Elsevier

Clinical Psychology Review

Volume 52, March 2017, Pages 148-163
Clinical Psychology Review

Review
Towards recovery-oriented psychosocial interventions for bipolar disorder: Quality of life outcomes, stage-sensitive treatments, and mindfulness mechanisms☆

https://doi.org/10.1016/j.cpr.2017.01.002Get rights and content

Highlights

  • •

    The recovery paradigm encourages new approaches to psychological therapies for bipolar disorder.

  • •

    Subjective quality of life can be reliably quantified, and is a key person-centric outcome measure in bipolar disorder.

  • •

    Response to psychological treatment appears to be moderated by stage of disorder, and new therapies should consider stage-tailoring.

  • •

    Mindfulness-based interventions target vulnerabilities that are important across stages of bipolar disorder, and warrant further research.

Abstract

Current adjunctive psychosocial interventions for bipolar disorder (BD) aim to impact illness course via information sharing/skill development. This focus on clinical outcomes contrasts with the emergent recovery paradigm, which prioritises adaptation to serious mental illness and movement towards personally meaningful goals. The aim of this review is to encourage innovation in the psychological management of BD by considering three recovery-oriented trends in the literature. First, the importance of quality of life as a target of recovery-oriented clinical work is considered. Second, the recent staging approach to BD is described, and we outline implications for psychosocial interventions tailored to stage. Finally, we review evidence suggesting that mindfulness-based psychosocial interventions have potential across early, middle and late stages of BD. It is concluded that the humanistic emphasis of the recovery paradigm provides a timely stimulus for development of a next generation of psychosocial treatments for people with BD.

Section snippets

The recovery paradigm and existing psychosocial interventions for BD

Initially driven by the mental health consumer movement, the recovery perspective has been adopted in mental health policies and guidelines worldwide (Commonwealth of Australia, 2009, Department of Health, 2011, New Freedom Commission on Mental Health, 2003). The recovery perspective has rapidly become the expressed goal of treatment for persons with persistent mental disorders (Song & Hsu, 2011). Indeed, recovery has so rapidly become instantiated in mental health guidelines throughout the

Measuring outcomes of psychosocial interventions for bipolar disorder

Commonly recognised elements of recovery are connectedness, hope and optimism, identity, meaning in life and empowerment (giving the acronym CHIME, (Leamy, Bird, Le Boutillier, Williams, & Slade, 2011), and there are consumer calls for the aims of psychosocial interventions to be more congruent with these humanistic values (Jones et al., 2013). Growing interest in recovery-congruent aims has, in turn, encouraged focus on outcome measures that capture broader subjective experiences of the

Clinical staging of bipolar disorder

Stage-sensitive treatment approaches are common outside mental health. In cardiac health, for example, the ischaemic heart disease model contrasts at-risk individuals, those whose illness is showing signs of progression (symptoms of hypertension, metabolic syndrome etc.) and those with overt cardiac disease (e.g., angina, Hickie, Scott, & McGorry, 2013).

The staging approach is less well developed in psychiatry than other areas of medicine. In BD, the staging approach has overlap with the notion

Mindfulness-based therapies for bipolar disorder

The concept of mindfulness has been taught in Buddhist philosophy for centuries and applied in western health contexts since the 1970s (e.g., Kabat-Zinn, 1982). More recently, it has been included in formal psychological therapies (for reviews, see Chiesa and Serretti, 2011, Hayes, 2004, Keng et al., 2011, Phang and Oei, 2012). Mindfulness as applied in psychological therapies has two defining features, namely, deliberate awareness of experiences in the present moment and a non-judgemental,

Discussion

The sea-change towards recovery-oriented services in mental health points to a corresponding need for a change in direction for BD practice and research. Arguably, practice has outpaced research in this domain, and researchers must catch up to a paradigm that is already extremely popular in public mental health (Tse et al., 2014). Our preceding review suggests that QoL will be a growing focus of interventions for BD within recovery-oriented practice and research, recently articulated models

Conclusions

While existing psychosocial treatments for BD warrant further refinement (David J. Miklowitz & Scott, 2009), the present review sought to encourage research into new approaches which align in various ways with the humanistic ‘recovery’ concept. The constructs of QoL, mindfulness and staging are not new in clinical psychology, but they have received limited attention in relation to serious mental disorders like BD. Evidence reviewed here suggests that the construct of QoL has face validity, and

Author contributions

G.M. and N.D.L. developed the study concept and drafted the paper. All authors contributed to subsequent drafts and approved the final version of the paper for submission.

Declaration of conflicting interests

Nil.

Acknowledgements

Nil.

References (211)

  • L. Dannahy et al.

    Group person-based cognitive therapy for distressing voices: Pilot data from nine groups

    Journal of Behavior Therapy and Experimental Psychiatry

    (2011)
  • M.D. Edge et al.

    People with bipolar I disorder report avoiding rewarding activities and dampening positive emotion

    Journal of Affective Disorders

    (2013)
  • C.S. Gama et al.

    Staging and neuroprogression in bipolar disorder: A systematic review of the literature

    Revista Brasileira de Psiquiatria

    (2013)
  • J.R. Geddes et al.

    Treatment of bipolar disorder

    The Lancet

    (2013)
  • P. Grossman et al.

    Mindfulness-based stress reduction and health benefits. A meta-analysis

    Journal of Psychosomatic Research

    (2004)
  • A.G. Harvey et al.

    Sleep disturbance as transdiagnostic: Consideration of neurobiological mechanisms

    Clinical Psychology Review

    (2011)
  • S.C. Hayes

    Acceptance and commitment therapy, relational frame theory, and the third wave of behavioral and cognitive therapies

    Behavior Therapy

    (2004)
  • J. Heissler et al.

