organ system throughout the body that helps us to know when we are in time. And so what we're doing with social rhythm therapy is leveraging all the daily routines and the social interactions that help us stay on track with the day and use those to help give cues to our brains, to our body clocks about when it is so that we can help our circadian rhythms run more smoothly.
Yeah, yeah, that's fascinating to me because you would think that we could be like, hello, we woke up, it is morning. But what you're saying is that we need to give signals to our body that it is morning or that it is time to do things. And I think that that's really interesting, especially because I would say, not a scientist, but that definitely our signals are confusing and get mixed up, right?
We know one of the biggest symptoms of oncoming hypomania and mania is directly related to our sleep and to light And all of the things, I think pre-treatment, if someone would have told me, just try having some rhythms, I might have been like, that seems like a really, because bipolar seems so big when you're in it, that seems, it seems like a simple solution. But you're here telling us there is research behind having these rhythms.
And I'm just really curious about what are the things that we can do for those rhythms? And then, yeah, I'll ask you that first. I have so many. Yeah, no, it's a great question. And you actually started to answer your own question, right? So you started talking about getting up in the morning. So a couple of things.
The time that we get up in the morning is probably the most powerful time setter timekeeper for our body clocks but it's not just when we wake up there's other things that we have to do to cue our brains that it is actually morning so they're, And you can do all of these or some of these, but there are options in your toolbox to help reinforce this process.
Obviously, one is light. So if you want to open your eyes and you want to get some sunlight exposure, if you're ambitious and your mood is pretty level, you might want to go for a walk. Or if you're not feeling that great, even just like opening the window and sitting close to the window for a little bit. again, it's giving information to your brain about the light cycle, which is really powerful. But there are other things that are powerful.
So actually getting vertical is really helpful because when we're upright, there are sensors in our blood vessels that sense the change in position. And being upright is telling our brain, oh, you're walking along here. You're up for the day. So getting vertical as opposed to just lying in bed, can't get up. Just getting up, even if you don't do too much, that helps. And your gastrointestinal tract also is wired up to your brain.
And so getting something into your gastrointestinal tract, even if you're not all that hungry, helps tell your brain, oh, okay, it's food starting, but we're starting the day here. So those are some examples of the kinds of things that you can do to help set your body clock on a good rhythm for the day by getting up and doing this at the same time every day if possible. It gives reinforcing information to your circadian rhythms.
Yeah, I find that fascinating. I was thinking about it and because we know most of us take medication that either help us sleep or the side effect is sleeping and so this is my absolute biggest struggle because. I take that medication and many of us do. I rarely, unless hypomanic, wake up like refreshed or it is actually very difficult for me to get up.
And I also, this is a little bit hard to implement in my life, but I'm going to tell y'all just in case some of you are like me, I am an on-call teacher. So people have work or different things that they get up. So my kind of job is not, I don't have the same day every day. And then I'm always like excited to sleep in on weekends. So when I heard this, I was trying to think about what that would look like, because when I work, I get up at 630. That is really hard for me on any other day.
So my question to you is, could it be like, is it still helpful if it's a range? Like for those days, I get up at 6.30, but any other day, could I range in between 6.30 and 8, or am I throwing things right off? So there are no absolutes here. What I would say is if you're functioning pretty well and feeling pretty good, and that works for you, then that works for you.
I think if your mood is not great, and you're really having trouble getting up, you know, at 6.30 on the mornings when you have to get up at 630, then the experiment that might be. Music.
And just try to be consistent even on the days when you don't have to get up and see if for some people that helps reset their body clocks and it makes it easier to just get up when you have to get up yeah and I was joking with you earlier it's so interesting to me because sometimes it gets to be like such a block. I know this is going to, some things are going to help me, right? But it's like our brains tell us sometimes I feel like I'm stealing the night
if I stay up late or my brain will tell me, you know, that a routine is boring. Right. But I love what you're saying is that there can be a range. I like that, that you're telling me around 45 minutes ish. And I liked what you were saying about depending where you're at. I know that we know it's not curable. We know that we're going to have episodes in some way, shape or form.
And so one of the things that I do that really aligns with this is once when I'm starting to notice early warning signs on either side of the spectrum, that is when I get extra strict about things because depression might come anyways, and this won't cure us, but any little step that we can do to help us feel a little bit better or maybe come out of it quicker. And I know that we want like a quick fix, right?
But I think I just would really encourage everybody to try these things and just try and check in with yourself. I know that I was saying that I was excited to have you on because I don't know about other people, but when I say I'm going to do something, especially like on the internet, I'm more likely to do that. And I, But I think we all need accountability, right? Human beings, we need to be accountable to other people.
