Goal

Although stress is not a central or core topic in bipolar disorders, it clearly plays an important role in triggering episodes, especially the early episodes – it seems gradually to lose its power with subsequent relapses. Hence it should definitely be included in a psychoeducation program for bipolar disorders. There are two (modest) goals for this nineteenth session: emphasize the importance of stress as a trigger for relapses, and talk about the breadth of the stress concept, which patients normally associate only with job pressures. Also, we try to give our patients information on the existence of various psychological tools that can help them to manage stress and anxiety better. We do not try to train the patient in these techniques during the session, although at one time we tried including an initial training in muscle relaxation. We later saw that this was not very useful for many of our patients and might even confuse some of them. The only thing we are trying to do is to inform the patient about a tool that could be advisable in certain cases.

Procedure

• As usual, we begin the session with an informal chat – which happens quite spontaneously by this stage in the program (in fact some effort has to be made by the therapists in the last three or four sessions to interrupt the group conversation rather than start it).

• We go over the distinction between causes and triggers (see Session 3, p. 73).