Staying Well with Bipolar Disorder

Russell, Sarah; Browne, Jan

doi:10.1080/j.1440-1614.2005.01542.x

Cited by 111 publications

(78 citation statements)

References 26 publications

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“…To our knowledge, only one previous qualitative study has examined the self-management strategies used by people to stay well with BD (Russell & Browne, 2005). The results of the study identifi ed two main themes-a 'stay well' concept and 'strategies to stay well'.…”

Section: Introductionmentioning

confidence: 99%

“…To avoid some of the limitations of the Russell and Browne (2005) study and our own previous qualitative research (Michalak, Murray, Young, & Lam, 2007), we committed to: use a carefully screened sample of participants, collect detailed quantitative data on symptoms, psychosocial functioning and quality of life (QoL) and utilize rigorous qualitative analysis techniques. Our objectives for the present paper are to: (1) describe the categories of self-management strategies identifi ed as effective by a sample of individuals with BD who are 'high functioning' and (2) to explore clinical implications of these fi ndings by synthesizing them with existing quantitative knowledge about strategies in adjunctive psychosocial interventions for BD.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Self‐management strategies used by ‘high functioning’ individuals with bipolar disorder: from research to clinical practice

Murray

Suto

Hole

et al. 2011

Clin Psychology and Psychoth

101

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The strategies adopted by a sample of people coping well with their BD show remarkable overlap with the targets of existing adjunctive psychosocial interventions for BD. The clinician can use this information to motivate clients to engage with such strategies. The present findings also serve to remind the clinician of significant individual differences in the personal meaning and concrete application of superficially similar strategies.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Self‐management strategies used by ‘high functioning’ individuals with bipolar disorder: from research to clinical practice

Murray

Suto

Hole

et al. 2011

Clin Psychology and Psychoth

101

View full text Add to dashboard Cite

show abstract

“…Studies that have explored how individuals with BD stay well have focused primarily on methods by which relapse is avoided and have defined recovery in terms of symptom reduction, rather than focusing on the subjective process of recovery. 289,290 Additionally, studies have focused mainly on individuals with long-term diagnosis of BD neglecting exploration of how these processes develop earlier on in the course of the disorder. No study has explored experiences of recovery from the perspective of the participants early in the course of their BD.…”

Section: Cognitive-behavioural Approach To Understanding and Preventimentioning

confidence: 99%

“…Some qualitative studies have explored how individuals with BD stay well, focusing primarily on methods by which relapse is avoided, rather than on the subjective process of recovery, highlighting the importance of both medication and psychosocial support in the context of active condition management by the individual. 289,290 Although clinically helpful, such reports define recovery in terms of symptom reduction and avoidance of relapse thus missing the more idiosyncratic personal recovery experiences that are often most important to service users. They also do not incorporate research which indicates that trajectories of symptomatic and functional improvement are often different 297,298 and that some individuals with significant residual symptoms can achieve high levels of functioning.…”

Section: Cognitive-behavioural Approach To Understanding and Preventimentioning

confidence: 99%

“…Studies of 'staying well' in BD have indicated roles for life style management, warning sign detection/mania avoidance medication and use of support services. 289,290 These reports defined wellness in terms of absence of relapse and recruited their sample on the basis of being out of episode for ≥ 2 years. The current study finds the processes involved in recovery may be different.…”

Section: Previous Researchmentioning

confidence: 99%

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Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Morrison

Law

Barrowclough

et al. 2016

Programme Grants Appl Res

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BackgroundRecovery in mental health is a relatively new concept, but it is becoming more accepted that people can recover from psychosis. Recovery-orientated services are recommended for adult mental health, but with little evidence base to support this.ObjectivesTo facilitate understanding and promotion of recovery in psychosis and bipolar disorder (BD), in a manner that is empowering and acceptable to service users.MethodThere were six linked projects using qualitative and quantitative methodologies: (1) developing and piloting a service user-defined measure of recovery; (2) a Delphi study to determine levels of consensus around the concept of recovery; (3) examination of the psychological factors associated with recovery and how these fluctuate over time; (4) development and evaluation of cognitive–behavioural approaches to guided self-help including a patient preference trial (PPT); (5) development and evaluation of cognitive–behavioural therapy (CBT) for understanding and preventing suicide in psychosis including a randomised controlled trial (RCT); and (6) development and evaluation of a cognitive–behavioural approach to recovery in recent onset BD, including a RCT of recovery-focused cognitive–behavioural therapy (RfCBT). Service user involvement was central to the programme.ResultsMeasurement of service user-defined recovery from psychosis (using the Subjective Experience of Psychosis Scale) and BD (using the Bipolar Recovery Questionnaire) was shown to be feasible and valid. The consensus study revealed a high level of agreement among service users for defining recovery, factors that help or hinder recovery and items which demonstrate recovery. Negative emotions, self-esteem and hope predicted recovery judgements, both cross-sectionally and longitudinally, whereas positive symptoms had an indirect effect. In the PPT, 89 participants entered the study, three were randomised, 57 were retained in the trial until 15-month follow-up (64%). At follow-up there was no overall treatment effect on the primary outcome (Questionnaire about the Process of Recovery total;p = 0.82). In the suicide prevention RCT, 49 were randomised and 35 were retained at 6-month follow-up (71%). There were significant improvements in suicidal ideation [Adult Suicidal Ideation Questionnaire; treatment effect = –12.3, 95% confidence interval (CI) –24.3 to –0.14], Suicide Probability Scale (SPS; treatment effect = –7.0, 95% CI –15.5 to 0) and hopelessness (subscale of the SPS; treatment effect = –3.8, 95% CI –7.3 to –0.5) at follow-up. In the RCT for BD, 67 participants were randomised and 45 were retained at the 12-month follow-up (67%). Recovery score significantly improved in comparison with treatment as usual (TAU) at follow-up (310.87, 95% CI 75.00 to 546.74). At 15-month follow-up, 32 participants had experienced a relapse of either depression or mania (20 TAU vs. 12 RfCBT). The difference in time to recurrence was significant (estimated hazard ratio 0.38, 95% CI 0.18 to 0.78;p < 0.006).ConclusionsThis research programme has improved our understanding of recovery in psychosis and BD. Key findings indicate that measurement of recovery is feasible and valid. It would be feasible to scale up the RCTs to assess effectiveness of our therapeutic approaches in larger full trials, and two of the studies (CBT for suicide prevention in psychosis and recovery in BD) found significant benefits on their primary outcomes despite limited statistical power, suggesting definitive trials are warranted.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life

