The Upside of Bipolar: Conversations on the Road to Wellness
Living with bipolar disorder sucks! Each week Michelle Reittinger and her guests explore tools and resources that help you learn how to live well with your bipolar. If you are tired of suffering and want to live a healthy, balanced, productive life with your bipolar, this podcast was designed with you in mind.
The Upside of Bipolar: Conversations on the Road to Wellness
EP 63: Small Steps, Big Impact: Building Sustainable Recovery Habits with Dr. Sheri Johnson
Dr. Sheri Johnson shares groundbreaking research on how circadian rhythms and reward sensitivity affect bipolar symptoms, offering practical approaches to wellness through lifestyle interventions. Her work at UC Berkeley's CALM program explores how time-restricted eating and Mediterranean diet patterns can strengthen body rhythms and improve mood stability.
• Bipolar symptoms affect circadian rhythms, with genetic factors influencing clock genes throughout the body
• Time-restricted eating (consuming food within a consistent 10-hour window) helps reset disrupted body clocks
• The Mediterranean diet provides essential nutrients for brain health without rigid restrictions
• Blue light from screens suppresses melatonin production, making sleep difficulties worse
• Small, incremental habit changes are more sustainable than overwhelming lifestyle overhauls
• People with bipolar symptoms often have heightened reward sensitivity that can be both a gift (creativity, drive) and challenge
• Including people with lived experience in research design improves treatment approaches
• Mindfulness, journaling, and relaxation techniques can help manage nighttime awakening
Visit calm.Berkeley.edu/participate to learn about participating in current studies on time-restricted eating, Mediterranean diet, or the upcoming study on reward sensitivity and circadian rhythms.
Instagram: @ucbcalmprogram
Facebook: The CALM Program at UC Berkeley
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Bluesky: @ucbcalmprogram
Tiktok: @ucbcalmprogram
Bio:
Dr. Johnson is the Director of the Cal Mania (CALM) Program at the University of California Berkeley. She has received funding from NARSAD, NIMH, NSF, and NCI. She has published six books and over 300 manuscripts. She is a fellow of the American Association for the Advancement of Science, Association for Behavioral Medicine Research, and the Association for Psychological Science, and the Center for Advanced Study in the Behavioral Sciences (2013-2014).
Her work focuses on circadian rhythms, impulsivity and reward sensitivity in bipolar disorder. She has used a broad range of techniques, from neuroimaging to cognitive and behavioral testing and personality tests, to understand these mechanisms. Drawing on basic science, she has conducted treatment development research to target these dimensions.
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Having bipolar disorder in the family and in the genes is related to whether you're going to become a military general. You're going to create a company. Your company's going to make a lot of money. Kay Jamison has written about how many unbelievable artists have had this, how many authors. So that big dream thing is a gift, but it's a curse.
Speaker 2:It's a gift but it's a curse. Hey, welcome to the Upside of Bipolar conversations on the road to wellness. I am so excited that you decided to join me today. We're a community learning how to live well with bipolar disorder and we reject that. The best we can expect is learning how to suffer well with it. I'm your host, michelle Reitinger of MyUpsideOfDowncom, where I help people with bipolar disorder use the map to wellness to live healthy, balanced, productive lives. Welcome to the conversation. Hey, welcome to the Upside of Bipolar. I am your host, michelle Reitinger, and I have a fantastic guest today for you.
Speaker 2:Dr Sherry Johnson is the director of Calmania, or CALM, program at the University of California, berkeley. She has received funding from NARSAD, nimh, nsf and NCI. She has published six books and over 300 manuscripts. She is a fellow of the American Association for the Advancement of Science, association for Behavioral Medicine and the Association for Psychological Science and the Center for Advanced Study in the Behavioral Sciences. Her work focuses on circadian rhythms, impulsivity and reward sensitivities in bipolar disorder. She has used a broad range of techniques, from neuroimaging to cognitive and behavioral testing and personality tests, to understand these mechanisms. Drawing on basic science, she has conducted treatment development research to target these dimensions. I am so excited to interview you today. Thank you so much for joining us.
Speaker 1:So thrilled to have the chance to meet with you. I'm such a fan of the work you do and the information you bring forward, and I'm thrilled to have this conversation. Thank you.
Speaker 2:Wonderful. Well, let's start with your story. We always start with everybody's story.
Speaker 1:I come from a family where a lot of the women have struggled with their moods. Nobody in those days was getting a lot of diagnoses, but it was always familiar for me and so I was drawn into psychology. I thought I was going to study depression. I went through my PhD program and went off to an inpatient mood disorder center where they started assigning me to work with people who had bipolar. And I loved the people. There's a little extra sparkle, there's a little extra energy, a little extra drive. But also this profound sense of how does somebody navigate when the differences in their being are so profound during a mania versus their regular self just hooked me.
Speaker 1:So I started working with people clinically and then I was working with somebody I really deeply admired who had bipolar disorder and he said wait, I don't get it. You keep planning to study depression. And is there anything more profound than trying to figure out why people move into manias when they do? When we don't have those answers, how could you not choose that as your science goal? And it was one of those life-changing moments where I just kind of looked across the room and thought he's right and did a pivot and started, you know, trying to figure out how do I get funding and how do I get expertise to kind of focus on that. That conversation, and a couple others like that, shaped decades of my life.
