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Cognitive Changes in Mania
- By Site Admin
- Published 03/16/2008
- Bipolar Disorder
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Cognitive Changes in Mania
The onset of mania or hypomania can often be a pleasant experience for people with bipolar disorder. Positive changes in mood can be quite dramatic, and people often feel energized, excited, and optimistic. On the other hand people sometimes find that mania and hypomania begin with irritability and agitation, or that they experience both feelings of dysphoria and euphoria at the beginning of a manic episode. For those who experience mixed episodes, quick changes can occur between being in a good mood and extreme irritability.
The symptoms of mania, hypomania, or mixed episodes usually emerge over a period of days to weeks. Often people become aware of a pattern in the development of their symptoms, for example, hypomania or mania may begin with one symptom such as insomnia, and then progress to other symptoms (e.g., increased sexual interest, feelings of euphoria). Changes in the nature of people's thoughts, or preoccupation with certain ideas can also be part of this progression. Some people learn to recognize these changes in their thinking and can say, It's happening again. I always start thinking that way when I'm getting high. This recognition can be a critical step for intervening early to prevent a full-blown manic episode.
COGNITIVE SYMPTOMS OF MANIA & HYPOMANIA
The cognitive changes associated with mania or hypomania include changes in the way people or situations are viewed, and changes in the amount and quality of new ideas. These changes can act as a signal that a manic episode is developing, and that action needs to be taken to prevent the symptoms from getting worse.
Increased Optimism & Grandiosity
When people are manic or hypomanic, the most common symptom is the development of an unusually positive view of self, the future, and the world at large. When people are becoming manic, they often find themselves feeling particularly self-confident and experiencing a general sense of well-being. This is often accompanied by beliefs that include overestimating their abilities, an optimism that causes them to view the world as particularly helpful, or an underestimation of the negative consequences of their behavior.
Sometimes this self-confidence can progress to the point where the person's thinking is grandiose and delusional.
When people are becoming manic or hypomanic they may develop a wealth of new ideas and plans that often have the potential to be successful. Unfortunately, when people are manic, it can be difficult to distinguish between good ideas and grandiose delusions. The other thing that often happens during a manic episode is that a person's ability to concentrate and follow through with plans is impaired (particularly when they are overactive or not sleeping much). All of these factors, together with little or no planning, can cause even the best ideas to fail.
During a manic or hypomanic episode, people may forget to consider the potential negative consequences of their behavior. There is a tendency to rush into an activity or make a decision without carefully considering the pros and cons associated with each choice. They may also be feeling so optimistic that they dismiss the potential negative consequences anyway.
Some people may think they have special powers, particularly in the areas of creativity and personal interactions. These beliefs are maintained when people focus only on events that appear to confirm the belief, while ignoring evidence to the contrary.
Paranoia
Early in the development of mania or hypomania, paranoid thinking is often evident, and may manifest as suspiciousness of others. This suspiciousness is often based on very real events and a history of bad feelings between the person experiencing mania, and the target of his or her paranoia. The paranoia is often maintained by focusing on evidence that confirms the paranoid thoughts. Interactions with the target person are likely be tense because of the suspicion involved, and the target person is likely to react
in some way to the tension and hostility. This reaction can then be read by the person as confirming their paranoia.
Increased Fluency of Ideas
During mania and hypomania, there is often a flood of new ideas and interests. People with hypomanic symptoms frequently overestimate how much can be accomplished in a given day and underestimate the time it takes to complete tasks. The increase in mental activity that accompanies mania acts to distract people from these tasks they have started doing, making it even more difficult to complete activities.
Thinking Errors in Mania
Social judgement can be impaired in hypomania and is usually quite impaired during manic episodes. People with bipolar disorder often experience a decreased sense of self-awareness during their interactions with others. They may say or do unusual things, or fail to notice the impact that their words or actions have on other people.
The Cognitive Behavioural Approach to Preventing Mania
The cognitive behavioural approach to managing the cognitive and behavioral changes associated with mania or hypomania include:
1. Recognizing subtle mood, cognitive, and behavioral changes to allow for early intervention
2. Evaluating and changing distorted or unhelpful thoughts and beliefs, or ideas such as suspiciousness
or grandiosity
3. Organising and scheduling of activities, ideas, or plans with the aim of limiting and containing overlystimulating
activities.
