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

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Abstract

Introduction: Bipolar disorder (BD) is a complex mental illness that results in substantial costs, both at a personal and societal level. Research into BD has been driven by a strongly medical model conception, with a focus upon pathology and dysfunction. Little research to date has focused upon strategies used to maintain or regain wellness in BD. Here, we present results from a qualitative study of self-management strategies used by a Canadian sample of ‘high-functioning’ individuals with BD. The aims of the present paper are two-fold: (1) To provide a description of the self-management strategies identified as effective by this sample of high functioning individuals and 2) to explore these results from a clinical perspective.

Methods: High functioning (determined as a score of either 1 or 2 on the objectively-rated Multidimensional Scale of Independent Functioning) individuals with BD type I or II (N = 33) completed quantitative scales to assess depression, mania, psychosocial functioning and quality of life, and underwent either an individual interview or focus group about the self-management strategies they used to maintain or regain wellness.

Results: The specific self-management strategies that individuals enacted are contained within the following categories: (1) sleep, diet, rest and exercise; (2) ongoing monitoring; (3) reflective and meditative practices; (4) understanding BD and educating others; (5) connecting to others and (6) enacting a plan. These strategies are discussed in the context of current treatment interventions and research findings, offering clinicians a broad range of potential techniques or tools to assist with their efforts to support individuals with BD in maintaining or regaining wellness.

Conclusions: 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. Copyright © 2010 John Wiley & Sons, Ltd.

Key Practitioner Message:

• People who function well despite a significant history of bipolar disorder identify a range of strategies that are critical in their wellbeing.

• Key wellbeing strategies are: (1) managing sleep, diet, rest and exercise; (2) ongoing monitoring; (3) reflective and meditative practices; (4) understanding BD and educating others; (5) connecting to others and (6) enacting a plan.

• These strategies constitute ‘tips from the experts’ that can be offered to clients to increase hopefulness and improve engagement with psychosocial interventions.

• Clinicians will be familiar with these strategies as elements of existing psychosocial interventions—the present qualitative data provides significant cross-validation of the importance of these behaviours.

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