Speaker 2:That's incredible. And it's so interesting because for all the years that I was struggling with my symptoms, initially I didn't have any idea what was causing anything. It just felt like this unpredictable experience that I was getting yanked onto a roller coaster I was holding on for dear life until it was over, and then I would survey the damage afterwards and then rinse and repeat. You know, it was just and it you feel like for me. I was constantly questioning myself, constantly questioning is this, is this normal, is this mania, is this like? What's going on with me? And it made me. I got to a point where I was very insecure. I constantly insecure about decision making, about, you know, ideas that I had. You know I would get these big ideas and start huge projects and then cause a lot of damage to my family and to myself. And and I got to the point where I was like afraid, afraid, I was scared. It caused a lot of fear and anxiety for me.
Speaker 1:Yeah, yeah, no. And so, michelle, I think you know what you've done listening to your narrative is you've gone so deep into thinking about what are the triggers, what are the things I need to do to protect my life if I'm feeling, you know, out of sorts, what are the ways I need to recover after going through that. And there's a real brilliance about that that I just I find very profound. And there's a real brilliance about that that I just I find very profound. And part of me has always sort of felt like why are we not listening to what people say about these triggers and how they got through those episodes and how they protected their life and then distributing that? Why are we counting on so many people to reinvent that? Which is why I'm such a fan of your podcast, because you're so beautiful in the way you describe that process for people, but I also think the clinicians. You describe that process for people, but I also think the clinicians need to take this to heart and the researchers need to listen and kind of do the research to put that on the map.
Speaker 1:So the first study I planned in bipolar disorder I was going to look at like negative life events, right, and people who had bipolar disorder kept signing up but then crossing out what I said were the study goals and saying to me you're studying the wrong thing. You need to study the times when we get super excited and goal-driven and reward-oriented and can kind of see this amazing thing that's gonna happen and it gets too big for us. And so I was like, okay, yeah, I better listen when 10 people like take your study and say I'll help you, but you're doing the wrong thing.
Speaker 2:Let's x that out and get you on track, and that also was a game changer for me. So, yeah, and that's incredible. I think one of the things that has been was very discouraging and I've heard this repeatedly from I don't know how many people is when people won't listen to us. I think there is, you know, especially during hospitalizations. I had severe trauma from hospitalizations where I was where I knew better Meaning. I know myself, I know what you're telling me to do is is going to cause problems, and I was told you know, no, I'm the, I'm the doctor, I know better. You need to listen to me and you know, for example, when at the end of one of my long hospitalization, they were insisting on putting me on a medication that had triggered psychosis in me and I and I kept telling him like this is not good for me and I had nobody else there to advocate for me.
Speaker 2:It was me by myself and I was so lonely for my family. I missed my children, I missed my husband, I wanted to go home and I was being told you can't leave unless you accept this. And it caught, it triggered a major episode, it caused all kinds of problems and that's one of the things that is very discouraging a lot of times is that I think we feel discounted and dismissed and, like people, don't you know, we're less than in some ways, we're a patient to be worked on rather than a person to be listened to, and that's one of the reasons why I love what you're saying. You know that you listen to and altered what you were doing because you realize that the people that you were trying to study and help had some perspective that maybe you didn't. You didn't understand yourself.
Speaker 1:Totally I. So one of the things I find most exciting that's changing, I think, rapidly in our field not rapidly enough, but it is changing is bringing lived experience into the research, into the university, into the training, and I see that as a really really healthy, important part of this. When I started thinking about doing my current study, I reached out to somebody I knew who had bipolar disorder and I said I kind of want you to be part of this from the ground up this time. And so we now we have a board of people with lived experience, we have people who are in every weekly meeting, who are doing coaching with us, and having their voices has helped me not make mistakes a lot of times and it really, you know, from the ground up we thought, okay, what I want to do. I want to help people kind of follow a healthy diet, follow a healthy lifestyle, give them coaching around that and see if it helps their whole well-being, see if it helps their bipolar symptoms. And I thought, okay, we can do this.
Speaker 1:And it was my lived experience board who was like, well, what resources are you going to build in from the get-go about if I'm too tired to get out of bed? What's healthy eating look like? If I have lost motivation and faith, what are you building in about? How do I get back on track the next week? So they were really just amazing in kind of coming forward with. What are the strategies we need to give people? What are the supports we need to give people Knowing like it's pretty darn hard to make behavioral change? Everybody in the universe knows like have a healthy lifestyle, that's great for you, and look at how many people in the world cannot pull that off right. It's not just people with bipolar disorder that find it really hard to follow a beautifully healthy lifestyle. It's just it's hard. So in so many ways, the lived experience core has been just amazing to me to work closely with and I hope that we'll see that in more and more research teams.
Speaker 2:Yeah, absolutely, and I, you know, see that in more and more research teams. Yeah, absolutely, and I, you know what I love about what you're saying. I've listened to doctors who I think they identify as holistic psychiatrists who are using alternative treatment methods, which I fully support. However, one of the challenges is a lot of times they don't listen to people. So, for one example in particular is ketogenic diets, and ketogenic diets are really hard for anybody to put into place, let alone somebody who is struggling with mood symptoms, and I tried to do ketogenic years ago and my family was lucky to get any food. You know we were.
Speaker 2:We went through periods of time where I was struggling to get out of bed. I wasn't taking showers. I would you showers. I was going through severe depressive episodes, and then I would get into this mode of like okay, we've got to change our diet, and it would trigger a hypomanic episode and I would get all this stuff. I would get hyper-focused on meal prepping and all this stuff, and then it's like revving your engine for an extended period of time. I would rev the engine to the point of crashing and then it would. It would. It's like revving your engine for an extended period of time, I would rev the engine to the point of crashing, and then it would crash.
