Social Rhythm Therapy

Social Rhythm Therapy is a form of psychotherapy which can help prevent mood swings. Every day we come in contact with important signals or events that help set our body’s clock and regulate our mood and hormone levels.  Examples include sunlight, sleep, exercise, meals and stress.  Regulating these daily rhythms can cut your rate of depression and mood swings in half.

Prevention when you feel well: How to keep mood swings from returning

1) Keep a regular schedule.  When you have a mood disorder, your body’s internal clock doesn’t always set right, so you need to schedule things that help set your clock.  Sleep, meals sunlight and exercise are important: do these at the same time each day (within ½ an hour).

2) Identify mood-restorers.  List activities that tend to restore your sense of daily rhythms. For many people the most important ones are getting out of bed, starting a major daily activity like work/school/ chores, being with someone who is important to you, eating dinner and going to sleep.  Other examples might include exercise, bathing, going outside, taking medication, reading and watching a favorite TV show. Try to do these activities at the same time each day (within ½ an hour). 

3) Identify mood-deregulators.  What things make you feel off-balance, over-stimulated, or disrupt your sleep?  Make a list; examples could be arguments or intense discussion, travel, late-night projects, bright lights, caffeine, noise, or crowds.  Try to avoid mood-deregulators at night to protect your sleep.  When possible, plan ahead for how to manage mood-deregulators.

Click here to learn more about how light, darkness and “blue light” can help you regulate your mood.

4) Self monitoring.  A social rhythm chart can help you plan and monitor your mood-regulators.  To complete this chart, record the actual time you did each important activity.  You can also rate how stimulating other people were during the activity, as social stimulation has powerful effects on our brain chemistry and daily rhythms. At the bottom of the chart rate your overall mood for each day.  If you find your mood has been off for a few days, look back through the prior week and see if it might be related to disruption in your daily rhythms.

In this blank chart, the 5 activities which tend to have the strongest impact on daily rhythms are listed.  You can add your own in the blank rows as you personalize this technique.

You can also chart your moods on a mood chart. Keeping a chart will help you identify things that destabilize your mood and help your doctor keep better track of your treatments.

Manage early signs of a high mood (activated, irritable, impulsive or manic)

1) Preserve Sleep.  Try to sleep at least 6 hours a night.  It’s more important to wake up at the same time each day than to go to bed at the same time. Consult with your doctor about sleep medications if needed. At night, turn down the lights (especially “blue lights” like TV and computers) and use bedtime rituals. Read more about sleep restoration.

2) Manage conflict. The 3-volley rule:  When an argument escalates to “3 volleys”, stop the talk and walk away.  A “volley” is an angry or argumentative statement.  For example, if you say 1. “I hate it when people interrupt me!” and your relative counters with, 2. “Don’t get angry, I thought you were finished talking!!” and you counter with 3. “That’s because you weren’t listening!!!”… that’s 3 volley’s, and a sign that you both need to disengage.

3) Manage impulses. The rule of 2’s:  If you have an idea that might be impulsive, try waiting two days before acting on it, or asking two people if they think it would be wise.  If it really feels uncontrollable, set a timer for one hour.  If the craving is still uncontrollable after one hour, allow yourself to indulge it.

Manage early signs of a low mood (depressed or empty)

Click on getting active to learn more.

—Updated 8/5/11 by Chris Aiken, MD