    Inefficiency of emotion regulation as vulnerability marker for bipolar disorder: Evidence from healthy individuals with hypomanic personality

    Journal of Affective Disorders

    (2014)
  • S.G. Hofmann et al.

    Acceptance and mindfulness-based therapy: New wave or old hat?

    Clinical Psychology Review

    (2008)
  • B.K. Hölzel et al.

    Mindfulness practice leads to increases in regional brain gray matter density

    Psychiatry Research: Neuroimaging

    (2011)
  • V.L. Ives-Deliperi et al.

    The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: A controlled functional MRI investigation

    Journal of Affective Disorders

    (2013)
  • S.L. Johnson et al.

    Preventing mania: A preliminary examination of the GOALS program

    Behavior Therapy

    (2009)
  • S.L. Johnson et al.

    Creativity and bipolar disorder: Touched by fire or burning with questions?

    Clinical Psychology Review

    (2012)
  • S.H. Jones

    Circadian rhythms, multilevel models of emotion and bipolar disorder: An initial step towards integration?

    Clinical Psychology Review

    (2001)
  • S. Jones et al.

    The bipolar recovery questionnaire: Psychometric properties of a quantitative measure of recovery experiences in bipolar disorder

    Journal of Affective Disorders

    (2013)
  • P. Jylhä et al.

    Differences in neuroticism and extraversion between patients with bipolar i or II and general population subjects or major depressive disorder patients

    Journal of Affective Disorders

    (2010)
  • J. Kabat-Zinn

    An outpatient program in behavioral medicine for chronic pain patients based on the practice of mindfulness meditation: Theoretical considerations and preliminary results

    General Hospital Psychiatry

    (1982)
  • N. Abba et al.

    Responding mindfully to distressing psychosis: A grounded theory analysis

    Psychotherapy Research

    (2008)
  • W.A. Anthony

    Recovery from mental illness: The guiding vision of the mental health service system in the 1990s

    Psychiatric Rehabilitation Journal

    (1993)
  • A.G. Awad et al.

    Measuring quality of life in patients with schizophrenia: An update

    PharmacoEconomics

    (2012)
  • P. Bach et al.

    The use of acceptance and commitment therapy to prevent the rehospitalization of psychotic patients: A randomized controlled trial

    Journal of Consulting and Clinical Psychology

    (2002)
  • P. Bach et al.

    Long-term effects of brief acceptance and commitment therapy for psychosis

    Behavior Modification

    (2012)
  • R.A. Baer et al.

    Assessment of mindfulness by self-report: The Kentucky inventory of mindfulness skills

    Assessment

    (2004)
  • R.A. Baer et al.

    Using self-report assessment methods to explore facets of mindfulness

    Assessment

    (2006)
  • D.H. Barlow et al.

    Unified protocol for the transdiagnostic treatment of emotional disorders: Workbook

    (2010)
  • T. Barnhofer et al.

    Mindfulness-based cognitive therapy for depression and suicidality

  • A. Bechara

    Decision making, impulse control and loss of willpower to resist drugs: A neurocognitive perspective

    Nature Neuroscience

    (2005)
  • C. Bergomi et al.

    Facing the dreaded: Does mindfulness facilitate coping with distressing experiences? A moderator analysis

    Cognitive Behaviour Therapy

    (2013)
  • M. Berk et al.

    Stage managing bipolar disorder

    Bipolar Disorders

    (2013)
  • M. Berk et al.

    Palliative models of care for later stages of mental disorder: Maximizing recovery, maintaining hope, and building morale

    Australian and New Zealand Journal of Psychiatry

    (2012)
  • S. Beynon et al.

    Psychosocial interventions for the prevention of relapse in bipolar disorder: Systematic review of controlled trials

    British Journal of Psychiatry

    (2008)
  • S.C. Bolge et al.

    Characteristics and symptomatology of patients diagnosed with unipolar depression at risk for undiagnosed bipolar disorder: A bipolar survey

    CNS Spectrums

    (2008)
  • T.A. Brown et al.

    A proposal for a dimensional classification system based on the shared features of the DSM-IV anxiety and mood disorders: Implications for assessment and treatment

    Psychological Assessment

    (2009)
  • K.W. Brown et al.

    The benefits of being present: Mindfulness and its role in psychological well-being

    Journal of Personality and Social Psychology

    (2003)
  • L.F. Brown et al.

    Participant perspectives on mindfulness meditation training for anxiety in schizophrenia

    American Journal of Psychiatric Rehabilitation

    (2010)
  • J. Carmody et al.

    Relationships between mindfulness practice and levels of mindfulness, medical and psychological symptoms and well-being in a mindfulness-based stress reduction program

    Journal of Behavioral Medicine

    (2008)
  • P. Chadwick

    Mindfulness for psychosis

    British Journal of Psychiatry

    (2014)
  • P. Chadwick et al.

    Mindfulness groups for distressing voices and paranoia: A replication and randomized feasibility trial

    Behavioural and Cognitive Psychotherapy

    (2009)
  • P. Chadwick et al.

    Experience of mindfulness in people with bipolar disorder: A qualitative study

    Psychotherapy Research

    (2011)
  • P. Chadwick et al.

    Mindfulness groups for people with psychosis

    Behavioural and Cognitive Psychotherapy

    (2005)

    • Cited by (0)

    ☆

    G.M. and N.L. developed the study concept and drafted the paper. All authors contributed to subsequent drafts and approved the final version of the paper for submission.

    View full text
    © 2017 Elsevier Ltd. All rights reserved.