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  Key Messages

  • Social support comes in all shapes and sizes
  • Social support can include emotional, informational and tangible forms of support
  • People with bipolar disorder often experience low social support
  • People with bipolar disorder with better social support have better outcomes

  Take Action

  • Assess your social network
  • Take steps to improve your social support system if necessary
  • Most evidence-based psychosocial treatments for bipolar disorder address social support deficits

  Learn more

Why relationships are important to your quality of life

Humans are social beings by nature. While we can survive on our own, we truly thrive when we’re surrounded by supportive others. Here we’ll give you some reasons why, share information about relationships and give a few suggestions on how you could improve yours.

'Social support’ describes helpful support from others: emotional support (e.g., love, compassion, etc.), informational support (e.g., giving advice) and tangible support (e.g., help with day to day needs)1. While we, as social creatures, instinctively sense that social support is helpful, many research studies show just how important it is for wellness.

Social support is linked to physical health (i.e., immune functioning, stress hormones and cardiovascular function)2, as well as psychological benefits. People with mental health challenges who live in close contact with others report feeling less isolated and lonely and more comfortable in having someone to discuss distressing symptoms or life events3 with. Even contact through more distant and casual relationships, such as shop owners, people in cafés, librarians or pharmacists, can increase life satisfaction and feelings of belonging3.

Social support can be especially important for people living with bipolar disorder as it relates to self-esteem (feelings of self-worth and confidence)4. Research studies suggest that people living with bipolar disorder with higher levels of social support recover more quickly from mood episodes5. They also describe better overall functioning and fewer weeks of mood episodes6, especially depression5,7, than people with lower levels of social support. Interestingly, how much social support a person thinks they have seems to make more of a difference to how well they feel than the actual amount of social support they have7.

Many people with bipolar disorder experience low social support, making it an important life area to target8. Unfortunately, symptoms of depression and mania can take a major toll on social life. 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 their close and distant relationships to be unavailable or inadequate9. Even between episodes, people with bipolar disorder report less contact with friends10. People with bipolar disorder can also be more sensitive to rejection from others, which relates to depression, poor social support, and quality of life11. People who have had many lifetime mood episodes (especially of mania) and some lasting symptoms report the most challenges in getting social support9,10.

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 disorder12,13. These negative interaction styles can also predict poor overall functioning6 and longer episodes5. 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:

Assess your social network. The first step to making improvements in your relationships is to consider all the people in your life who could become sources of support. As we know, social support can come in many shapes and sizes, from a parent or supportive roommate to frequent chats with a shopkeeper. Try to keep an open mind for all the 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.

Ask yourself what your ideal social life looks like. Everyone has a different picture of what’s ideal. Some people thrive with lots of relationships and social contact, while others prefer just a few close friends. Sometimes it’s helpful to have friends who have a shared understanding of bipolar disorder or similar experiences – support groups can be a place to identify people who understand what you’re going through. Sometimes it’s also helpful to have ‘fun’ friends: friends whom you simply join for activities (like going to the movies) without needing to talk about deeper issues.

Ask yourself how close your actual relationships and social life are to your ideal vision of them. If your actual social network is smaller than your ideal, you may need to take steps to widen it. You may be interested in strengthening current or past relationships.

  • Make relationships more important by putting them higher on your list of things to do. It may be helpful to schedule your week’s socializing in advance to prevent you from putting it off.
  • 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”. You can make gains in your sense of connectedness by reaching out just once or twice a week.
  • Make social meetings regular (e.g., a walk with a friend at the same time each week).
  • Combine socializing with activities (e.g., cook, carpool or exercise together).
  • Allow closeness without pushing it. Relationships work best if they don’t feel like an obligation or a duty.
  • Try to be vulnerable, open and accepting to allow for intimacy to develop.  
  • Try to have a balance in your friendships between giving and receiving.
  • Try to nurture and build a variety of relationships, not relying on just one person for support.

Or, you may want to widen your network by creating brand new relationships.

  • Can you meet people through your leisure interests (e.g., pottery class, book club)?
  • Are there familiar faces in your life who seem open to friendship?
  • Are there local support groups or programs you could join?
  • Could you volunteer, take some classes or meet people at work?
  • How about joining a community or fitness centre, club or spiritual community? 
  • Can you choose to live in a shared space with other people?

You might find that you want to revamp your social networks to promote healthier relationships and lifestyles. For example, you may need to find friends who don’t use 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 support14 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 community14.

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 supportive. Interpersonal and Social Rhythm Therapy (IPSRT) focuses in large part, too, on interpersonal challenges. 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 for symptoms of mood and social anxiety. 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.