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Bipolar brain fog can make everyday tasks feel harder, but practical strategies can help support better focus, memory, and daily functioning.
Key Takeaways
- Try centralizing all your important notes, appointments, and to-do lists into one calendar or phone app.
- Don’t be afraid to use simple tools like sticky notes or written instructions to help with multi-step tasks.
- Focusing on your overall bipolar treatment plan is often the best first step toward clearing brain fog.
- These cognitive hurdles aren’t a reflection of your intelligence, and using workarounds is a strategy many successful people share.
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Deb M. of South Dakota has dealt with memory problems for a long time. Names, appointments, even special events like her children’s birthdays — they all drift off to some Never-Never Land. Of course, plenty of people struggle to find their keys or stay on top of things at work, yet researchers now recognize that glitches in recall, planning, and staying on task can be core parts of living with bipolar disorder.
While brain fog is a common experience, there are plenty of ways to help your mind stay on track day to day. By using modern technology and old-fashioned techniques — like setting alerts on your smartphone, organizing your workspace, and choosing a spot to keep your keys and wallet — you can compensate for these lapses. For especially severe symptoms, it might be worth exploring rehabilitative training.
Daily Organization Strategies
Deb’s mood swings have been well-controlled for years, but she still relies on workarounds for her forgetfulness and lack of focus. She uses a calendar divided into half-hours: Everything she needs to do goes onto that calendar, and important events get highlighted. She also sets her phone to remind her when it’s time to do chores, run errands, and go to her volunteer job.
“I keep the instructions for the cash register right next to me so that I can consult them anytime,” says Deb.
According to a study published in Frontiers in Psychiatry, about 38 to 40 percent of people with bipolar have no cognitive challenges, while 20 to 30 percent deal with “obvious cognitive deficits.”
“There’s quite a bit of heterogeneity in the cognitive abilities of people with bipolar disorder, which often predicts how well they function in the community,” says Katherine Burdick, PhD, director of the Mood and Psychosis Research Program at Brigham and Women’s Hospital in Boston and a professor at Harvard Medical School.
Improving Focus Through Bipolar Treatment
When you stay on top of your treatment, your ability to focus and sustain attention tends to improve over time. The type of impairment and how heavy a burden it creates varies from person to person. In addition to “future memory” (remembering things you’ve planned) and “past memory” (recall), common challenges include filtering out distractions, maintaining concentration, absorbing new information, and solving problems.
An outreach effort, TestMyBrain.org, aims to help you gauge your cognitive abilities while contributing to brain research. It offers click-through screens with exercises to see how well you can solve puzzles and pay attention.
“The test will help people assess their cognitive function right in their living room,” says Thilo Deckersbach, PhD, an associate professor of psychology at Harvard Medical School who’s linked to the project through MoodNetwork, a similar collaboration of researchers and “citizen scientists.”
With results from TestMyBrain in hand, you can have a fruitful discussion with your doctor about how to address cognitive difficulties. It’s important to raise your day-to-day challenges with psychiatrists, therapists, and physicians, since memory blips and attention lapses often aren’t part of the clinical conversation.
Addressing Bipolar Disorder as the Root Cause
As with any bipolar symptom, the first step is to find effective treatment for the underlying brain-based disorder.
“We know that with treatment of bipolar disorder, the ability to focus and sustain attention over time improves, although the recovery of cognition is not always full,” says Christopher Bowie, PhD, professor of psychology at Queen’s University in Kingston, Ontario.
Bo R. ended up dropping out of university because of trouble paying attention and remembering facts for his exams. He’s doing better in those areas since working with his doctors to find more effective treatment for his bipolar 1 disorder, which was diagnosed in 2010.
As a result, he’s now working part-time as a computer technician and resuming his studies. He chronicles his moods each day so he can be sure he’s staying in balance, and he also uses some practical methods to cope with his mind’s quirks.
“I now use an electronic Outlook calendar, which is great for helping me remember appointments and perform tasks,” he says.
In addition to those tips, Dr. Bowie notes that self-care — stress reduction, healthy nutrition, and regular exercise — plays an important role in helping your brain work its best. He also suggests cognitive behavioral therapy (CBT) to counteract self-critical and self-defeating thoughts.
Professional Cognitive Training Options
Cognitive remediation, also known as cognitive training, offers one-on-one and group interventions to teach you new strategies. It’s used with people who have brain injuries, attention-deficit hyperactivity disorder (ADHD), and other psychiatric diagnoses.
Dr. Deckersbach has seen how effective such training can be for people with bipolar. In an older clinical trial, participants “functioned significantly better in a real-world environment at the end of the study than they did at the beginning.”
More recent research also supports his findings. A randomized controlled trial published in the journal Bipolar Disorders found that cognitive remediation therapy can be beneficial to individuals with bipolar 1 and bipolar 2 who deal with cognitive challenges.
Practicing exercises to build your “memory muscles” is a big part of cognitive remediation. That might involve re-creating word lists, listening to a voicemail, and trying to remember all the details.
At Columbia University’s Lieber Recovery and Rehabilitation Clinic in New York City, participants might watch a video of people at a concession stand giving food and drink orders, then work on recalling the virtual customers’ names and orders. Although cognitive training programs tend to be based at academic medical centers, there are efforts afoot to make them more accessible.
Researchers are also studying whether medications that improve wakefulness may help with cognitive problems in people with bipolar disorder, Dr. Burdick reports.
“In the future, we’re likely to find that improving cognitive abilities in patients with bipolar disorder will best be accomplished with a combination of medication and cognitive training or remediation,” she says.
Self-Help and Lifestyle Tools
None of the techniques used in cognitive remediation reflects secret scientific know-how, but they are practiced so that they become second nature.
“One of the points that we make is that these are strategies that are used often by successful people,” says Elizabeth Twamley, PhD, a professor of psychiatry at the University of California in San Diego. “It’s very straightforward … and it really lends itself to a self-help model.”
Dr. Twamley has developed training manuals that are available for free to home users at CogSMART.com. She recommends reading through the manual to find ideas that suit not only your particular challenges, but also your personality. In general, she emphasizes two core skills: Centralizing information in a calendar system and writing down everything — preferably in the calendar, but on your hand if necessary.
Carla F. of Mississippi prefers sticky notes. “As soon as I think of something I need to do, I write it down on a sticky note — including chores at home and doctors’ appointments,” she explains. “I put the sticky notes on the door frame of the kitchen, which I pass through many times each day.”
She adds that after seeing the effectiveness of her reminder system, her husband and two grown daughters have adopted it, too.
Twamley notes that addressing cognitive deficits appears to improve overall well-being. That’s not news to Carla. Her system “not only helps my memory,” she reports, “but it helps calm me down.”
Editorial Sources and Fact-Checking
- Huang Y et al. Cognitive Impairment Mechanism in Patients with Bipolar Disorder. Neuropsychiatric Disease and Treatment. February 2023.
- Chen W et al. The Heterogeneity of Longitudinal Cognitive Decline in Euthymic Bipolar I Disorder With Clinical Characteristics and Functional Outcomes. Frontiers in Psychiatry. July 2021.
- Deckersbach T et al. RESEARCH: Cognitive Rehabilitation for Bipolar Disorder: An open trial for employed patients with residual depressive symptoms. CNS Neuroscience and Therapeutics. October 2010.
- Strawbridge R et al. Cognitive Remediation Therapy for Patients With Bipolar Disorder: A Randomized Proof-of-Concept Trial. Bipolar Disorders. March 2021.
UPDATED: Originally printed as “The Memory Question,” Fall 2015