Speaker 2:I would feel like a failure. Nobody was eating anything and again, I wasn't shopping, you know, and so I've recognized a lot of times you present these really complicated scenarios for people who need something really super basic and and also not to feel like a failure when when you struggle with it. And so I loved that about what you're doing with your study when I was introduced to the study. That you're doing is that you provide coaches that understand what the people are going through. You provide people that understand.
Speaker 2:You have people working on, I'm assuming, on the way that the study is set up in the first place, helping you get insight into what kind of challenges people might run into in that scenario. So I mean that is brilliant and I want to see more of that, because that's how you actually get to success. We're not lab rats. We are people who are struggling with pretty serious symptoms and we want to get well, but a lot of times, some of that is outside of our like power the idea of doing these big things, making these huge changes that require a lot of consistency and and effort. If we start getting. That could actually be a trigger for hypomania.
Speaker 1:I love that you also touched on this other part of it, which is that one of the things I think a lot about with mania is that kind of getting captured by something exciting and goal oriented and that getting too big and too uncontrollable and there's a risk for lifestyle change, that it's too big, right. So one of the things we built in really early on was well, how do you think about one feasible change every week, practice that, see how it goes. Then you do your next change Like and if all your goal is to make sure that when you go to the grocery store this week you get some extra fruits to add to the diet this week, that's fabulous. That's great and it's interesting.
Speaker 1:You know I'm supervising all these coaching sessions and you know you can just hear this drive. You can hear how much people want to take it on full force, go hard at this, do everything they can for their health, everything for the research, for the science, and so my coaches are often the ones who are saying, okay, that's great, but what's the most important part here and what do we need to focus on first and what's going to be hard about this? Let's go ahead and dwell on. Where's that going to get tricky with, you know, big dreams, big hopes, big goals. Um, how do we? How do we pace it?
Speaker 2:yeah, so let's talk a little bit. I want to talk. Probably we got a little bit ahead. I want to go back just a little bit and talk about your studying of like triggers, for I believe that you studied like the triggers for hypomania and mania, and is that what led to this, or are those? I'm assuming those things have to be related somehow.
Speaker 1:They are. So I think about two kinds of triggers and things that can kind of weave into kind of manic vulnerability. One is this kind of what we call reward, this sense of getting too enticed by the goals and all of a sudden you're up and going and it's two in the morning and everybody else has piped down and you're still alive with where this could go and how this is going to unfold and what it's going to mean and people getting too excited about that. So we've done a lot of work on that over the years. But part of that, and the part that we've gotten really interested in too, is there's a thing called the circadian rhythm, your day-night rhythm, and it's biologically wired. So we know a lot about your body, has a lot of internal clocks. You have an internal clock in your body, has a lot of internal clocks. You have an internal clock in your brain, but you have internal clocks in almost every cell of your body and every organ of your body and it's genetically driven and then it's influenced by lifestyle factors. Good health means having a really strong circadian rhythm so that when it's daytime you are on and full of your energy and you're concentrating and everything feels good, and when it's daytime, you are on and full of your energy and you're concentrating and everything feels good. And when it's time to go to sleep, you go to sleep, you drift off to sleep, you sleep deeply, you sleep through the night. Everything's good.
Speaker 1:For many people with bipolar disorder, there's genes for clock, genes that are not as powerful. There's signs before the illness that that rhythm isn't as strong, and when that rhythm gets out of whack it's sometimes a little tell that mania is. They're at higher risk for mania. So we've been fascinated about what happens when those two processes collide. So now imagine that I'm not the person who gets great clues from my body that it's time to power down and go to sleep, and I just moved into a phase where I am on fire about conquering things and there's nothing in my brain that goes that's all great, pick it up tomorrow. I'm going to stay through the night and make this happen. And now I'm missing all those beautiful things that happened during sleep. To reset my dopamine, give me a breather, give me back my perspective. So by six in the morning, when other people start waking up, I've been up all night. Go and go and go and the whole thing begins to take off. So those are two things. That was a handful. Do you want?
Speaker 2:me to talk? Yeah, I do want to. I want to talk a little bit more about circadian rhythm because I think I think there's a. Often people understand that sleep is important, but I don't think that people fully understand why, and I've. You know, I had one young woman on my show a long while back. She was one of my earlier guests whose first manic episode was brought on by sleeplessness. She went several days without any sleep and started having a psychotic episode. You know she, she ended up in full blown psychosis, ended up hospitalized, and this, this lack of sleep, seemed to be the trigger for you know, so it's.
Speaker 2:It feels a little bit like chicken and an egg, the chicken and the egg kind of thing where, like, did this, did the sleeplessness cause that? You know, you know what I mean. Like it starts to feel like you're chasing your tail a little bit with it. But, but I also, as I've gone through the healing process, found myself settling into a more natural circadian rhythm. I recognized that that sleeplessness was a big issue, and so if I started having issues with sleep, I would immediately go to the things that I know help me relax my mind, relax my body. You know the micronutrients, that the you know, mindfulness, meditation, the things like that that would help settle things down, because I knew if I, if I allowed that to persist, I was headed for trouble.
Speaker 2:But but it wasn't something that I ever really studied. So I'd like to actually talk about that a little bit, if you're, if you're okay, if we can explore that a little bit more. Because, because I know that a lot of people in my audience are going to be able to relate to bargaining with God for sleep. You know, laying awake at night with your man, your mind, just right, rolling and rolling and rolling over, and you can't get it to shut off. And you know, as a mom with young children, when this was happening I was like in tears. You know just begging, like please just let me sleep, please just let me sleep. Like, if you let me sleep, I'll do this. Like I was like trying to offer something because I couldn't get my brain to shut off and and it would, like I said it's like revving the engine and I knew if this persisted that after a little while I was going to end up in a severe depressive episode.
