January 13, 2020

By Katherine Ponte, JD, MBA, CPRP

My dad was dying. I hated my job. I was struggling with school. A classmate groped me in front of other classmates. I was having a nervous breakdown.

I wanted an explanation. I wanted something I could address to make me well. I wanted someone and something to blame. But all I was given was a label – bipolar disorder.

I might have been more willing to accept my diagnosis if someone had explained it to me in the context of the life events I was experiencing. It might have made sense to me if I had connected the diagnosis with those stressful events.

Many years later, I learned that my stressful life events did have something to do with how I was feeling, reacting and behaving. For people with a pre-existing genetic vulnerability to mental illness, severe levels of stress can trigger mental illness. Research has shown this connection for major depressive disorder (MDD), bipolar disorder and schizophrenia.

High levels of stress can also cause an episode or make symptoms worse for someone who already has mental illness. For bipolar disorder, stress can contribute to hypomania and mania. For schizophrenia, it may contribute to hallucinations and delusions. And for MDD, it can deepen depression.

This is why managing stress is so important. In order to manage stress, we need to know the warning signs that stress levels are too high and learn healthy coping techniques.

Signs of Severe Stress

Not all stress is bad. In fact, it can be helpful for gaining motivation, building resilience and encouraging growth. However, stress can negatively affect a person and their health if not properly managed, especially for someone with mental illness.

The are many physical and emotional signs that stress is negatively affecting someone. In fact, according to the American Institute of Stress, there are 50 common signs and symptoms of too much stress.

One of the most common physical signs of high levels of stress is sleep deprivation.In one survey, over 40% of Americans reported that stress had prevented them from sleeping. Other physical signs include frequent headaches and aches and pains. Examples of emotional signs include anger, mood swings, difficultly concentrating and irritability.

Sources of Stress

Stress affects each person differently. A person’s genes and previous experiencesinfluence how sensitive they are to stressful life events.However, certain circumstances or life events are generally known to cause stress and can help pinpoint where an individual’s symptoms might be coming from.

The  Holmes-Rahe Stress Inventory scores a person’s “stress inventory” using 43 stressful life events. Each event is assigned a numerical score. The higher the total score for all events, the more vulnerable a person is to a stress-induced health breakdown, which may include the triggering of mental illness.

The top three stressful life events identified by the inventory are the death of a spouse, divorce and marital separation. Illness is also a top stressful life event.

When stressful life events happen, we may not be able to change the sitation or eliminate our stressors, but we can learn to manage our stress levels in a healthy way.

Methods for Managing Stress

There is no one size fits all strategy to managing stress – each person should identify which coping methods work best for them. It can help to develop coping strategies that address specific sources of stress.Also, the ability to easily incorporate coping strategies into your routine and lifestyle increases the likelihood of maintaining the practice. Keep in mind that small steps can have a big impact.

Problem-focused Coping 
Problem-focused coping is when a person directly confronts a stressor or tries to find a solution to the stressor. For example, if having too many commitments is causing you stress, you may consider eliminating one of them to better manage the others. It can be tough to implement problem-focused coping if the sources are difficult to address, such as a stressful job situation or family relationship. In these cases, rather than grapple with the source of stress, an emotion-focused approach might be more effective.

Emotion-focused Coping 
Emotion-focused coping is when a person focuses on regulating their reaction to a stressor. This approach allows a person to accept their stressors and find ways to shift how they experience them. For example, if a family member causes you distress, you can journal your feelings or reframe your thoughts about the situation to better regulate your feelings.

Wellness-focused Coping
There are eight interdependent dimensions of wellness: physical, intellectual, financial, environmental, spiritual, social, occupational and emotional. Each type of wellness has a different method for coping with stress.

PhysicalAny form of exercise can relieve stress. Research has found that 30% of adults felt less stressed after exercising.

Intellectual: Activities that engage your mind such as reading, journaling about emotions, and jigsaw puzzles are all helpful coping tools.

Financial: According to the American Psychological Association, money and finances are a top stressor for Americans. Money management resources can provide strategies and solutions for money-related stress.

Environmental: Spending time in nature and green spaces is shown to help relieve stress.

Spiritual: Connecting with yourself and the world around you through meditation, prayer, or other forms of spirituality can have many benefits for stress relief.

Social: According to a 2015 survey, “43% of those who say they have no emotional support report that their overall stress has increased in the past year, compared to 26% of those who say they have emotional support.” Staying in close touch with family and friends, seeking out opportunities to make new friendsand participating in community activities are all important methods for dealing with stress.

Occupational: Next to money, work is the second leading stressor with 60% of people finding work-related stress to be significant. One important form of occupational stress relief is to do work that you are truly passionate about, if possible. It’s also helpful to take time to recharge and establish healthy boundaries and work/life balance.

Emotional: To address your emotional wellness, you can detach yourself from stressors, practice relaxation techniques, try reframing your thoughts, or go to therapy, among many other possibilities.

Stress is a persistent force in our lives. Many people have come to accept it as normal, even when it gets out of hand, and let it build. But changing our relationship with stress is critically important for improving our health and well-being.

Had I known that stress could trigger my bipolar, I would have done more to address the stressors in my life. We often hear “mental illness can happen to anyone.” While this is true, we should also recognize that effectively managing stress can reduce the risk of developing mental illness or worsening symptoms. And this is one of the few tangible and actionable strategies we have to reduce that risk.

The goal is not to avoid stress but to manage it effectively. Stress is something we can and should address for the sake of our mental health.

Katherine Ponte is a mental health advocate, writer and entrepreneur. She is the founder of ForLikeMinds, the first online peer-based support community dedicated to people living with or supporting someone with mental illness, and Bipolar Thriving, a recovery coaching service for caregivers and their loved ones affected by bipolar disorder. She is also the creator of the Psych Ward Greeting Cards program in which she personally shares her recovery experiences and distributes donated greeting cards to patients in psychiatric units. She is in recovery from severe bipolar I disorder with psychosis. She is also on the board of NAMI New York City. 

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