BIPOLAR SOBER / BIPOLAR / PERSPECTIVES / DBT
BIPOLAR THROUGH A DBT LENS.
ACCEPT WHAT IS.
CHANGE WHAT YOU CAN.
01 / DIALECTICS
TWO THINGS
CAN BE
TRUE.
Changing reality requires first accepting reality.
— Marsha M. Linehan
DBT is about teaching you how to experience intense emotions without automatically reacting to them, tolerate distress without making your circumstances worse, and develop healthier relationships with yourself and others. It is about accepting yourself as you are while recognizing that some of your behaviors need to change. You have valid emotions, but they don’t have to control your actions. DBT places equal importance on acceptance and change.
Dialectical thinking is the foundation of DBT. It is the understanding that two seemingly contradictory things can be true at the same time. For example, you can accept yourself the way you are but at the same time acknowledge that you need to change certain behaviors. You can recognize that bipolar disorder influences your actions while still taking responsibility for their consequences. This approach challenges all-or-nothing thinking. Acceptance doesn't mean that nothing needs to change. Change doesn't mean that who you are right now is unacceptable.
02 / WISE MIND
FEELINGS.
FACTS.
BOTH.
There are three “minds” in DBT:
Feelings strongly influence thinking and behavior
May act impulsively, interpret situations through intense emotions, make decisions based on what feels necessary in the moment
Emphasizes facts, logic, objective information
Focus on practical consequences while overlooking emotional needs
Integrates emotional and logical
Allows you to acknowledge what you are feeling while considering reality, your values, and the potential consequences of your actions
For you, with bipolar disorder, Wise Mind may also mean relying on an established safety plan, professional guidance, and trusted outside perspectives. You don’t have to ignore your emotions to make reasonable decisions. You can listen to them without allowing them to make every decision for you.
03 / MINDFULNESS
NOTICE
BEFORE YOU
REACT.
Mindfulness is a core skill in DBT. While experiencing symptoms, DBT encourages you to recognize the experiences without automatically identifying with them. You don’t say you are angry; instead say you are experiencing anger. Create a distinction between the experiences and your identity. DBT emphasizes three mindfulness skills:
- Observe: Notice your emotions, thoughts, and sensations without immediately reacting.
- Describe: Put your experience into words without adding judgments or assumptions.
- Participate: Engage fully in what you're doing rather than becoming trapped in your thoughts.
Mindfulness doesn’t require a perfectly calm mind, just an observant one. You are simply experiencing things, not becoming them.
04 / DISTRESS TOLERANCE
SURVIVE
THE FUCKING
MOMENT.
Distress tolerance is another key ability: experiencing emotional pain without trying to escape, eliminate, or act on it.
With bipolar disorder, difficult emotions can feel unbearable. Instinct says to do something about it to provide immediate relief like drinking or another impulsive decision, even if that “solution” causes problems. DBT teaches you that not every painful situation can be resolved immediately and that your goal should be to get through it safely. Use the STOP skill:
Stop: Resist the urge to react immediately.
Take a step back: Create distance from the situation.
Observe: Notice what you're feeling, thinking, and wanting to do.
Proceed mindfully: Choose an action based on your goals rather than your immediate impulse.
Other distress tolerance strategies are paced breathing, grounding exercises, temporary distractions, self-soothing, and considering the consequences of acting on an urge.
If you want to drink, talk to someone right away about the urge and remove yourself from the triggering environment. If you cannot remove yourself—like if you're having a manic episode—talk to the psychiatrist and talk to someone you can trust, report your mental state and ask for help. Don’t pretend you’re fine and don’t need help; don’t convince yourself your emotions are unreasonable.
You don’t have to feel better immediately, and sometimes the most important accomplishment is getting through a difficult moment without making the situation worse.
05 / EMOTION REGULATION
NAME THE
DAMN THING.
Emotional regulation is important. It involves recognizing, understanding, and responding to your emotions in ways that support your well-being by identifying them rather than categorizing them as simply good or bad. With bullshit bipolar, there’s an extra layer of changes in mood, energy, sleep, and cognition all influencing your emotions. You can ask yourself:
- What emotion am I experiencing?
- What happened before I started feeling this way?
- What thoughts are influencing this emotion?
- What is this emotion urging me to do?
- Does the intensity of my emotion fit the current circumstances?
- What response would help me in the long term?
06 / OPPOSITE ACTION
DON'T FEED
EVERY
FEELING.
You need to check the facts, asking yourself what evidence you have for your emotions.
Another technique is Opposite Action, which involves choosing a behavior that counters an unhelpful emotional urge when that emotion or its intensity doesn’t fit the facts. If shame urges you to isolate, reach out instead.
You can’t always choose how you feel, but you can practice choosing what you do with those feelings.
07 / RELATIONSHIPS
SAY WHAT
YOU FUCKING
MEAN.