Speaker 1:So it's exhausting, yeah, so then also, how do you put the brakes on finding calm, which is my research program for a reason? So a couple of things. One, your words on this are so beautiful and really capture. It does work both ways, and so, but we do know that a night without sleep is not a good thing. So there's an Italian group I don't know how they got the ethics on this, the ethics board do agree to this. They brought in people who had bipolar depression, were in a depression state, kept them up all night and by the next morning showed that about 12% of them had shifted from depression straight into hypomania. Experimental evidence, right. We also repeated the study, which I'm like how did your ethics board let you do that? But anyway, we have experimental evidence and we have longitudinal evidence that a night without sleep is not a good thing. So I love that. You were like okay, how do I calm this? And certainly you know deep breathing and meditation and anything that relaxes the body, relaxes the mind, is good. I'm not a psychiatrist, but a lot of doctors will say look, I'm going to give you a pill you can take that'll zonk you out if you're having that experience. So that's something people can talk to a doctor about a PRN. But then the other thing we've been fascinated by is how do you just strengthen that day night rhythm? And you know there's a lot of people who look at light therapy. And that's important because you actually have a different receptor in your eye that's sensitive only to the light frequency at dawn and dusk. It fires off, it shoots straight back into a brain region called the suprachiasmatic nucleus. It feels like super fragile, you know thing. But you have a brain region we like to say SCN because we can pronounce it that then sends a clock through the whole brain and it is sort of tuned by the light at dawn and dusk. So many people are fascinated by that.
Speaker 1:I was working with a circadian person named Lance Kriegsfield, a scientist who I adore, and he came to me and he said are you watching what's happening down at Salk Institute? And I said what do you mean? And he said have you been hearing about time-restricted eating? I said no, I have no idea what you're talking about. People at Salk who were doing mouse studies started to realize that when they fed their mice was as powerful for the mouse's day-night rhythm as the light exposure at dawn and dusk or for mice. It's a different clock, but food timing was as powerful as light and part of that has to do with it.
Speaker 1:Beyond this beautiful clock you have in your brain, the SCN, you have clocks in every cell of your body and every organ of your body and your stomach and your liver and your kidneys and all of those peripheral clocks are going to get shaped profoundly by very careful timing of your eating. So they started to kind of look at it's a version of intermittent fasting. But some forms of intermittent fasting are very harsh. Some are like you don't eat for two days. This is much more about eat at the same darn time every morning.
Speaker 1:So your body has a little wake up cue, gets the hormones going your appetite is actually really predictive and then knock off your eating a couple hours before you're going to go to sleep. Because if you're still eating, melatonin comes along. Melatonin and your kind of insulin are a little bit in collision and melatonin is your sleep agent, your sleep hormone, so you don't want different hormone systems fighting in those last couple hours before you go to sleep. So basically it comes down to eat the same 10 hours every day, eat by the clock and you're going to give your body a very powerful signal of like hey, this is your morning, this is your night, this is your morning, this is your night. And if we can make that system a little better, the hope is that then people can sleep more deeply and also have a little bit more of a cue of like you know, time to power down.
Speaker 2:One of the things that happens a lot of times with people who are struggling with these symptoms is they've been sleep disrupted for so long that it's almost like they can't figure out how to reset themselves. You know what I mean. So what are the things that people can do that will help kind of reset that clock for themselves? So you're talking about these things like if somebody did this, and I want to make sure I highlight for my audience you're currently doing a study that has to do with this, and can you talk a little bit about that study? How long, in general, do people see that it takes for them to kind of reset that clock? I don't know if you've found that yet or if you can share that, so let's start there. I don't want to give you too many questions.
Speaker 1:Okay. So our study is actually to compare two forms of healthy eating. We're really fascinated by this eat by the clock time, restricted eating but the other piece we're really fascinated by is the Mediterranean diet. We're very invested in the idea that there are these signs that bipolar disorder is a whole body phenomenon. People with bipolar disorder often also have metabolic symptoms, cardiovascular things going on. Energy is profoundly involved. So how do we support whole health? And so this study is to take folks who are already on medications mood stabilizers and say what happens if we add one or the other of these healthy lifestyles and track can we make a difference in symptoms and quality of life? And if we could hand this out for free to people, could we promote better stability for people around the world who have bipolar symptoms and want something else to add in. So Welcome.
Speaker 1:Trust gave us money to do the largest study that I've ever heard of of healthy eating and bipolar disorder and whether it makes a difference. We're recruiting people. We've said we'll find 450 people to follow each person's experience very carefully of what worked, what didn't, who does well, who can do it, who can't. What supports do they need so we can take it forward? Boards do they need so we can take it forward. We don't have data yet, but we're actually really excited to have 70 people enrolled, helping us by logging their experience, logging their diet.
Speaker 1:One thing I can tell you for sure is it's a process, so we log for two weeks before we even start to set the timing of eating, because we're trying to figure out, well, what is your midpoint. And for people with bipolar disorder, sometimes there isn't a set bedtime, wake up time. So what's the middle of that? We make a guess. We set our timing window. Sometimes we say let's start with a 12 hour eating window and do that for a week or two, then bring it back to 10. And maybe we're going to shuffle it, but we're going to titrate it really carefully so it doesn't mess up their lifestyle.
