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• Psychotherapy • Research • Training
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Module 7: Behavioural Strategies for Preventing Mania
Behavioural Strategies for Mania
BEHAVIOURAL STRATEGIES FOR PREVENTING
MANIA
Behavioural Changes in Mania
One of the hallmarks of bipolar disorder is the distinctive behavioural changes that take place when a
patient begins to experience hypomania and mania. Activity levels and libido increase and hours spent in
sleep decrease. This cycle of increased activity and decreased sleep (or physical rest) can itself perpetuate
and escalate the mania.
These changes in activity levels usually begins slowly and builds over time. As such, activity levels can be
used as a measure for tracking the progression of the elevation in mood. When you recognise that your
mood begins to be elevated, it is important to begin monitoring your activity levels. If your activity levels
begin to consistently and progressively increase, your early intervention strategies should be activated to
prevent a full-blown episode of mania. Here are two strategies you can incorporate into your early
intervention plan.
Preventing Sleep Disruption
Research has shown that sleep deprivation can be both a trigger to, and a consequence (symptom) of,
mania. Some patients find that with little or no sleep, they become exhausted, but cannot slow down
enough to fall asleep. These symptoms may escalate into a full blown episode of mania and possibly
psychosis. Other bipolar patients may enjoy the increased energy and vigour, but find that this level of
energy and activity cannot be sustained without negative consequences, such as irritability and paranoia.
The best strategy for coping with sleep disruption is to prevent it. If it is possible, try to forecast or
identify times when your normal sleeping habits are likely to be disrupted (eg, when having to rush for a
deadline, travelling, going on holidays, etc.)
Here are some good sleeping habits to maintain, so that you can prevent a hypomanic or manic episode:
Going to bed and waking up at the same times each day
Avoid napping if it causes night-time insomnia (or don’t take too long a nap)
Try to minimise sleep disruptions (eg, share night-time responsibilities, bring favourite pillow on
holiday, use ear plugs or eye shields, or medications)
Avoid overstimulation (eg, too much physical activity before bedtime,
caffeine)
Avoid thinking too much at night (do some relaxation exercises or calming
activities)
Limiting Your Activities
Besides pharmacological intervention, there are some strategies you can implement to prevent mild or
moderate mood elevation from becoming a full-blown manic episode. The key principle for any behavioural
intervention for preventing mania is to limit activity and to keep activity levels to a “normal” level. It is
recommended that while you are well, use a Weekly Activity Schedule (provided on the next page) to plan
and organise your regular week, and ensure that there is a balance of responsibilities, pleasant activities, and
time for sleep and/or rest. Then, when you begin to suspect that you may be hypomanic, use a separate
activity schedule to monitor your activity level and compare it to your “normal” and balanced schedule. If
you find that your activity levels have increased significantly, try to get yourself to slow down and return to
your normal weekly schedule. You could also ask a friend or family member to help you do this.