And so having a buddy who works with you on this can be really a game changer. Someone who, for their own reasons, whether because they have bipolar disorder or they want to maybe try out a healthier lifestyle. But together, you can keep each other in check and go back and forth about how you're doing and troubles that you're having and doing some brainstorming and problem solving. So I think doing the accountability thing is human.
Yeah, for sure. And I love the idea of talking to your person like when you're euthymic or when you're not in. Specifically, for me, it would be more in the hypomanic stage, right? If I make these plans and talk to my person when I am not full in, because I know that if I was hypomanic and I was, if it was my husband, I'm like, you can't tell me when to go to bed. But I think if you tell someone you trust, then they can kindly remind you as well.
And I think for me, I would, and others, I know we talk about it a lot, is I would encourage everyone to take, I know that I would probably be able to get up to seven if I took my medication earlier. So I need to get eventually to the other side. And another thing that I noticed is I never used to eat breakfast. And I know a lot of people, like sometimes when you're depressed, you're not hungry or when you're hypomanic, you're just going, so you forget.
But I really noticed that one changed for me when I started, even if it was just a little something or a smoothie or just something. Yeah. I noticed now when I get up, I can't not have something. So you can train your body. And I love how you are just reiterating that just that work with yourself, right? And that it's not, you're saying, tell me if this is what you're saying, but you're saying that to do these things like the best you can, right?
Because I know when I get perfectionists, I'd be like, I didn't do it perfect. Forget it. And you're saying start with these things. Yeah, I mean, the way I think about it is it's tools in a toolbox. So I think that these are all things that you can use at the service of your well-being in a way that makes sense for you. And I want to stay away from rigid directives because everybody's different.
These tools work differently in different people's hands. But I think adhering to the general principle, the more regular, the better. It's a good operating principle. And the extent to which you follow the specifics, it's going to vary based on how you're doing and also your personal style. Yeah. One of the things that I love that I've heard you talk about, I love the word social. And I just really so much believe not just in self-care, in community care and in connection.
And so I loved when you talked about keeping a rhythm of when you interact with people or talk to people. And I'm wondering if you could speak to that. Yeah. So we track actually five things when we're doing the science of this and use that to measure how regular people are and And the things that we track, and these are good signposts for all of us throughout the day and things that we can work on in terms of specific activities that we try to anchor in our days and be more regular with.
The first is the time out of bed. We've talked about that. The second is first contact with another person. We are social beings and our interactions with other humans helps our brains, our bodies to stay on track. The next would be the time that we start our usual activity. And again, this is going to, it was interesting because in your life, you talked about the fact that you're on call and you might do one thing one day and then not have something to do the next.
But I think we can all think about putting things into our lives that we would do every day, even if it's different things each day. The more classic version of this is you do one thing Monday through Friday, but then you have to come up with something to do at the same time on Saturday and Sunday. It sounds like your schedule's more variable than that. But we track that. We track the time that you have dinner. And again, remember your gastrointestinal
tract at that point is saying, oh, it's getting close to wind down time. Yeah. And then the time you go to bed. So those are some anchors that we are really paying attention to in social rhythm therapy. And then more broadly, the context in which all of this stuff is happening, our lives, the people in our lives. Social context, because these aren't just happening in isolation, of course.
Yeah. And when you talk about the time that you interact, so is there research or do you encourage people like try and make contact with another human being like before noon, or is there an idea there? So the idea here is that it's yet another input into our circadian systems and consistency is probably more important than the absolute time. Some of us are just grumpy in the morning and nobody really wants to talk to us. That'd be okay to wait a little bit later.
And some of us are morning people and as soon as we're up, we want to chatter with somebody and that's fine too. And again, so that's why this is really personalized. And I think it doesn't matter so much the absolute time you do it as the consistency because it's helping to regularize your circadian rhythms.
Yeah, yeah. So if you're someone listening, maybe that loves someone that lives with bipolar disorder, and perhaps, I know a lot of people ask me, like, what can I do when my loved one is depressed, or they ghost me, or they're not around? It sounds like it would be really helpful for you to connect to them by sending a text or a message. And I can't guarantee that we will answer. But I think even getting that. Some kind of connection would really help.
Because I know that I have the tendency to hibernate. And I think that I really love that. And I know I heard you mention, I think it was in another podcast that something like, and this is very pertinent to me, because as a content creator and a podcaster, a lot of my connections are online. And so I know that sometimes like just posting isn't interactive, but is it as helpful when you're in a community? Because we have a wonderful community online that we talk back and forth.