Speaker 1:Like the last thing we want is some person with bipolar disorder not getting to have dinner with their family because they think, like I have to stop eating. Like how do we, how do we think about the most important social pieces for you, lifestyle pieces, and then build a rhythm that's going to work for you. And so we'll work with people across 10 weeks, see if we can get that rhythm in place and then we'll follow them across time to see is it making a difference? Is it making a difference at the end of those 10 weeks? But what does it look like months later too?
Speaker 2:And it's really interesting that you mentioned the Mediterranean diet, that that's the diet that you chose, because, I mean, there are a lot of different diets out there and a lot of claims about the diets, but I've actually seen solid research on the Mediterranean diet Drs Bonnie Kaplan and Dr Julia Rucklage, who've done a ton of research in the field of micronutrition and micronutrient support. That's where they have people start, you know they, that's what they they encourage in their book. They even have, you know, a section with recipes and guidelines for how to you know how to eat healthy eating using the Mediterranean diet. They're not huge fans of like major changes as well, like you were talking about, you know, helping support, actual.
Speaker 2:I think that there's a tendency. You have to be really careful with people who are, you know, struggling with this, because we have a tendency to go like full bore into it and then burn out and crash, you know, and then feel discouraged and give up, right and so more more so, I think, than than somebody in the general population who isn't struggling with these symptoms. And the thing I love about the Mediterranean diet specifically is that the brain support that comes from the nutrients that you're putting, that you're putting into your body. You know I don't think that we understand enough about nutrition. I know for certain. You know like in my personal experience and most of the people that I work with, they never had never once had a doctor talk to them about nutrition. Not one time.
Speaker 1:Right? Well, because it's not. If there's not enough science for the doctors to feel confident, we have got to take on, build the knowledge base. But yeah, the Mediterranean diet outside of bipolar disorder, I mean, there are now studies of thousands of people that say this is great for your heart, it's great for your immune system, it's great for your brain, it's great for your cognition. Your body needs these healthy nutrients.
Speaker 1:Another thing I really like about it is it's very focused on how do you bulk up a little bit of the healthy stuff in your diet and let's not punish you If you want to have an ice cream, think about that as an extra. That's okay. We don't ban anything, but we just keep the focus on each week, how do we add another little bit of a healthy habit? What's the thing you're going to give your body? What's the ritual you're going to put in place to just give yourself a little bit of healthy stuff for your body vegetables, fruit, whole grains and you're right, there's like a million resources.
Speaker 1:I'm glad their book really goes into this on like how do you find recipes? How do you do this? A lot of people think it's going to be super expensive, but it's actually very affordable foods like whole grains and lentils and beans are like the stuff of grad school. That's how you survive. Grad school is you eat a whole lot of those very healthy proteins that are very, very cheap. The other thing is you can adapt it for every spice kit in the world. So if you love Mexican food, put your Mexican spices on top of those beans. If you like Japanese and Asian food, put your Asian spices on top of those whole grains. So it's very adaptable and there's a lot of good tips out there about how to make it work.
Speaker 2:Yeah, and one of the things that I love about what you said you've said a few times now and I this is something I advocate as well is you're, you are developing habits for healing, that the point is to develop a habit, and so we, you need to start with something small and achievable. And you know, especially coming from a, you know, a bipolar symptom background, I knew if I tried to make a whole bunch of changes at one time, it was not sustainable, and so I and I'm a big advocate of alarms, I use alarms for everything. Anytime I'm trying a new habit, I will set alarms throughout the day. Don't turn the alarm off until you've done the thing, but it needs to be something simple and really easy to do so that my brain doesn't get in the way of, like, building it up and thinking, oh, this is such a big thing to do, you know, and so make you know.
Speaker 2:If somebody is trying to change their diet, pick something that you do, like you know, especially if you're introducing a bunch of things that are new to you. You know, maybe somebody has never eaten any lentils before in their life, so don't try and change your whole diet and put a whole bunch of lentils and you're not going to like it. Your body's going to crave other things. You know you got to change little things at a time, but but the thing that's beautiful about it is, in my experience, is as you develop these habits for healing, you have incremental wins and you start to feel better, which then gives you the more motivation to continue moving forward with that. And I'm wondering if you've seen that in your study so far, if that's something that you've seen play out.
Speaker 1:Yeah, I want to have you come talk to all the people in our study because you're just such a voice for kind of how to make this happen, and it fits so well with the science. Yeah, the hardest thing we're hearing in coaching is people having really high expectations for changing everything and then being so deeply worried about letting themselves down, letting us down, and so we're really trying to empower people to just say one change at a time. And then the science of this is log it and nobody likes logging. It feels geeky and kind of science world. But actually those small steps of just monitoring how did it go and what got in the way each day are kind of how you do develop a ritual and a habit. And what I'm hoping is that people can take this not as a scorecard for did I make a mistake today, but more a way to give themselves credit for you know what today I fed my body, I fed myself, I did something good, thank you.
Speaker 1:Like those small rituals to feel good about.
Speaker 1:And we're always sort of saying of course you're going to have your Saturday night where the Mediterranean diet's out the window right and of course you're going to have your Saturday night where you ate later than you wanted to, or you were out with your friends and you weren't going to, or you weren't going to tell your grandma you weren't going to have a late night dinner. Right, like all those things. Right Like, give yourself permission and just work on. How much can you create a ritual? How much can you create a habit that feels comfortable, cause that's what's going to stick.
Speaker 2:Yeah, and one of our mantras in my group is curiosity, not judgment, so that we are yeah, because it's because they're.
Speaker 2:I think one of the things that we I believe is very common in our community is we're very judgmental of ourselves. People often judge us. You know, the behaviors that come out of these symptoms are not socially acceptable. Often, you know, they are embarrassing, they're discouraging and we are very hard on ourselves. We're very judgmental of ourselves and it needs to. There needs to be a shift that occurs.
