| Try a Change of Pace | |
(Guides' Note: Sometimes we focus so much on drug therapy for manic depression that we forget about psychotherapeutic treatment. The following article addresses a behavioral therapy technique called "pacing" which can be practiced very beneficially in conjunction with walking. We here at About.com's Bipolar Disorder Guidesite believe that exercise is an important part of regaining and maintaining mental health, and we like this idea of turning exercise into walk therapy.)
People with a diagnosis of Bipolar Disorder often feel that they have no control over their own rhythms. However, your rhythms are not solely a result of chemical reaction somewhere up in the land of neurotransmitters. Behavioral change needs to be part of a medication and therapy regimen. The knowledge that behavior is flexible has been around since B.F. Skinner, and recent research shows that neural pathways are changeable with time and practice. How do you change your behavior? First you need awareness of a different kind. This awareness is the physical side of the psychological story. There is daily work to be done that will help you feel more in control. "Pacing" is a tool for regaining a sense of control and learning that a "process" view of life can be creative and satisfying. Many people with Bipolar Disorder can't shift their pace or focus easily. There is a "locked in" feeling to the upswing and downswing modes. It is as if your accelerator is stuck, or you have run out of gas. There is a need to find other paces and the different focus levels that exist rather than these extremes; a need to learn how to gently shift from one focus area to another, and to change pace when you want to. This article introduces a new form of therapy that uses behavioral techniques to learn a middle ground focus and moderate pacing. SPECIFIC METHODS There are specific methods for learning to be aware of which focus area you are in and which pace. I can put you behind the steering wheel of a sports car and tell you all about shifting gears, but unless you have experience with a sports car you will have to learn to "listen to the engine." Listening to your engine will give you the information you need to know when to shift gears. Without getting to know the rhythm of the engine you will have many problems driving the car. If you don’t know what gear you are in, you don’t know when to shift into another one. You don’t know the sequence: for example, that fourth gear doesn’t shift well back into first. And when you are stopped, it is good to go through all the gears before you get into overdrive. Your system of focus and pace works the same way. While driving you have to be aware of the road in front of you, your car, the cars beside you and in back of you. You have to focus outside the car and inside the car. All this is a great metaphor. So how do you get "under the hood"? The easiest way to make behavioral changes is becoming aware of focus and pace and learning to shift them around as you need to. You have to feel which pace you are in and which focus you are in, in order to work on changes. You can experience focus levels right now: Inner Focus An inner focus area is made up of your internal world of thoughts and feelings. To experience fully you can close your eyes right now. You will also notice an inner rhythm, of breathing and heart rate. Close your eyes and listen... Middle Ground As you open your eyes, look at your desk in front of you or the back of someone’s head or whatever is in the space about three to four feet ahead. This is a middle ground focus. There are people and tasks and places in it. This middle ground is where many bipolar people have little or no experience. However, It is where the majority of people spend most of their time. This is the focus area for daily tasks and processes. Big Picture Now shift your gaze to a space about eight to ten feet ahead of you. This is a larger focus area where you see many things and full of action. HOW IT IS DONE It is easier to shift gears when you can recognize your own rhythms. We live in a world of motion, so we can use walking as the easiest and most practical movement for learning about pace and focus. PACE Three paces are used in the walk as clues to the level of energy that accompanies an idea or emotion. This pacing of physical movement allows a full range of pace and focus to be experienced. A Slow Pace Slowing down can be a relief as pressure to push ahead becomes de-pressurized, as we regain a sense of where we are and when we are. The act of slowing down may reveal an emotion or problem. Slow rhythms can feel like paralysis, depressed, sad, and sluggish. The slow pace may be scary as you become more involved in your deeper feelings. Pacing will help you shift into or away from these feeling as you gain more control. Moderate Pace The moderate pace is a walking rhythm without the push or pull of a strong emotion. In this pace, you are in a rhythm that facilitates integration of your internal world with the external world. With a moderate pace your thoughts and feelings and the environment can work together to create plans, develop tools, and think through actions. This is a bipolar practice pace. Thinking through potential actions is different than going for the high feeling of the potential results only! Even with imagined success there is a process to use and evaluation tools available. Rapid Pace Moving rapidly through the world can be due to choice, pressure or fright. Some people walk rapidly with the belief that they are avoiding the deeper feeling state that is present in a slower pace, or that they will be rewarded when they reach their goal. The problem with the fast pace occurs when it is idea-driven and not part of a process. Important cues and opportunities to encounter problems will be passed by. PROCESS Daily life can be fulfilling when you have planned your moves in middle ground and have used an inner focus to orient your feelings and know the big picture environment. With these paces and focus areas, you can see the landscape both inside and outside of yourself. The ability to get things done and gain momentum evolves from feelings of confidence. When you feel safe in the environment and have a plan based on knowledge and feelings then you can move joyfully and satisfied. With this three-pace structure, you can experienced the range of your emotional world. With practice of self-observation you will be able to experience more integration of thoughts and feelings at all three levels. The three paces work with the three focus areas as a pattern for rhythm and reflection. Being aware of the pace you move in is a way to monitor your internal rhythms. WHY IT WORKS When you are the observer and the actor, you can change your behavior. When you practice techniques for control you can use them in daily situations. Talking about your behavior in a therapist’s office isn’t enough. You are the one who walks out the door into a world full of emotional cues. You are the one who can benefit from finding middle ground and working with your own pace and focus. Sara Denning Abbott is a behavioral psychotherapist in private practice in New York City. Her specialties are Bipolar Disorder and Attention Deficit Disorder. She is currently involved in research on pacing and focusing as therapeutic tools. She is an Associate Member of the American Psychological Assoc., a member of The American College of Sports Medicine, a personal trainer and member of AFAA, The American Fitness Association. You can get answers to questions and learn more about pacing and focus techniques at http://www.therapywalk.com.
