A longitudinal study of bipolar disordered clients going through an intensive psycho-educational intervention program
Although it is still possible to encounter the view that medication is the only method of treatment for bipolar disorder, research shows that there is a significant need for a comprehensive and integrative approach to this complex disorder. The current thesis firstly describes the rationale and development of a new, psychological intervention specifically directed at bipolar disorder, and secondly reports on an evaluation of this approach to treatment. Using a longitudinal design with replication across 13 participants, combined with the use of multiple case study methodology and qualitative data collection strategies, which allowed for triangulation between multiple data sources, it is concluded that the newly developed Therapeutic Instability Model approach to treatment had a significant and positive impact on factors of importance when treating bipolar disorder. These factors included hopelessness, known to be predictive of suicidal behaviour, and perceived control over internal states, a central aspect of bipolar disorder. As part of the evaluation, insights into which factors are important for client satisfaction and perceived usefulness of a treatment were also gained and it is argued that these should be borne in mind when attempting to develop interventions with high effectiveness and low dropout from treatment. The study further-more found positive changes occurring as a result of the intervention in thoughts, feelings, behaviours and illness related knowledge, and began a mapping of the participants' understanding or subjective models of their disorder's aetiology and maintenance. Further, two distinct patterns of change in important variables were observed during treatment and appear to be related to the participants' general attitude to having future episodes of mania. In relation to this, it was noted that specific interventions, such as behavioural experiments, may be more important for outcomes of treatment for individuals with a positive/ambivalent attitude to mania compared with individuals who do not share this attitude to manic experiences. It was argued that these findings could have potentially important clinical implications and a number of suggestions with regards to further research in this, and other, areas relating to the study were finally made.