Speaker 2:You know, one of the it started for me the first time that this came into play was I have a coping mechanism which is excessive television watching and and I I was viewing it as an addiction and I went to addiction recovery programs. I was like putting locks on my television, I was doing all these things to try and stop the behavior, not understanding that it was a coping mechanism. And I finally had a therapist asked me the question what are, what need are you trying to meet? And I I was so caught off guard by the question. I was like what are you talking about? And she said what need are you trying to meet with this? And I had to think about it for a while because I didn't even I had never considered there was a need being met by this coping mechanism, and so I think that that's one of the things that is so important.
Speaker 2:As people are trying to, we become detectives in our own lives. You know what? What is that? What's behind? What's motivating this behavior? You know, I've got this symptom.
Speaker 2:Something is motivating the behavior that is attached to the symptom, and get curious about it rather than judging ourselves. It doesn't mean that we. It doesn't mean that we are going to accept the behavior I don't like. I don't like spending hours and hours on end watching television programs that are mindless and uplifting. You know, that's not something I want to continue in my. I wanted to continue in my life.
Speaker 2:However, it didn't do me any good to beat myself up about it. I needed to get curious about what was underpinning that behavior and then, once I could figure out what was causing the behavior, how can I meet that need in a better way, in a healthier way, that that is more productive in my life? And so I think the same thing would be true for any you know, as you're trying to develop new habits. If you're struggling with it, ask the question why, instead of judging yourself and beating yourself up. Why am I struggling with this? What's what's going on. Is there a way that I can do this differently? That would be easier, you know, more conducive to success for me, and maybe not even looking at success or failure, because those are judgment words as well. But in order to accomplish what I'm trying to accomplish, how can I tweak things? What can I do differently? How can I find a way to meet those needs and be curious about the struggle rather than judgmental about it?
Speaker 1:That's beautiful. I always sort of think, like what we want to be able to do is hold the goal out here, reflect on it, think about what makes this hard, what makes it easy, what makes it fit, and then go from there. And I think there's a lot of things that make that harder in bipolar disorder. One is the whole topic of feeling out of control is just scarier, right. And there's also that self-critical. You know, picking back up after everything that's happened, it's easy to feel demoralized, scared, self-critical, and I love that you're such a voice for like you can get through this. You know, like let's take a curious, one goal at a time kind of thing. The other thing that we've written about, we've tried to understand, is that I think people with bipolar disorder often set very high goals for themselves. They want to make a difference. They've set bigger life ambitions, bigger life dreams, bigger goals, and they have more of a worry about what happens if that doesn't happen. We call that the double-edged sword, because the good side of it is sometimes people with bipolar disorder make profound difference. You know, I mean we have more. It's related Having bipolar disorder in the family and in the genes is related to whether you're going to become a military general.
Speaker 1:You're going to create a company. Your company is going to make a lot of money. Kay Jamison has written about how many unbelievable artists have had this, how many authors. So that big dream thing is a gift, but it's a curse, you know, because sometimes it's easier to take a small step than a big step, and if you're holding yourself to this standard of I'm going to do this huge thing, then it's easy to fall short. It's easy to feel self-critical, it's easy to get into a cycle of well, that's not so big, but meanwhile some of life is you put one small foot forward, kind of thing.
Speaker 1:So I'm really fascinated by how people juggle what they expect of themselves and hold to kind of having a big dream. But not let it overwhelm, we're all just trying to get through the day too.
Speaker 2:Yeah, absolutely, and I love the thing I love about this study and I'd like to know more about if you've done anything related to circadian rhythm outside of this.
Speaker 2:I would like to talk about that a little bit more. That's such an important topic and as I was preparing for this, I had the thought like I don't think I've had anybody on to talk about circadian rhythm. How is that possible? Like it's such an important topic and so critical to well being. But I would love to hear more about you know what what other things that you have learned and what studies you've done perhaps related to circadian rhythm and improving that, because I think that that's what a lot of people who are struggling with these things want to know. So I love the study. I want to make sure at the end we'll talk about if somebody is interested in participating in this study, how they can reach out to you. But what other resources or studies have you done that are related to that, because it's such an important resource for people who are trying to recover, who are trying to heal, who are trying to live healthier lives with their symptoms.
Speaker 1:Yeah. So our biggest study on this front is about to launch. We're going to do a worldwide study for people in English-speaking countries looking at circadian rhythms and reward and how they move together. So we're going to be asking people to kind of take quick games on their cell phones three or four times a day to look at how excited they are about rewards and games and winning and how that changes with day-night rhythms. We're going to be logging their sleep. We're going to be following people across time. Some of them will do brain scans in the evening to see if pathways in the brain that are about goals and going after things are powering down in the way we would expect as it gets into the evening. So stay tuned. We will be putting up stuff on our website about what people who are interested to kind of follow their own reward and circadian rhythms using these cell phone apps and seeing what we can figure out.
Speaker 1:I've been less in the circadian rhythm space. I've been more of a fan of that, but one of the things that I'm proud of that we did is we have a lot of work out there on what this looks like in adults and we have a study under review where we said okay, but how much of that is the aftermath of years of mania and depression, and does that just scramble this system? So we were able to work with a group of adolescents who were sort of very new to having the illness and we were able to show that their circadian rhythms also look blunted. They don't show the same strength of day-night rhythm. So what does that mean? They look less energetic by day. They look too energetic and less sleepy at night, but we can see it very early on as people move into having these symptoms. So that's under review. Wish us luck with reviewers. I'm proud of it. I think it'll get its way into the world, but we'll see.
