For Healthcare Providers

Quality of life improvement in people with bipolar disorder is a critical target for clinical attention1, 2,3. In particular, a second edition of the evidence-informed manual for Cognitive- Behavioural Therapy (CBT) for BD was published in 20105 CBT for BD draws eclectically from other evidence-based therapies for BD, and rests on therapeutic knowledge and skills familiar to many healthcare providers.

As a background to this reading, we note that an integrative approach has been recommended7

  • Improve ability to recognise changes in mood, signs of prodromal periods and to respond quickly and effectively (via pre-planning) to these prodromal symptoms
  • Increase knowledge about and acceptance of BD, including acceptance of and adherence to medication regimens
  • Encourage daily monitoring of mood and sleep
  • Improve interpersonal communication, particularly in the family
  • Improve significant others’ understanding of BD, including ability to identify and productively respond to prodromal symptoms
  • Re-engage with social, familial and occupational roles
  • Improve stress response and emotion regulation skills, especially around goals and reward activation
  • Proactively stabilise sleep/wake and other social rhythms
  • Identify and critique maladaptive thoughts and beliefs, particularly in relation to the self and the disorder
  • Reducing drug or alcohol misuse

Efficacy of psychosocial treatments for BD is improved with early identification of episodes, understanding of the triggers for mood change and key predictors of these changes, such as changes in sleep and activity.  This knowledge requires the person with BD to be mindful of changes in mood, and as such daily mood monitoring is a central element of treatment.

Motivational interviewing has proven effective in engaging this client group in discussion about the reasons why they are using substances, in considering the pros and cons of this behaviour and dealing with factors underlying ambivalence to change4,8.

Finally, a strongly collaborative working relationship, and a therapeutic approach emphasising skill-development and empowerment is recommended.

An older black woman is talking to her pharmacist about her medication.

Resources for Healthcare Providers

Select clinician-focused books, key peer-reviewed publication citations and tools are provided (at a QoL domain level) below.

