recovery in people with bipolar disorder: what does it mean, and what does it matter?

Recovery in people with bipolar disorder: What does it mean, and what does it matter?

Erin Michalak, PhDDepartment of PsychiatryUniversity of British ColumbiaVancouver, Canada

Circadian rhythms…

The spectrum of bipolar disorder

Mania

Hypomania

Depression

NormalMood

Variation

Normal

Goodwin FK, Jamison KR. Manic-Depressive Illness; 1990.

CyclothymicPersonality

CyclothymicDisorder

Bipolar IIDisorder

UnipolarMania

Bipolar IDisorder

SevereDepression

Bipolar disorder: the low down

• Common - robust epidemiological studies suggest a lifetime prevalence rate of 1-2%, but bipolar spectrum disorders will affect many more

• Complex, chronic, highly disabling

• Striking comorbidity, particularly with substance abuse (50-60%) and anxiety disorders (80%)

• High rates of suicide

• Serious public health concern

Gaps in the BD field

Conducted within framework of a biomedical model:

• Gap: majority of research quantitative - scant qualitative, little community-based research

• Gap: psychosocial determinants of outcome relatively neglected

• Gap: narrow measurement of outcomes - little focus on QoL, wellness, resiliency, strengths

Questions that shape my program of research

What psychosocial factors insulate people with BD from the potential havoc the condition can wreak, and what factors make them more vulnerable?

What are the determinants of QoL, wellness and recovery in people with BD?

What can we do clinically to improve psychosocial outcomes?

My intentions for today:

1. To describe our team’s ‘community-based participatory’ approach to research

2. To tell you about two studies of recovery in people with BD and give you some headline results from them

My intentions for today:

1. To describe our team’s ‘community-based participatory’ approach to research

2. To tell you about two studies of recovery in people with BD and give you some headline results from them

Community-based participatory research methods

Example CBPR techniques:

1. Annual CIHR-funded Community Engagement Event

2. People with BD as co-authors, co-investigators, grant-holders, ‘knowledge brokers’

3. Community Consultation Group

4. Community Advisory Group

5. CIHR-funded Café Scientifques

Stigma

Recovery

QoL

Community-based participatory research methods

Example CBPR techniques:

1. Annual CIHR-funded Community Engagement Event

2. People with BD as co-authors, co-investigators, grant-holders, ‘knowledge brokers’

3. Community Consultation Group

4. Community Advisory Group

5. CIHR-funded Café Scientifques

Stigma

Recovery

QoL

2011 Community Engagement Event: Exploring creativity in bipolar disorder

2011 Consultation Events1.

3.

2.

Documentary Screening

Crooked Beauty by Ken Paul Rosenthal

A powerful documentary that explores understandings of creativity and bipolar disorder.(2010, USA)

Why? by Carol Halstead

A woman who at 60 years of age finally has a chance to talk about her life through art. (1993 Canada)

Chomavision by Bruce Saunders

An 86-year-old lifelong artist whose story is archetypical of a life lived with creativity and bipolar disorder as major drivers. (2011, Canada)

• 7:10pm Film Screenings

• Each film will be followed by a 15-minute post-screening discussion facilitated by

Bruce Saunders and Erin Michalak.

• 7:00pm Welcome

Screening Program

Crooked Beauty

Chomavision

Why?

Community Engagement Day

Methods

22 participants, 50% BD type I, 50% BD type II/NOS, mean age 42.7 years, 4 men, 17 women, 1 transgendered

Quantitative data collected

Divided into four focus groups, 1.5 hours

Tape recorded, thematic analysis. Also graphically recorded

How does BD enhance/add to creativity? Do different mood states have different impacts on your creativity? How does creativity relate to treatment? Do BD medications help or hinder creativity? Are there ways of tailoring treatments for BD that could help you express your creativity?

