“On the Level” A community based intervention for individuals with Bipolar Affective Disorder (BPAD) Daniel Flynn, Senior Clinical Psychologist, Mary Kells, Clinical Psychologist, Maria O’ Sullivan, Psychologist in Clinical Training, Gráinne Kearney, Volunteer Clinical Psychology Assistant Department of Clinical Psychology, North Lee Adult Mental Health Service Evidence-Based Practice: NICE Guidelines

Healthcare professionals should assist clients with Bipolar Affective Disorder by: • • • Building a therapeutic relationship • Advising on careful & regular self-monitoring of

symptoms (including early warning signs & triggers) M

anaging lifestyle (e.g. sleep hygiene & work patterns) Developing coping strategies (1.1.1.3) 3

Key aims of the Programme

   Understand and discuss what BPAD is Identify early warning signs for episodes Develop behavioural and cognitive strategies for managing both depression and mania    Deal with stressful events that can trigger episodes Monitor and understand mood symptoms Play an active part in their ongoing recovery and relapse prevention The treatment of BPAD is based primarily on psychotropic medication to reduce the severity of problems, stabilise mood and prevent relapse… However a range of psychological and psychosocial interventions can also have a significant impact in the short and long term (1.4 + 1.5) 3

How the programme evolved: Phase 1

: September – October 2009 (Pilot)

Phase 2

: November 2009 –February 2010

Phase 3

: March 2010 – May 2010

Phase 4

: Due to commence

Introductory Workshop

: Provided on an as-required basis (Day therapy programme, St. Michael’s unit)

Practice-Based Evidence

Logistics of providing psychological support to individuals with BPAD: Demand exceeds available supply of individual therapy sessions.

Changes

Focus group: Patients reported: •

“

BPAD is not talked about

”

• •

“

Feeling isolated

” “

Not realising other people were experiencing similar episodes

” Step by Step Evidence into practice

Research to date has shown that group interventions using a CBT framework as an adjunct to traditional treatment for BPAD are beneficial in regard to relapse prevention, enhancement of treatment for residual depressive symptoms, and improvement in functionality. Furthermore they may also be a cost effective way of delivering psychosocial treatments.

1,4,5

What is the On the Level group?

The ‘On the Level’ group is a skills training programme offering persons with a diagnosis of BPAD an adjunct to their existing treatment. The programme is based on cognitive behavioural therapy (CBT), which aims to support individuals with bipolar disorder in monitoring, examining and changing thinking and behaviour that can be associated with extreme mood states.

The Journey: Phase 1

Pilot based on ‘Keeping your balance’ 2 • • • programme & supplementary materials.

Participants: 6 already attending individual therapy Evaluation: Focus group Attrition: 4 completed programme.

Phase 2

- Revised programme content based on • • • • feedback from pilot.

Evaluation: Introduced pre- & post- measures Participants: 7 commenced programme Attrition: 3 completed programme Reasons: 2 moved counties, 1 hospitalized, 1 infrequent attendee not present for final session.

• • • • • •

Phase 3

Developed information leaflet (approved by communications office) Manual devised for programme Evaluation: Ongoing assessment (BDI-II 6 Altman Mania Rating Scale 7 ) Participants: 9 pre-assessment, 7 commenced group Attrition: 4 completed programme Reasons: 2 hospitalized, 1 infrequent attendee.

Phase 4- Next Steps

• • • • Delivery: Extend to 10 sessions (due to time pressure phase 3) Manual: Further refinement based on feedback Research: Introduction of waiting list group Proposed: Ongoing support group and family education group - survey attendees.

Inclusion Criteria

• Currently attending North Lee Adult Mental Health Services (open to all sectors within North Lee) • • Primary diagnosis of BPAD Mood currently stable.

Referral Process:

• •

Referral options

Referral form to be completed by members of treatment team. OR Self-referral & referral form signed by consultant

Processing referrals

• On receipt of referral, individuals contacted and informed of when next group is likely to commence (letter copied to consultant)

All groups are closed

.

Pre-group assessment

• Meeting with group facilitator.

• • Evaluating individual needs.

Battery of measures (BDI-II, Altman Mania Rating Scale), • Consent to participate in research

(Protocol in development)

References:

1.

Castle, D., Berk, M., Berk, L., Lauder, S., Chamberlain, J. and Gilbert, M.

2.

3.

4.

5.

6.

7.

(2007) Pilot of group intervention for bipolar disorder, International

Journal of Psychiatry in Clinical Practice, Vol. 11, No. 4.

Centre for Clinical Interventions () Keeping your Balance Programme.

National Institute for Health and Clinical Excellence (2006) Bipolar

disorder: The management of bipolar disorder in adults, children and

adolescents, in primary and secondary care. UK, National Collaborating Centre for Mental Health.

Patelis-Siotis, I., Trevor Young, L., Robb, J., Marriott, M., Bieling, P., Cox, L. and Joffe, R. (2001) Group cognitive behavioural therapy for bipolar

disorder: a feasibility and effectiveness study. Journal of Affective Disorders, Vol. 65.

Zaretsky, A., Rizvi, S., and Parikh, S. (2007). How well do Psychosocial

Interventions work in Bipolar Disorder? The Canadian Journal of Psychiatry, Vol. 52, No. 1.

Beck , A.T., Steer, R.A. and Brown, G.K. (1996) Beck Depression Inventory

II, Psychological Corporation, USA.

Altman, E. Hedeker, D. Peterson, J.L. and Davis J.M. (1997) The Altman Self rating Scale. Biological Psychiatry, 42 pp. 948 -955