Would it count if it was like me talking to someone on Instagram or does it have to be phone or face-to-face or is it a little bit flexible? In terms of tracking first contact with another person, we do want some kind of reciprocity. And so I think like just a post doesn't really count because you don't get anything back.
But if you're talking with somebody in an online community, it's interesting because most of the studies were not done when, or the earliest studies were not done when online communities were available and active. So these are great questions. I think clearly people get lots of support from online communities and that's terrific and I think you can have that contact.
So using technology, it doesn't have to be in person or by phone, but I think there has to be some kind of back and forth, some reciprocity. Yeah, I love that. That's really good. I was thinking about when you were talking about this, I was thinking about some kinds of messages that I might get or questions. And I was thinking about how it's really helpful. Like for me personally, it's really helpful to have family, right?
I have children. So there's definitely, if I don't go to work, I drive a kid to school or they make dinner for my family. I find that when I'm alone, I get out of those rhythms. Or one thing, I had to remind myself to eat lunch when they went to school, when they were littles, because I had to make them lunch. So I was always having lunch at a certain time. And then when they went to school, I'm like, oh, yeah, like I actually have to eat it myself.
And I know a lot of people live alone and might not have a family to remind them of that but I know a lot of people have pets that remind them yeah that's yeah this is the interesting thing all living things including children and pets have circadian rhythms and if you're, living with another being that has circadian rhythms you can often tie your circadian rhythms to theirs. If you have a dog, they're going to get you out of bed, right?
Because they're up, they've got this, oh, my brain is awake now, and so are you. Little kids, for sure. Yeah, I love that. My dog, it's awesome. He, like, we usually go to bed at a certain time. And if it starts to creep past that time, he, like, huffs at us and, like, moves around. And he won't go by himself because he has his little comfy crate. But he'll huff and move around and try and get her, like, tell me to go to bed. I think that's pretty awesome.
Yeah. Yeah. And if you're listening to this and you're someone that lives alone or you don't have a pet, one of the things that I would suggest one of the things that I did with the lunch thing is I actually connect with someone and remind that we remind each other or I remember during COVID. We would meet online like on zoom to have lunch together because I I was so I'm a huge extrovert Dr. Holly. And so that I needed all kinds of connection.
And so I encourage people like find someone, find some different rhythms that way. I think that, yeah, having that accountability, I just find, I don't know why it is, but I just find it so much harder just myself. I always tell myself oh later but if someone else knows or is interacting with me it's that much easier we are social beings right and we take our cues from other humans and in our kind of post-modern sometimes fragmented world that we live in leveraging technology for the good.
Is really a great message because it can reproduce some of those social connections that back before electricity, we were living in communities by virtue of just, we were all like living together. And that was, we were taking cues from one another and that's how we're wired. That's how we're biologically wired. Yeah. Yeah.
That's fascinating. I'm curious also, would you would say that eating the other meals at the same time is just as important like lunch and dinner because it indicates to our body what time of the day it is from a science standpoint the the two meals that seem to be most predictive of stable rhythms or being consistent with meals is breakfast and dinner but but lunch also helps pace us across the day again just, the data primarily support breakfast and dinner, but I wouldn't dismiss lunch.
I think that these regular patterns, keeping your body on track throughout the day is definitely going to help overall and give you a sense of consistency. Yeah. Doing all of your having meals at the same time, I think can be really helpful. Yeah. Yeah. And I'm really excited because I want to ask, I'm definitely going to be doing some follow-up posts on Instagram to hear from the community. Just what are things that they do in certain episodes that help them.
I know I talk about, because I get so busy and have a really hard time slowing down when I'm hypomanic. So I have like car snacks and I have, I put things in place so that their food is there. Maybe I'm, maybe I'm busy or I, when I don't want to make meals, I make sure I have frozen ones or I get them delivered or there are little tricks that you can do. And I know that some of those have really helped me. So I love that. Those are some great suggestions.
Yeah. I've had to really find creative ways to work alongside my bipolar disorder just because just saying to myself, eat lunch or just saying, like when you are in the full body experience, it's really hard.
So if you set yourself up ahead of time, yeah you're able to find more success I'm really curious what did it look like like you had I'm just trying to picture what that looks like so you had a group of folks that lived with bipolar or unipolar disorder and then did they like check in with you and then you measured like quality of life how did what did that look like I'm so curious our clinical trials how did we do that.
People agreed consented to participate in the studies and we delivered the psychotherapy and then we asked people to fill out a whole bunch of questionnaires so we could try to understand what was happening and what was helping what was not helping and we also use this thing called the social rhythm metric, which is in the book that, that I recently published. And you can, you can download it actually from the new Harbinger website and use that as a tracking tool.
