Why relationships are important to your quality of life
Humans are social beings, and while time alone is important, most of us thrive when we also have supportive others in our lives. Relationships, of course, are complex, always changing, and interwoven with diverse social issues. As such, we cannot cover the broad range of relationships and social issues here. So in this section we’ll discuss relationships from the standpoint of ‘social support’. We’ll share information about supportive relationships in the context of bipolar disorder, and give a few suggestions to try in your own social life.
First, however, it is important to start this section with a note on safety. Relationships exist on a spectrum, so there may be times when it can be hard to tell when certain behaviours cross the line from healthy to unhealthy, or even abusive. This can occur in any type of relationship. Domestic abuse disproportionately affects children and women, but anybody, of any gender, sexuality, ethnicity, or social class can be affected. Click here to learn about the types of abuse, and some warning signs of abuse in partner relationships.
Many people with bipolar disorder experience low social support12,13. Symptoms of depression and mania can take a major toll on social life14. When depressed, people tend to keep to themselves. When manic, symptoms can push people away. As a result, many people living with bipolar disorder report both close and distant relationships to be unavailable or inadequate15. Even between episodes, people with bipolar disorder report less contact with friends16, and increased sensitivity to rejection from others, which relates to depression, poor social support, and quality of life17. People who have had many lifetime mood episodes (especially of mania) and some lasting symptoms report the most challenges in getting social support15,16.
Again, supportive relationships are beneficial, but not all relationships are helpful. Research has looked at interaction styles within families (i.e., how families communicate with each other), as family relationships are a frequent source of social contact. Family interaction styles that are described as critical, hostile, intrusive or over-involved predict higher rates of relapse in people with bipolar disorder18,19,20. These negative interaction styles can also predict poor overall functioning9 and longer episodes6. So, while relationships may provide support, relationships with people close to you that have a lot of conflict in them can add to your stress, so it’s a ‘double edged sword’.
How to take action
Ask yourself what your ideal social life looks like. Some people thrive with lots of relationships and social contact, while others prefer just a few close friends. It can be helpful to have a friend with similar experiences and struggles as you have – support groups can be a place to identify people who understand what you’re going through. But it can also be helpful to have a casual friend who you participate in a concrete activity with (like going to the movies or taking a bike ride) without needing to talk about deeper issues.
Assess your social network. The first step to making improvements in your relationships is to consider the people in your life who are, or who could become, sources of support; importantly, consider what you can do to provide mutual support to those people, as a one-sided relationship is not healthy for either participant. Try to keep an open mind for possibilities for relationships. You could include family, friends, co-workers, neighbors, healthcare providers or other acquaintances and familiar faces. You can include people you speak to regularly, people you haven’t seen in quite some time, or people you don’t know very well yet.
You might find that you want to change your social networks to promote healthier relationships and lifestyles. For example, you may need to find friends who don’t use recreational drugs or take part in unhealthy behaviours that may put you at risk for a mood episode. One useful source of social support is peer support by ‘informed supporters’. Informed supporters are people who are living well with a condition similar to yours. They are trained by a mental health professional to provide support21 and can be helpful in providing emotional and practical support for managing your condition. Becoming a peer supporter to others can help you feel a greater sense of connectedness with your community21.
Ensure that you have a healthy balance of social contact. Too much social contact can be exhausting or over-stimulating, increasing your risk for mood symptoms. It’s essential to find the right balance for you. It can be helpful to monitor your mood as you make changes to your social life. You might find that your depressed mood improves with more social contact. However, if you have too much, you may find you are becoming at risk for hypomania or mania.
Many therapies have been proven helpful for people living with bipolar disorder. Family-focused Therapy (FFT) targets family interactions to help make relationships more supportive18. Interpersonal and Social Rhythm Therapy (IPSRT) focuses in large part, too, on interpersonal challenges22. IPSRT helps people build and maintain healthy relationships, while learning to recognize and end unhealthy ones. While Assertiveness Skills Training is not specific to bipolar disorder, it may be helpful, rather than using passive-aggressive or aggressive communication styles. An example of a passive-aggressive communication style would be giving someone the ‘silent treatment’ when you’re angry with them. An example of an aggressive communication style would be saying things that are meant to hurt someone. These communication styles can wreak havoc on relationships.
If socializing is difficult for you, you may want to consider Social Skills Training or Cognitive Behavioural Therapy (CBT). CBT can be helpful to improve mood symptoms and social functioning23. It can help challenge distorted (or false) thinking patterns about yourself or others. In particular, CBT can help to cope with over-sensitivity to rejection, which many people living with bipolar disorder report. CBT also works to gradually schedule in regular social activities and other healthy behaviours.
Ask yourself how close your actual relationships and social life are to your ideal vision of them. You may be interested in strengthening current relationships, or working on past ones. If your actual social network is smaller than your ideal, you may need to take steps to widen it. If it is large and not feeling healthy for you, you may want to concentrate on strengthening some relationships while easing off on others.
Quick tips for connecting with others
Some ideas for connecting with others in a supportive way:
Be vulnerable - with those who have earned it.
For emotional support, building intimacy and trust requires vulnerability. However, it’s important to be vulnerable with those people who have earned it. Pay attention to those people in your social network who make you feel emotionally supported, safe, and understood, and see if you can practice being vulnerable with these people. For those people in your life that don’t feel supportive or safe, it can be helpful to manage your expectations around what they are capable of offering you and setting healthy boundaries around the relationship.
Nurture variety in your relationships.
Try to nurture and build a variety of relationships, not relying on just one person for support.
Recognize that different people can support you in different ways.
Relationships are not all good or all bad. Some people may provide great tangible support (e.g. a family member who is always there to help drive you or drop off food when you are unwell) or informational support (e.g. a health professional giving medical advice) but they may not have much capacity to provide the most helpful emotional support. Other supports may provide great emotional support, but don’t have much capacity to help in other ways. It can be helpful to recognize that we are all human with limitations, and be clear around who to ask for the kind of support you need in each situation.
Create balance in your relationships.
Try to have a balance in your friendships between giving and receiving.
Avoid pushing for closeness.
Allow closeness without pushing it. Relationships work best if they don’t feel like an obligation or a duty.
Be communicative about what's on your mind and what you need.
We often expect others to “know” what is needed and offer to do it without being asked, leading us to feel disappointed or hurt if the other can’t read our minds. Try to be direct and specific in asking for what you need (e.g. “I’d love to have some time to talk tonight” or “It could be really helpful to have someone to walk with tomorrow”). It can also be useful to plan ahead by teaching your social supports about what is most helpful when you experience mood symptoms.
Prioritize and make time for your relationships.
Make relationships more important by putting them higher on your list of things to do. It may be helpful to consider your week’s socializing in advance to prevent you from putting it off.
Keep your relationship goals concrete.
Set goals that are specific, realistic and scheduled. For example, instead of “I’m going to create an ideal social network”, try “I’m going to call Roy today”. Try reaching out just once or twice a week for a conversation.
Meet with people regularly.
Try and make social meetings regular (e.g., a walk with a friend at the same time each week). Apps like FaceTime and Skype are great for this if part of your network is overseas.
Widening your network
Or, you may want to widen your network by creating brand new relationships.
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