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Effective Acclimations, Transitions, & a 'Five-Point Prize'
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In the last section, we discussed three non-medicinal treatments for depression. These treatments included: electroconvulsive
therapy; light therapy; and repeated transcranial magnetic
In this section, we will examine the three key aspects
of stress on bipolar child clients. These three key aspcts are biological
processes; social factors; and transitions. We will also include three
techniques to reduce these stresses, namely Acclimation, Point System and
3 Key Aspects of Stress
♦ 1. Biological Processes
First, we will discuss the biological processes unique
to bipolar clients. As you know, the hypothalamus works with the limbic
system in the genesis of emotion. Together, they are involved in the
control of hormone secretion and the regulation of the autonomic nervous system. Researchers
today have found that many of the clinical features of depression and mania as well as the physiological findings suggest some dysfunction in the limbic-hypothalamic
One consistent finding is that the interval between sleep onset
and the beginning of the first period of REM is shortened. The hypothalamus also regulates the pituitary gland, which also activates the adrenal gland
to release cortisol, inducing the stress response. If this stress response is continually tripped for the wrong reason or if it cannot be turned off, it could be potentially damaging to the client. Such dangers as unhealthy
weight gain, heart disease, and hypertension can all be caused by excessive
♦ 2. Social Factors
Secondly, we will discuss the way social factors affect
the stress response. Interestingly, social factors directly influence
the intensity of the stress response. When an infant is separated from
its mother, his or her body responds by producing the stress inducing hormone
cortisol. However, the levels of cortisol can also correlate with the
level of social support the infant has during separation.
the most dramatic levels of cortisol occur when infants are completely isolated
in a new environment. However, separated infants who remain in familiar
surroundings with other mothers and infants show minimal signs of distress
and minimal increases in adrenocortical activity. I have found that bipolar
children with separation anxiety can buffer their fears if they have at least
one or two figures of social support.
Carolyn was a young mother of nine year old Jacob. Jacob had extreme separation anxiety and hated to be left with any new babysitter. To help
Carolyn with Jacob’s separation anxiety, I asked her to acclimate young
Jacob to any new babysitter. For instance, when Carolyn needed to hire
a new babysitter, she asked the young girl over during weekends when Carolyn
was still at home.
While Carolyn was in the room, the babysitter would
play with Jacob and until Jacob became used to her and even friendly. Once
this bond of friendship was established, I asked Carolyn to leave the room. If
Jacob began to show signs of stress, the babysitter would cope with him by
distracting him with toys and by holding him in her lap. This extra support
during mild separation built to a level in which the babysitter could almost
completely dissuade Jacob from his separation anxiety and Carolyn could leave
him alone for a couple of hours. Think of your "Jacob" who
has separation anxiety. Could he or she benefit from babysitter acclimation?
♦ 3. Transitions
Common stressors for bipolar children are the same for any child, but the reaction and intensity of the stress is much more severe for bipolar child clients. For
instance, one of the main stressors for any bipolar child client is a transition in any daily schedule or routine, such as a move or a new school. These
transitions will trigger the stress hormone and the client may fly into a rage
or depression, depending on their reaction. Often, in the first few sessions
with a new client, he or she is going through a transition.
Technique: The Point System
To help children
in their early sessions, I use "The Point System" which
has been reported to work in and out of therapy sessions. For instance,
Jacob was irritated and isolated his first few sessions. To help him
speak to me, I stated that he would receive points when he answered my questions. When
he reached five points, he would receive a prize.
We kept score on a
small chalkboard in my office and every time he reached five points, I let
him pick out a toy to play with. Sometimes, I would have candy on hand,
but only when a manic episode was far from occurring. The extra sugar
may put an already jittery client over the edge into mania. Think of
your transitioning client. Would he or she respond to "The
Technique: a 10 Category Transition Form
Because transitions also occur in the home, I suggest that parents of bipolar
children fill out a "Transition Form" when any
change to the current environment is imminent. This form is meant
to aid parents in monitoring their child’s moods and activities. The
transition form had several blank spaces with categories to fill. These
categories included the following:
1. Expected transition
2. Date transition will begin
3. Date transition will end
4. Beginning preparations date
5. Tactics: (i.e. reading books about transition, talking about transition,
work with child to design schedule for transition period)
6. Mood observations pretransition
7. Mood observations day before transition
8. Mood observations day of transition
9. Mood observations posttransition
10. Mood observations two weeks posttransition
These categories are specially designed to help parents monitor their children
during transitions and their ensuing mood cycles. Think of your transitioning
clients. Could his or her family benefit from the "Transition
In this section, we discussed three key aspects of stress on bipolar
child clients, which were biological processes; social factors; and transitions.
We also included three techniques to reduce these stresses, which were Acclimation,
Point System and Transition Form.
In the next section, we will examine three difficulties
bipolar children have in relating to other children. These difficulties
include impulsiveness; defiant attitudes; and disempowerment.
What are three key aspects of stress on bipolar child clients?
To select and enter your answer go to .