et al. 2023

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ImportanceBipolar disorder–specific psychotherapy combined with pharmacotherapy improves relapse risk, symptom burden, and quality of life, but psychotherapy is not easily accessible.ObjectiveTo determine if a smartphone-based self-management intervention (LiveWell) can assist individuals with bipolar disorder to maintain wellness.Design, Setting, and ParticipantsAn assessor-blind randomized clinical trial enrolled participants from March 20, 2017, to April 25, 2019, with 48-week follow-up ending on April 10, 2020. Participants were randomly assigned to usual care or usual care plus the smartphone intervention stratified by relapse risk based on initial clinical status (low risk: asymptomatic recovery; high risk: continued symptomatic, prodromal, recovering, symptomatic recovery). Participants with bipolar disorder I were recruited from clinics in the Chicago and Minneapolis-Saint Paul areas. Data were analyzed from June 19, 2020, to May 25, 2022.InterventionsThe smartphone-based self-management intervention consisted of an application (app), coach, and website. Over 16 weeks, participants had a coach visit followed by 6 phone calls, and they completed daily and weekly app check-ins. The app provided adaptive feedback and information for developing a personalized wellness plan, the coach provided support, and the website provided summary data and alerts.Main Outcomes and MeasuresThe primary outcome was time to relapse. Secondary outcomes were percentage-time symptomatic, symptom severity, and quality of life.ResultsOf the 205 randomized participants (mean [SD] age, 42 [12] years; 125 female individuals [61%]; 5 Asian [2%], 21 Black [10%], 13 Hispanic or Latino [6%], 7 multiracial [3%], 170 White [83%], 2 unknown race [1%]), 81 (40%) were randomly assigned to usual care, and 124 (60%) were randomly assigned to usual care plus the smartphone intervention. This clinical trial did not detect a reduction in relapse risk for the smartphone intervention (hazard ratio [HR], 0.65; 95% CI, 0.39-1.09; log-rank P = .08). However, decreased relapse was observed for low-risk individuals (HR, 0.32; 95% CI, 0.12-0.88; log-rank P = .02) but not high-risk individuals (HR, 0.86; 95% CI, 0.47-1.57; log-rank P = .62). Reduced manic symptom severity was observed for low-risk individuals (mean [SE] difference, −1.4 [0.4]; P = .001) but not for high-risk individuals (mean [SE] difference, 0 [0.3]; P = .95). The smartphone-based self-management intervention decreased depressive symptom severity (mean [SE] difference, −0.80 [0.34]; P = .02) and improved relational quality of life (mean [SE] difference, 1.03 [0.45]; P = .02) but did not decrease percentage-time symptomatic (mean [SE] difference, −5.6 [4.3]; P = .20).Conclusions and RelevanceThis randomized clinical trial of a smartphone-based self-management intervention did not detect a significant improvement in the primary outcome of time to relapse. However, a significant decrease in relapse risk was observed for individuals in asymptomatic recovery. In addition, the intervention decreased depressive symptom severity and improved relational quality of life. These findings warrant further work to optimize the smartphone intervention and confirm that the intervention decreases relapse risk for individuals in asymptomatic recovery.Trial RegistrationClinicalTrials.gov Identifier: NCT03088462

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Staying Well with Bipolar Disorder

Abstract: Staying well involved participants being mindful of their illness, which enabled them to develop an individual stay-well plan, including intervention strategies to prevent episodes of illness.

Cited by 111 publications

References 26 publications

Self‐management strategies used by ‘high functioning’ individuals with bipolar disorder: from research to clinical practice

Self‐management strategies used by ‘high functioning’ individuals with bipolar disorder: from research to clinical practice

Psychological approaches to understanding and promoting recovery in psychosis and bipolar disorder: a mixed-methods approach

Effects of a Smartphone-Based Self-management Intervention for Individuals With Bipolar Disorder on Relapse, Symptom Burden, and Quality of Life

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