Let's look at how you can learn to manage your thoughts to prevent mania.
First, you need to learn to recognize what sorts of thoughts you get when you are beginning to get high. When you are in an elevated mood, thoughts that are overly positive might not be helpful to you because they could cause your mood to spiral upwards toward mania. Just like negative thoughts are considered to be unhelpful when you are depressed, thoughts that overly positive are also considered unhelpful when your mood is elevated.
Record those thoughts that might be overly positive when you are in a mildly or moderately elevated mood. You might not know whether or not they are helpful and that's why it is a good idea to write them down. You might find that some of your thoughts seem a little grandiose and are quite different from how you would normally view a situation, and these would be considered unhelpful to you. The next step is then to develop a more balanced thought in place of the initial unhelpful thought. Here are some questions you can ask yourself to help you develop a balanced thought:
• What evidence do I have that my thoughts are true?
• What facts or details might I have ignored or overlooked?
• What other ways are there of viewing the situation?
• If I were not feeling high, what would I be thinking?
• What is a balanced view of this situation?
It is probably very helpful if you practice before you start feeling high. Remember that preventing a full-blown episode of mania is all about EARLY recognition of the warning signs and intervening quickly before they escalate. Recognizing early warning signs of mania is essential because cognitive behavioral therapy might not be very effective once a person is in a full-blown manic episode.
Summary
• The symptoms of mania, hypomania, or mixed episodes usually emerge over a period of days and may have a pattern in their development
• Cognitive changes associated with hypomania and mania include increased self-confidence and optimism, and an increase in creative ideas and interests
• Sometimes, paranoid thinking might be present and is demonstrated through suspiciousness of others
• Judgement can sometimes be impaired when mood is elevated
• Just like negative thoughts are considered to be unhelpful when you are depressed, thoughts that overly positive are also considered unhelpful when your mood is elevated.
• It is important to be aware of these thoughts, to write them down and develop a balanced view of the initial thought. The ultimate purpose of this is to prevent a full-blown episode of mania
• Try to practise this exercise before you actually start feeling high
• Preventing a full-blown episode of mania is all about EARLY recognition of the warning signs and intervening quickly before they escalate
The onset of mania or hypomania can often be a pleasant experience for people with bipolar disorder. Positive changes in mood can be quite dramatic, and people often feel energized, excited, and optimistic. On the other hand people sometimes find that mania and hypomania begin with irritability and agitation, or that they experience both feelings of dysphoria and euphoria at the beginning of a manic episode. For those who experience mixed episodes, quick changes can occur between being in a good mood and extreme irritability.
The symptoms of mania, hypomania, or mixed episodes usually emerge over a period of days to weeks. Often people become aware of a pattern in the development of their symptoms, for example, hypomania or mania may begin with one symptom such as insomnia, and then progress to other symptoms (e.g., increased sexual interest, feelings of euphoria). Changes in the nature of people's thoughts, or preoccupation with certain ideas can also be part of this progression. Some people learn to recognize these changes in their thinking and can say, It's happening again. I always start thinking that way when I'm getting high. This recognition can be a critical step for intervening early to prevent a full-blown manic episode.
COGNITIVE SYMPTOMS OF MANIA & HYPOMANIA
The cognitive changes associated with mania or hypomania include changes in the way people or situations are viewed, and changes in the amount and quality of new ideas. These changes can act as a signal that a manic episode is developing, and that action needs to be taken to prevent the symptoms from getting worse.
Increased Optimism & Grandiosity
When people are manic or hypomanic, the most common symptom is the development of an unusually positive view of self, the future, and the world at large. When people are becoming manic, they often find themselves feeling particularly self-confident and experiencing a general sense of well-being. This is often accompanied by beliefs that include overestimating their abilities, an optimism that causes them to view the world as particularly helpful, or an underestimation of the negative consequences of their behavior.
Sometimes this self-confidence can progress to the point where the person's thinking is grandiose and delusional.
When people are becoming manic or hypomanic they may develop a wealth of new ideas and plans that often have the potential to be successful. Unfortunately, when people are manic, it can be difficult to distinguish between good ideas and grandiose delusions. The other thing that often happens during a manic episode is that a person's ability to concentrate and follow through with plans is impaired (particularly when they are overactive or not sleeping much). All of these factors, together with little or no planning, can cause even the best ideas to fail.
