How can I change my thought patterns and control my mood swings?

I'm 29 and a mother of two. After I had my second child two years ago, I developed severe mood swings. I go from happy to sad to angry to depressed, on a daily basis and often with little to no warning. I usually try my best to hide it and just bottle it up/compartmentalize the feelings, but that is an exhausting and frustrating process that usually just makes it worse. I cannot control them, and I've been trying to figure out how to get a handle on them. I have been trying to journal daily, but I can't always keep up on it. Logically, I know what triggers me, but in the moment my emotions take over, and then it is impossible for me to control it. Usually I can recognize it right away, but sometimes I am not able to until my husband brings it up to me. It has been causing serious issues in our relationship, because it affects him and my children as much as it does me. The unpredictability of the mood swings and my behavior when I get overly angry or depressed is unhealthy for me and for my family. I am on Sertraline (200mg SID) and LAMOTRIGINE (100mg BID) for depression and anxiety, and my mood swings. I was diagnosed with borderline personality disorder and major depressive disorder (and was told I had symptoms of schizoid, but I don't know what that is) when I was 16, and I'm worried that I have also developed bipolar since having my son. I have not been able to afford to see or talk to a therapist. I am working with my primary care doctor to make that happen, but I am hoping I can get help finding some coping skills to try some that would work for me, so that I am able to function better day to day and keep my motivation up, keep my energy steady, be able to control my mood swings when they first begin rather than riding them out, and not lose my temper or get depressed over something small and basically meaningless. I get overwhelmed by day-to-day things (the messes from the kids, knowing that I haven't gotten done what I needed to get done and knowing that I will have to do it plus more tomorrow), and I desperately need to figure out how to control it or work through it. I want to be in control of it, but it's in control of me most of the time.
Asked by Phoenix22

Hi Phoenix22 and thank you for asking me your question about changing your thought patterns and decreasing mood swings. You mentioned that your mood swings have become more frequent and more difficult to moderate after you had your second chid about two years ago. From your description, it sounded that you were not having mood swings from feeling "high" or manic to then shortly afterwards experiencing a swing in your mood to severe depression. I am not trying to diagnose you and without conducting a diagnostic interview in person, would not be able to diagnose you with anything. In any case, my first thought, when reading the title of your question was that you were experiencing Bipolar Disorder. While psychotherapy can be helpful in decreasing severity and frequency of  mood swings in a person with Bipolar Disorder, the most important issue first would be to consult a psychiatrist to figure out which medication combination would work best. After that, therapy could be useful.

You mentioned being diagnosed with Borderline Personality Disorder. If this diagnosis predates the birth of your second child, then I would want to be certain that the doctor treating you evaluated you for Post-Partum Depression, to ensure the diagnosis is correct and to rethink medication choices. 

Your symptoms do sound to be consistent with Borderline Personality Disorder and assuming this is the case, it could be helpful to read about Cognitive Behavioral Therapy (CBT), particularly exercises that discuss and teach you how thoughts lead to emotions and together, these influence actions and behaviors. In addition, it would be helpful to learn about cognitive distortions which often cause us to believe that situations are much worse than they really are and happen as automatic thoughts. It could be helpful to determine which of the types of cognitive distortions influence your thoughts and emotions the most and from there, you could modify these distortions and automatic thoughts so that your thoughts are not as severely negative and then you would have less negative emotions and thoughts influencing your daily actions and behaviors. 

If you were in therapy, I would also introduce Dialectical Behavioral Therapy, (DBT) the only therapy approach to lead to reliable improvements in better mood regulation in individuals with Borderline Personality Disorder.  DBT involves several modules in which a person learns to make decisions and settle disagreements only when you can approach these issues from what is called a "Wise Mind". The wise mind is not under the influence of alcohol or drugs, it is calm and able to assess all aspects of a problem and incorporate the information needed to come to an informed decision or resolution. DBT also teaches mindfulness mediation which teaches a person to be present in the here and now and not worrying about things from the past and future. Another of the core modules of DBT teaches the many activities and methods a person can engage in to help them tolerate distress, or deal with pain and other unpleasant variables without resorting to impulsive and destructive actions and behaviors. The final core module teaches Interpersonal Effectiveness. This is exactly as is sounds, how to relate to other people while remaining calm and civil as well as communicating effectively. Some versions of DBT have additional modules that are helpful, however the ones that I have mentioned here will be found in any article or book on Dialectical Behavioral Therapy.

The information from Cognitive Behavioral Therapy can usually be found online with persistent searches. I wish I could come up with a single book on CBT to suggest, however all the ones that I have are written either with a lot of clinical language or written academically and would be like text books and not of help to you. As for DBT, much can be found on the internet, although an even better source would be one of the Dialectical Behavioral Therapy workbooks. There are several available and they have information and lessons that are easy to understand and are printed and bound like spiral notebooks so that you can make copies of the worksheets in the book. The worksheets are helpful because they go over lessons and ask you to think of personal examples and answer questions from the viewpoint of the personal situation that you chose at the beginning of the worksheet.

Along with those suggestions, I think it is important for you to see a therapist who is well versed in DBT as soon as you are able.

I hope this information gives you a helpful place to start and I wish you the best of luck and a great life,

Daniel Boyle Downey, LCSW