So people filled it out every day and then brought it in and we looked at it and we're like this, and people rate their mood. And we look at the relationship between the regularity of their routines and mood and energy and tried to.
Collaboratively problem solve what was taking you off track what can you do differently can you anticipate we did a lot of this so next week all your kids are on vacation and like your whole life is going to be upended like how's this going to affect your schedule and what can you do to stay on track even though lots of things are going to be changing so some anticipatory work and so really getting in the weeds together to try to figure out ways first to establish regular routines
and then to keep them regular. And then we measured what was happening. Yeah. That's so fascinating to me. I think that's wonderful. You just brought up a really important point and I experienced it last year because it was my first time going overseas. And we talk a lot about online, the time change and even those things like one hour and bipolar is just so sensitive to any kind of change. And I love that you said that you helped people think about how to prepare for that.
Can you speak to that? What kinds of things did you talk about or what kind of things did people put into place for those kinds of scenarios? Yeah. So the first is just being intentional about it and thinking, so what is going to change? What is this going to look like? And some of the strategies that we use are actually to make, so gradual change is easier on your circadian rhythms than abrupt changes. So if you can gradually shift things, your body can usually be like,
okay, this is working. Okay. But if you go from getting up at seven to getting up at noon, like you're like, wait, whoa, whoa, I don't know where I am. Um, so what we work on often is like making changes to, to routines to align with the new location or the new time zone. Okay. Time to try to make it a little bit more gradual if possible. That's one thing we do.
The other thing we talk about is keeping some things. Um, on the same time zone as where you're coming from, even if you can't do everything. So maybe you can keep your meals more or less the same or time that you take your medication or the time that you interact with other people for the first time in the day. So if you can keep some of this stuff on track, that also helps to settle your circadian system.
Yeah. Yeah. I found that really helpful. I took my medication when like it would have been the daytime in Europe, but we were on the plane. So I took my medication for that so that it was easier to adapt instead of just staying awake on the plane. And I found that really helped because I was pretty nervous that it was going, I didn't want to throw myself into an episode when I was trying to have this, our first trip ever overseas.
And so I really looked into that and I didn't ever really realize how affected I was by time change. And over the last two years, I tried to do a week ahead, 15 minutes, change the bedtime and do it slowly. Like you said, I tend to be all or nothing, right? So I'm like, I'll just change really quickly. And you're right. It doesn't usually go that well. And so, yeah, I just really encourage people. I thought, no,
this isn't going to make that much of a difference. But even like my husband was like, oh, this time change was much smoother, which was really helpful. And I love too, what you said is the gradual, right? I know if you're someone listening and you're like, oh my goodness, I have to change everything immediately. I think what I'm taking from this is pick one thing to start with and then pick the next thing and slowly.
Because I tend to, I have really mean inner critic that's, oh, you can't even do it. You can't do it perfect. Just forget it all. That's not going to work for you. And I'm really excited to start with one and then move into the others.
I think that- i think you're absolutely right you don't want to make huge changes you want to start small you want to you know try it out see what you think i think one of the cautionary notes on that is it can take like a week until if it's working give yourself a little and you don't have to perfect the whole time yeah you'll give yourself some time to see if it makes a difference before.
Either going on to something else or saying that this is really helpful and the other thing you said, which I just also want to call out is you said that your husband, when you guys were working together, that, more gradually adjust to the time change. And he was like, oh, that was easier. I think that was a really smart move because when you engage other people in the process, whether or not they've got bipolar disorder, again, this gets back to the accountability, the social support.
And frankly, this stuff is good for anybody, right? As I say, anybody with a brain, this is going to be helpful. And so if you know anybody with a brain, whether it's another human being or a mammal who happens to cohabitate with you, these things, these kinds of slow, gradual changes and consistency are just good pretty much for everybody.
Yeah. And I really encourage people. I know it was hard for me at first to hear people in my close circles experience, but I find that it's really helpful for me to talk about other people and see what they notice.
So I'll write down like what they notice when I'm hypomanic or what they notice because sometimes I'll I remember in the beginning I was like oh my medication doesn't work at all and my husband's okay let's take a breath actually I noticed this and this because I want such dramatic things to happen and I wanted like cure and what I'm realized over like the last 10 or so years once I was stabilized or in treatment and diagnosed, that I really could have that reflective capacity,
whereas in the beginning, and I wouldn't have seen what others see. So I love what you're saying. Yeah, don't give up. Try and it might not. We're not promising that it's going to be miraculous, but it's going to help. And it might be really hard, but it really is going to help.