During a manic or hypomanic episode, people may forget to consider the potential negative consequences of their behavior. There is a tendency to rush into an activity or make a decision without carefully considering the pros and cons associated with each choice. They may also be feeling so optimistic that they dismiss the potential negative consequences anyway.
Some people may think they have special powers, particularly in the areas of creativity and personal interactions. These beliefs are maintained when people focus only on events that appear to confirm the belief, while ignoring evidence to the contrary.
Paranoia
Early in the development of mania or hypomania, paranoid thinking is often evident, and may manifest as suspiciousness of others. This suspiciousness is often based on very real events and a history of bad feelings between the person experiencing mania, and the target of his or her paranoia. The paranoia is often maintained by focusing on evidence that confirms the paranoid thoughts. Interactions with the target person are likely be tense because of the suspicion involved, and the target person is likely to react
in some way to the tension and hostility. This reaction can then be read by the person as confirming their paranoia.
Increased Fluency of Ideas
During mania and hypomania, there is often a flood of new ideas and interests. People with hypomanic symptoms frequently overestimate how much can be accomplished in a given day and underestimate the time it takes to complete tasks. The increase in mental activity that accompanies mania acts to distract people from these tasks they have started doing, making it even more difficult to complete activities.
Thinking Errors in Mania
Social judgement can be impaired in hypomania and is usually quite impaired during manic episodes. People with bipolar disorder often experience a decreased sense of self-awareness during their interactions with others. They may say or do unusual things, or fail to notice the impact that their words or actions have on other people.
The Cognitive Behavioural Approach to Preventing Mania
The cognitive behavioural approach to managing the cognitive and behavioral changes associated with mania or hypomania include:
1. Recognizing subtle mood, cognitive, and behavioral changes to allow for early intervention
2. Evaluating and changing distorted or unhelpful thoughts and beliefs, or ideas such as suspiciousness
or grandiosity
3. Organising and scheduling of activities, ideas, or plans with the aim of limiting and containing overlystimulating
activities.
Let's look at how you can learn to manage your thoughts to prevent mania.
First, you need to learn to recognize what sorts of thoughts you get when you are beginning to get high. When you are in an elevated mood, thoughts that are overly positive might not be helpful to you because they could cause your mood to spiral upwards toward mania. Just like negative thoughts are considered to be unhelpful when you are depressed, thoughts that overly positive are also considered unhelpful when your mood is elevated.
Record those thoughts that might be overly positive when you are in a mildly or moderately elevated mood. You might not know whether or not they are helpful and that's why it is a good idea to write them down. You might find that some of your thoughts seem a little grandiose and are quite different from how you would normally view a situation, and these would be considered unhelpful to you. The next step is then to develop a more balanced thought in place of the initial unhelpful thought. Here are some questions you can ask yourself to help you develop a balanced thought:
• What evidence do I have that my thoughts are true?
• What facts or details might I have ignored or overlooked?
• What other ways are there of viewing the situation?
• If I were not feeling high, what would I be thinking?
• What is a balanced view of this situation?
It is probably very helpful if you practice before you start feeling high. Remember that preventing a full-blown episode of mania is all about EARLY recognition of the warning signs and intervening quickly before they escalate. Recognizing early warning signs of mania is essential because cognitive behavioral therapy might not be very effective once a person is in a full-blown manic episode.
Summary
• The symptoms of mania, hypomania, or mixed episodes usually emerge over a period of days and may have a pattern in their development
• Cognitive changes associated with hypomania and mania include increased self-confidence and optimism, and an increase in creative ideas and interests
• Sometimes, paranoid thinking might be present and is demonstrated through suspiciousness of others
• Judgement can sometimes be impaired when mood is elevated
• Just like negative thoughts are considered to be unhelpful when you are depressed, thoughts that overly positive are also considered unhelpful when your mood is elevated.
• It is important to be aware of these thoughts, to write them down and develop a balanced view of the initial thought. The ultimate purpose of this is to prevent a full-blown episode of mania
• Try to practise this exercise before you actually start feeling high
• Preventing a full-blown episode of mania is all about EARLY recognition of the warning signs and intervening quickly before they escalate