Speaker 2:Yeah, and it's you know, it always begins with identifying the issue in the first place. You know, once we can identify the issue, then we can start figuring out like, what do we do about it now? And I know that I, you know, I don't know if you've had much experience with blue light. You know, yeah, yeah, because that's one of the things. I've seen some articles about the disruption in the circadian rhythm that occurs because of our exposure to blue light, and it's definitely a menace.
Speaker 1:It's definitely a menace to your melatonin.
Speaker 2:Yeah, and is that? So I was going to ask you if you knew much about. You know what I don't want to speak to. I don't have the articles to quote, so I don't. I'm not going to try and speak any kind of with any authority, but what have you seen about that? How does blue light, which we know for anybody in the audience who doesn't understand what I'm talking about this is exposure to screens. So our cell phones, our televisions, our computers emit blue light that affects our brain, it has an effect and it has an impact on melatonin. So can you talk a little bit about that, Because I know that that for me, that was a huge disruptor.
Speaker 1:Yeah. So let's back up for a minute and talk about melatonin for people who aren't familiar with what melatonin is, melatonin is a hormone or a chemical that has a strong day night rhythm. It tends to come on at night and it promotes, it helps people go to sleep. So as the melatonin comes on, that's part of why it's easier for people to kind of drift off to sleep. So the degree of melatonin release, or how well that melatonin is working, is shaped by how powerful your circadian rhythm is, or your day-night biological rhythm. And so if you have a weak circadian system, one of the ways that may show up is the melatonin system not working as well to give you these cues for your body that it's time to power down and go to sleep. So melatonin is a really critical part of this whole system, and what we know is that even small amounts of light, as melatonin is starting to kind of be released and do its work, suppress more release of melatonin, and blue light is an important part of that. So people will think well, it's okay that I'm just quietly looking at my cell phone in bed or just watching TV to power down, but that light is enough to suppress melatonin.
Speaker 1:And now you've lost one of the signals, one of the really important signals for your body that it's time to go to sleep. So there's more than one influence on whether you can go to sleep. One is how long you've been awake, for you accumulate something called the sleep debt. Sleep One is how long you've been awake, for you accumulate something called the sleep debt, and so that's just building up and building up, building up, and then when you go to sleep, it disappears very, very quickly. So you have sleep debt and you have melatonin. So there's still ways people can sometimes fall asleep, even if their melatonin is crushed. But you're taking out half of the story there. But you're taking out half of the story there. You're taking out half of the influence that helps us just go.
Speaker 2:Okay, it's time drifting off, yeah, and it's so interesting, one of the things that I learned as I was trying to figure out a way to keep myself asleep. So a lot of times people with bipolar will struggle with staying asleep. Maybe you can fall off to sleep really quickly and then a couple hours later you're wide awake again in the middle of the night. That's the circadian system right there, and one of the things I figured out. And I think I must have read an article. It's usually triggered like these discoveries are often triggered by reading something about it.
Speaker 2:But I realized when I'm wide awake at night, don't watch television and don't get on my phone and I have a micronutrient that I will. I don't know if it's a micronutrient, I think it's considered micronutrient. Anyway, I have a supplement that I take at night if I'm, if my brain is racing and my body is kind of alert, that helps kind of calm down those reactions in my body. And I will read. Those are the two things that I'll and I'll read something that's not super engaging, like I'm not going to read a fantasy novel. That's really exciting, that I want to keep reading.
Speaker 2:You know, I'll read, I'll read something that's interesting but not like super engaging, that my brain is like, yeah, I've had enough of that and those two things. Or writing you know I'll like journal or something to get whatever's in my head that thinks it needs attention out onto a piece of paper and usually within about half an hour I can fall back asleep and have a good night, you know, finish through the rest of the night. But I used to watch shows, like you know I would or or scroll through my phone and I didn't realize that I was working against myself. You know I was thinking I just can't fall asleep and I didn't realize. Well, the reason you can't fall asleep is you're working against yourself with this blue light. You know that's that is combating your body's natural system for trying to calm itself back down and go back to sleep Totally.
Speaker 1:You know, the other thing I think people don't talk about enough is that mood stabilizers and antidepressants also strengthen circadian rhythms and there's all kinds of really interesting cellular level, molecular level, biological level work going on to understand that and to try and think about how that works so you could kind of bulk it up. So I think we have there's actually really great lifestyle work around how to help people sleep. So there's a program called Cognitive Behavioral Therapy for Insomnia which you can take online. There's online apps to support CBTI that's the cute little CBTI that's out there and then there's lifestyle things to kind of get rid of the stuff that would mess with your sleep, and then there's medication approaches. So this is one place where I think there's a lot of tools that people can choose from. But so vital to kind of think about it.
Speaker 1:I also want to sort of say for people who are hearing this and then there's almost a kind of terror that happens if you're up at two in the morning and you've heard like didn't Dr J just say that that can trigger mania, and now how am I supposed to sleep right, to just help your body and mind relax and deep breathing and reading and kind of focusing on your favorite spot in the universe. All of those things are also going to help your body and your mind relax, and making a concerted effort to give that to yourself in those moments is going to achieve some of the important goals of sleep. So I don't want people lying awake at two in the morning going, oh no, what happens if shift gears and do your deep breathing and count your sheep or visualize your last beautiful place you were in?