And I'm hoping I'm just haven't really thought what it would look like but I'm hoping to do almost like, social rhythm challenge and do some things on the internet with folks where that's cool yeah like I was thinking let's do and then I'll post something and once a week and we check in hey do does anybody else need to work on their sleep awake thing does anybody else and then we can check in on each other that would be cool yeah I love it and again it's that accountability part
which is so important because if you're in it together, you're likely to stick with it. Yeah. I love that idea of, not being alone in it. And so I love, and I love a challenge. Dr. Holly, this is, I'm really excited about starting to implement some of these things. I'd love to talk about your book. I know there are people in my subscribers and people online that I've been talking to that have just really raved about the book.
So could you tell us what, you know what the book looks like and how it can be helpful i would love to hear about it so this book is was a long time in the making so this is something that we've been working on in research settings for a really long time and i would get so many emails where people would say oh where can i get a therapist who can help me with this and we have trained a lot of therapists There are a lot of good therapists, not enough,
never enough, and not always easily accessible. And my goal in writing this workbook was, can we get this to, because I think these are powerful tools. I think they're really helpful tools. And I want to get them in the hands of anybody who wants to try them out. And so the goal of the workbook was to put this stuff down on paper, the stuff that we do in the clinic, the stuff like the tips and tools that we've come up with over the years in a format that people can do in a self-guided fashion.
I think it works well with therapy as well in conjunction with a therapist, if you happen to have a therapist who can work with you on it. But it's written to be totally self-guided so that you can do it on your own.
And it consists of information so that you have some of the stuff we're talking about right now what are circadian rhythms how do they work what how can we shore up our circadian rhythms so it gives you some information and then it's really a lot of exercises to get you thinking about the kinds of things that are anchors in your life the kinds of activities that.
Give us signals that our circadian system is on track or not on track going through these these as I said, these five activities that we know from research affects the regularity of our routines and in turn predict whether we're going to have a new mood episode. So how to be systematically tracking those activities, how to problem solve if, You're struggling to make changes that you want to make in order to get more regular with specific kinds of routines.
A lot of things we've been talking about, again, now, how to anticipate changes in disruption and doing some worksheets around anticipating changes. Focusing a lot on sleep and wake times because that's hugely important. It's a big deal in bipolar disorder. Lots of tips, tools. And worksheets to try to help people be mindful of, attentive to sleep, and then also to make gradual changes to make it more regular.
Yeah, I love that. I think that's really amazing because I feel from what I've seen from it and what I've heard from others is just sometimes it can be overwhelming just to read pure nonfiction or huge things at once. And I love how it's broken down and I love how it's interactive. And I think that's really important. And I loved also what you said about just really thinking about your own life.
And I love that you're not giving an exact prescription, but yet looking at how you can realistically follow some of these things in your own life. And that just gives me a lot of hope. And we will have all Dr. Holly's information in the show notes and where you can get yourself the workbook. And yeah, I'm really, really excited about it. Before we wrap up, was there anything I didn't touch on or anything that you wanted to have last words about?
I think that I'm so impressed with your commitment to. Health and finding ways to support wellness, recognizing the fluctuations that are part of bipolar disorder. And I'm hopeful that some of these tips and tools that are in this workbook and that we've been talking about today, people can adapt and personalize to use in different phases of the disorder in different ways.
And at time, and also when mood symptoms are pretty low, because we also know that having more regular routines can help prevent new episodes. I really appreciate your sort of nuanced thinking about the experience of having bipolar disorder. And I would encourage people to find ways to integrate these tools into really the whole spectrum of bipolar experiences. Awesome. Thank you. Thank you so much for all the work that you do and the commitment you've had over many years to helping my people.
I just think that it's just really inspiring and touching to me that people would study specifically, right? Sometimes I know for years I struggled to find help or practical things that I could do as someone with bipolar disorder. I always joke about how I went to certain therapy and it was like, write in your journal or do these things that, and I was like, I'm hypomanic. I can't. So I would find other ways. And so all that to say is thank you for your work.
And I'm really excited about the workbook. And I know it's going to help so many. And so I will put all of Dr. Holly's information below. go follow her on Instagram and go and get the book. Send us messages. Tell us what you think about the book and keep an eye on Instagram because I do want to start these either challenges or just encouraging posts and networks where we can check in on each other because I know that I would love my community to check in on me and see how I'm doing.
So thank you for being here. thank you for coming on and for just for who you are in this world i really appreciate you thank you so much for inviting me this has been a whole lot of fun and i really look forward to learning more about what you and the community do with these. Online support systems around social rhythm so excited to hear more yeah that's awesome this is bipolar thanks again for tuning in you can find video versions of this is bipolar on our YouTube channel.
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