The Creative Life: A Night of Live Music Celebrating BD

My intentions for today:

1. To describe our team’s ‘community-based participatory’ approach to research

2. To tell you about two studies of recovery in people with BD and give you some headline results

Community Consultation Day 2010: “Through my eyes: the concept of

recovery in people with bipolar disorder

Dr. Erin Michalak, Dr. Rachelle Hole, Ros Irving, Dr. Vytas Velyvis

Method

Cecil Green House, University of British Columbia

30 participants – 5 focus groupso Individuals with BD/family members

“What does recovery mean to you as a person living with BD or as a family member of someone living

with BD?”

“What strategies have helped or hindered your recovery or the recovery of your family member

living with BD?”

Analysis and results

Transcripts coded manually and analyzed using thematic analysis

Within the ‘meaning of recovery’ theme, four subthemes identified:

“Re-thinking the Language of Recovery” “Shifting the Framework” “The Art of Managing BD” “Understanding the Journey of BD”

Results cont

“Re-thinking the Language of Recovery” Dissatisfaction with term recovery, majority felt it

was inaccurate or unhelpful

“I think management is a really good word … like to be in recovery sounds like, you know, it happens, you get better, Ta Da. And that’s not the case because it is chronic. You’re sort of in-between recoveries”

Jamie Livingston, CREST.BD member

Results cont

“Shifting the Framework” Focus on wellness versus illness, emphasis on

QoL, happiness, engagement with life

Vytas Velyvis, CREST.BD member

“…This is the most stable I’ve been in years since being put on lithium and it’s hard. It feels bland. It feels like cafeteria food. You know, I’m being sustained but I’m not, I don’t feel nourished.”

Results cont

“The Art of Managing BD” Three sub-themes: of life: “Sense of Self”, “The

Role of Loss and Acceptance” and “Letting Go of Stigma”

“taking responsibility for yourself”, “empowering one’s self” and “growing”

Ros Irving, CREST.BD member

Results cont

“Understanding the Journey of BD” Three sub-themes: of life: “Sense of Self”, “The

Role of Loss and Acceptance” and “Letting Go of Stigma”

“I would say that it isn’t necessarily going back to who you were, but it’s developing a new life, it’s transforming, growing…and rebuilding a whole new life. So there is hope but it’s moving forward as opposed to trying to get the past back. That’s my interpretation of recovery”.

Sara Lapsley, CREST.BD member

www.crestbd.ca

“Constructing recovery narratives in people with bipolar disorder: Exploring potential impacts.”

Rosalind Irving, Dr. Erin Michalak, Dr. Rachelle Hole

CREST.BD team member Ros Irving

Recovery Narrative project

We are made up of stories but many have lost their story (Jean Houston, 2009)

A narrative of possible recovery is necessary if a person is to recover, but it is the fact of its being a shared narrative that matters (Bruner, 2002)

Methods

Research Objective: Does clinician-guided construction of recovery narratives in people with BD impact subjective recovery?

10 participants with BD type I or II 3 x 1.5 hour sessions Audio-recorded Satisfaction, recovery and QoL assessed pre and post

intervention

Constructing the narrative

Elicited through normal psychotherapeutic process Rogerian approach of unconditional positive regard Client encouraged to tell own story, prompted by questions Clinician explored significance of events, note-taking Clinician underlined salient points from previous session

for possible further exploration in sessions 2 and 3 Story continued with clinician prompting client to explore

significance and meaning Notes provided to client, who then wrote up own narrative

Purpose of the recovery narrative (for clinician)

Can help the therapist become aware of the client’s view of the cause of BD, potentially resulting in more effective interventions

Therapist’s understanding and empathy may be deepened

Potential impact on therapeutic alliance

Purpose of the recovery narrative (for client)

To piece together a coherent story of self (since identity development may have been interrupted and sense of self damaged)

To help develop a sense of agency, reduce aloneness, process grief

To give suffering new meaning since it can help others by providing role modeling and hope.

To counteract external definitions of self based on the illness (leading potentially to self-stigma)

http://www.scottishrecovery.net/

erin.michalak@ubc.cawww.crestbd.cawww.facebook.com/#!/CRESTBDBipolarResearch