Speaker 2:Yeah, and one of the things, one of the things you learn in mindfulness, when you're, when you're practicing mindfulness, is focusing on this, you know, on the deficit of where you are to where you want to be, sometimes widens that space. And so, rather than thinking, oh, I just want to fall asleep, rather than focusing on where you want to be, just focus on being present, calming yourself down and utilizing. I encourage people to explore the different resources you know. Try mindfulness, meditation, which I think is a big one. There are relaxation, you know, recovery kind of things that you can do with yoga. That will help kind of relax your body, kind of bring you back, tell your body everything's okay, you're safe, everything's fine. You know, writing out the stuff that's in your head.
Speaker 2:A lot of times your brain just is trying to get your attention for something, and that's why I found journaling so productive, because give it a place to go. Tell your brain, yes, I'm paying attention to you and I want to do it right now, but I'm going to put it down and then I will remember to work on it tomorrow, you know, but but I think, practicing those different things and try not to focus on the deficit between you know I'm wide awake and I want to be asleep right now and just focus on. What can I do in this moment to calm down? How can I, how can I bring myself into a calm state? How can I relax my body? Interested in in, you know, looking into this and participating in this study. The two, the two different things you're studying are restricted eating and then Mediterranean diet. Is that correct?
Speaker 1:Yeah, so people can come to our website it's called calmberkeleyedu and learn more about our studies. They can sign up online. They can read more of the detail. They can send us an email with questions. We welcome questions, but the study we're enrolling folks in right now is comparing time-restricted eating or eating 10 hours a day at set times against the Mediterranean diet and trying to figure out what support people need to follow that. And then in a couple months we'll launch our new study, which is not about treatment, it's not about change. It's about just understanding this kind of how we call it rhythm and rewards. How does your day-night rhythm influence what happens with the way you go after rewards at night?
Speaker 2:That's so interesting. Can we talk just a little bit about that? Sorry, so you've mentioned a few times Sorry, that was a question that I had earlier and I forgot about it. So you've talked about rewards, studying like rewards and mania and their connection to each other. Can you talk a little bit about what that is and what you mean by that and what you've seen that has made you think? Let's do a study on this.
Speaker 1:Yeah, so I probably spent 20 years on this topic of rewards and mania, and I wasn't the first. There's a guy in the field named Depew who said okay, so, first backing up, you have a brain system that helps you when there's an exciting, positive reward out there. It propels you into a state of energy, it helps you focus on it, it gets your brain thinking about it, it gives you the joy about like, okay, we're going there right, and we all have that system. It's called your reward system. It's neurobiological, we know where it is in the brain, it's dopamine, and it's a good thing, right? We all need a way that if I said, hey, there's a million dollars on the opposite side of campus, you would mobilize and you would run fast to go get it. So we all have it and it's adaptive and it's beautiful and it does all these things that Depew, a long time ago, said. Boy, all those signs of mania sound an awful lot like what you expect of a reward system in full tilt. And what if, at the heart of mania, what we have is a reward system that is somehow dysregulated so that once it goes into full tilt, it's harder to bring it back down, harder to bring it back down. So we've liked to think of it as a kind of extra sensitivity to going after rewards. They're more exciting, they're more alluring, they're harder to let go of and we have self-report scales we can give that are about this. We all know people who like it doesn't take much out there for them to go into sheer joy, juice full tilt. I'm going there. We all know people who are closer to Eeyore. Where you go there's a million dollars on the other side of campus and go, somebody else is probably going to get it Right. So we all, we are all titrated.
Speaker 1:I think for bipolar disorder it's not just that it moves into highs, it's also that it's dysregulated. It's hard to bring it back down into check. During the lows it goes way too low. So that opens up a lot of doors for us. One is some prediction, because it turns out that that system is designed to respond when you're in the middle of exciting, stimulating possibilities. You're in the middle of exciting, stimulating possibilities, so that's.
Speaker 1:The bad news of this is that some of the moments that are so exciting in life are also vulnerable for kicking this off. But if you know that, then you can work closely with your doctor when you're going through those periods and you can work to kind of give yourself back calm, even in the middle of life's best moments. You can go in the bathroom and take three deep breaths. You can make sure that you retreat, go to sleep, think about it the next day. You can learn to do yoga. You can learn to do self-calming things. You can learn to work with your doctor to titrate medications, but that those are critical moments to make sure that you and somebody who loves you or somebody who watches you is keeping tabs on. Did this just get too high? And how do we help you re?
Speaker 2:regulate. I could talk to you all day. This is fantastic. I'm so excited for the things that you're studying, and if somebody wants to connect with you, what's the best way to go about that?
Speaker 1:Go straight to our website, columnberkeleyedu Berkeley, by the way, is hard to spell, it's B-E-R-K-E-L-E-Yedu and they can email, they can sign up for studies, they can see what's coming next and I will say you know, getting this right and figuring it out depends on hearing from as many people from as many different backgrounds as we can, and also hearing from them when we didn't get it right, or they want us to tweak things, or they want our study to get better in some way. So, yes, we'd love for everybody in the universe to sign up, but we also want to hear if there's ways that this doesn't fit for people.
Speaker 2:Fantastic and I'll make sure all of your contact information, the website, everything is linked in the in the show notes so that people can reach you easily. Thank you so much for all the work you're doing and thank you again for being a guest today.
Speaker 1:Thank you for everything you're doing. It's really just beautiful to connect to you and to watch what you're doing, so best of luck with this, thank you.
Speaker 2:All right, Until next time, Upsiders. Hey, thanks for joining us today. If you're ready to start on your path to wellness with bipolar, go to myupsideofdowncom and get your free mood cycle survival guide four steps to successfully navigate bipolar mood swings. If you're ready for more, check out the Map to Wellness. Until next time, Upsiders.