Home Resources
  1. Frank, E. Interpersonal and Social Rhythm Therapy (IPSRT): A Means of Improving Depression and Preventing Relapse in Bipolar Disorder. Household care tensions can contribute to the onset of a bipolar disorder episode and this article includes a case example describing the application of IPSRT principles within the context of home life.
Spiritual Resources
  1. Pesut, B., Clark, N., Maxwell, V., & Michalak, E.E. Religion and Spirituality in the Context of Bipolar Disorder: A Literature Review. This article reviews current literature which explores the role of religion and spirituality for individuals with bipolar disorder and its relevance as a means of coping and explaining the condition (originally published in Mental Health, Religion and Culture, 2010). 
  2. Koenig, H.G. Research on Religion, Spirituality and Mental Health: A Review. Recent studies have identified that religion and spirituality may serve as a psychological and social resource for coping with stress. 
  3. Tepper, L., Rogers, S.A., Coleman, E.M., & Malony, H.N. The Prevalence of Religious Coping Among Persons with Persistent Mental Illness. The results of the study suggest that religious activities and beliefs may be particularly compelling for people experiencing more severe symptoms, and increased religious activity may be associated with reduced symptoms. Religion may serve as a potentially effective method of coping for people with mental illness, warranting its integration into practice. 
  4. Weisman de Mamani, A.G., Tuchman, N., & Duarte, E.A. Incorporating Religion/Spirituality Into Treatment for Serious Mental Illness. Findings from this study indicate that religion and spirituality can often be incorporated into treatment in a way that coalesces with patients’ values and enhances treatment gains. Future research could investigate how therapists’ own spiritual values interact with those of their clients, and whether congruency in spiritual values has any impact on treatment efficacy. 
  5. Bassett, H., Lloyd, C., & Tse, S. Approaching in the Right Spirit: Spirituality and Hope in Recovery from Mental Health Problems. This article highlights the importance of including spirituality and hope in assessment and treatment in order to move towards a recovery-orientated health-care service. The role of hope in assisting practitioners to be sensitive to the spiritual needs of clients is demonstrated. 
  6. Hodge, D.R. Spirituality and People With Mental Illness: Developing Spiritual Competency in Assessment and Intervention. Suggestions for spiritually competent practice are provided, including guidelines for discerning authentic spiritual experiences from manifestations of mental illness that reflect spiritual content. The article concludes by reviewing a number of spiritual interventions that may flow from a spiritual assessment. 
  7. Fallot, R.D. (Ed.) Spirituality and Religion in Recovery from Mental Illness: New Directions for Mental Health Services (vol. 80). This volume of the journal New Directions for Mental Health Services focuses entirely on spirituality and mental health. 
  8. Culliford, L. Healing From Within: Spirituality and Mental Health. Web-based article that provides research evidence demonstrating how religious/spiritual beliefs and practices can act as preventative factors for mental illness. Severity and relapse rates have been shown to reduce, while recovery can be enhanced for some individuals.
  9. Cook, C., Powell, A., & Sims, A. (Eds.) Spirituality and Psychiatry. Textbook for healthcare providers outlines how to assess spiritual needs and the influence of spirituality with psychosis, suicide, and substance abuse.
Independence Resources
  1. Sell, H., Nagaswami V., & World Health Organization. Promoting Independence of People with Disabilities Due to Mental Disorders: A Guide for Rehabilitation in Primary Health Care. A manual in eight modules, focusing on psychosocial rehabilitation. Each module covers a different aspect related to promoting independence in people with mental illness.  
  2. Michalak, E.E., Yatham, L.N., Kolesar, S., & Lam, R.W. Bipolar Disorder and Quality of Life: A Patient-Centred Perspective. Several quantitative studies have generally indicated that quality of life is markedly impaired in patients with bipolar disorder. This paper presents a series of in-depth qualitative interviews conducted as part of the item generation phase for a disease-specific scale to assess quality of life in bipolar disorder.
Leisure Resources
  1. Craik, C., & Pieris, Y. Without Leisure, ‘It wouldn’t be much of a life’. People with mental illnesses view lack of leisure activities as detrimental to wellbeing. It is critical to include leisure components in interventions. In occupational therapy interventions, it may be practical to suggest activities that meet therapy’s goals, but also have potential to serve as leisure activities. 
  2. Iwasaki, Y., Coyle, C., Shank, J., Messina, E., & Porter, H. Leisure-Generated Meanings and Active Living for Persons With Mental Illness. A leisure activity experienced as meaningful may positively influence stress-coping, recovery, adjustment and active living for a person with a mental illness. The personal, meaningful aspect of a leisure activity may have its root in one or more domains: self-expression, companionship, spiritual revitalization, belonging, etc. 
  3. Mansell, W., Powell, S., Pedley, R., Thomas, N., Jones, S.A. The process of recovery from bipolar I disorder. Deciding how to handle leisure activities may be key in getting benefits from them without being pushed by them into mania. Fear of eliciting a manic episode was the participants’ driving force for controlling their involvements in activities recognized as pleasurable. 
  4. Caldwell, L. Leisure and Health: Why is leisure therapeutic? A well-crafted personal leisure plan can have a significant positive impact on a person’s quality of life. Physical activity leisure is well-established in having positive influences on life outcomes. Leisure activities with the best outcomes involve people developing a sense of personal responsibility and feeling active. 
  5. Krumm-Merabet, C., Meyer, T.D. Leisure activities, alcohol, and nicotine consumption in people with a hypomanic/hyperthymic temperament. Adolescents with hypomanic tendencies may by nature enjoy the positive effects of leisure; however, their temperament also puts them at risk of experiencing negative activities that might have future undesirable consequences, e.g., uncontrolled use of alcohol.
  6. Meyer, B., Rahman, R., Shepherd, R. Hypomanic personality features and addictive tendencies. There are some implicit incentives that may lead a person with a hypomanic personality to allocate time to activities with perceived rewarding potential outcome. Some may have a positive influence on a person’s life. But it is also possible that a favored activity may take so much time that other activities are neglected or performed less well.