Bipolar disorder, as you know, can really mess up your shit—especially the ways you communicate, respond to conflict, and maintain relationships. During periods of emotional intensity, you might become defensive, withdraw from others, react angrily, or struggle to express your needs. You also can experience frustration when people misunderstand your diagnosis or interpret your symptoms as character flaws.
DBT teaches interpersonal effectiveness: the ability to communicate your needs, establish boundaries, maintain relationships, and preserve your self-respect. Three important DBT approaches are:
DEAR MAN
Helps you communicate requests, express your needs, and negotiate effectively:
- D — Describe: State the facts without judgment.
- E — Express: Explain your feelings and opinions.
- A — Assert: Clearly ask for what you need or say no.
- R — Reinforce: Explain the benefits of your request.
- M — Mindful: Stay focused on your goal.
- A — Appear confident: Use a steady voice and confident posture.
- N — Negotiate: Be willing to discuss alternatives.
GIVE
Helps you maintain relationships through gentleness, interest, validation, and an easy manner:
- G — Gentle: Avoid attacks, threats, and judgment.
- I — Interested: Listen and show interest in the other person.
- V — Validate: Acknowledge their feelings and perspective.
- E — Easy manner: Be warm and approachable; use humor when appropriate.
FAST
Helps you maintain self-respect through fairness, appropriate apologies, honesty, and staying true to your values:
- F — Fair: Be fair to yourself and others.
- A — No unnecessary Apologies: Don’t apologize for having needs, feelings, or boundaries.
- S — Stick to your values: Stay true to what matters to you.
- T — Truthful: Be honest; avoid exaggerating or making excuses.
These skills encourage you to balance three important goals: obtaining what you need, maintaining healthy relationships, and respecting yourself. It’s not required to abandon your needs for a relationship, excuse your behavior, or tolerate mistreatment. Healthy relationships require communication, accountability, boundaries, and mutual respect.
08 / RADICAL ACCEPTANCE
REALITY
DOESN'T NEED
PERMISSION.
Radical acceptance: an old friend. You did this when you went to jail, when you accepted that you have bipolar disorder and ADHD, when you accepted your trauma. Radical acceptance is acknowledging reality as it is rather than continually fighting against something that happened or is happening. You don’t have to like it, but you just accept it and deal with it best you can—which you do.
09 / PUT IT INTO PRACTICE
OKAY.
NOW WHAT?
During episodes, try to respond rather than react. Manic episodes are a huge pain, and DBT encourages you to notice behavioral changes and create safeguards before your judgment becomes significantly impaired. Get support when critically needed.
In a depressive episode, DBT teaches you to acknowledge your suffering without adding unnecessary self-judgment. Don’t criticize yourself for struggling; practice self-compassion and break responsibilities into manageable steps. Your progress doesn’t have to be dramatic to matter.
During a mixed episode, the symptom combination can make the emotional reactions hard to manage; DBT encourages you to slow down responses, avoid impulse decisions, and use crisis-survival skills. Recognize your warning signs and seek timely treatment. This means to use your impulsivity plan and lean on others and your treatment team for help.
10 / IMPULSIVITY & ADDICTION
AN URGE
IS NOT AN
OBLIGATION.
Impulsivity and addiction are two areas where you struggle the most. You get the “fuck its”. It comes about with mania mostly. DBT teaches you to recognize that an urge is an experience, not an obligation. You can notice a desire to act without immediately following it. Examine the urge, turn it over in your hands. Study it. This will get easier through growth, practice, planning, and support. Hone your impulsivity plan and stick to it.
11 / SELF-VALIDATION
JUDGE THE
ACTION.
NOT YOUR WORTH.
You used to feel a lot of shame about having bipolar disorder, and that may return again someday. You are embarrassed by it sometimes still. You still disappoint yourself. You regret decisions you make during episodes and get frustrated by the bullshit your symptoms have pulled. You also can internalize the stigma.
You need to try practicing self-validation which means acknowledging that your emotions and experiences make sense within the context of your circumstances. It doesn’t mean your conclusions are accurate or your actions are justified though. DBT teaches you to separate judgment from observation. Make judgments about the actions or situation, not who you are as a person.
12 / A LIFE WORTH LIVING
BUILD A LIFE
BEYOND THE
CRISIS.
A goal central to DBT is helping you build a life worth living. This means developing a life that reflects your values, relationships, interests, and aspirations rather than organizing your entire existence around emotional crises.
You spend a boatload of time managing things and recovering, worrying, and stressing all because of this bogus illness. DBT encourages you to look ahead and build positive experiences, develop a sense of competence, and work toward meaningful goals. Every symptom won’t disappear, so participate in your own life. You can build a life that isn’t bipolar-centric.
YOU CAN ACCEPT THIS MOMENT.
AND STILL
CHANGE IT.
DBT says two things can be true at once. And it is true: you are doing the best you can with the skills, resources, and circumstances available to you, and you can continue learning skills that help you do better.
You don’t have to choose between acceptance and change nor between acknowledging your suffering and taking responsibility for your life.
You are not your diagnosis.
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