Self-management strategies important in bipolar disorder
MedWire News: High functioning patients with bipolar disorder who have a long history of illness use a range of self-management strategies to aid their well-being, a qualitative study has shown.
Strategies fell into six broad categories: sleep, rest, exercise and diet; ongoing monitoring; enacting a plan; reflective and meditative practices; understanding bipolar disorder; and connecting with others.
“Clinicians can use these qualitative data to underscore the power of proactive well-being strategies and inspire positive therapeutic engagement,” Erin Michalak (University of British Columbia, Vancouver, Canada) and colleagues comment in the Journal of Affective Disorders.
Noting a lack of prior research in this area, Michalak et al recruited 32 patients with bipolar disorder who had a significant clinical history of illness, in terms of episodes and hospital admissions, but whose functioning and quality of life were in the normal clinical range.
Participants underwent either an individual interview or focus group session to answer open questions about the self-management strategies they used to maintain or regain wellness.
Sufficient and regular sleep was identified as one of the most important strategies for maintaining or regaining wellness. Choosing healthy foods, eating regularly scheduled meals, and taking vitamin supplements was also commonly mentioned, as was regular exercise.
Participants described the importance of learning to pay close attention to their moods and activities, in order to judge when to make changes. Related to this was planning for impending manic or depressive episodes, involving either an informal understanding between family members or friends or a more detailed document to guide decisions.
A variety of reflective and meditative practices were advocated by patients - ranging from practices such as Tai Chi, yoga, and meditation to activities like regular journal keeping, inspirational reading, and praying.
Many patients sought out information about their illness through a variety of channels including books and newsletters, the internet, attending groups and talking to healthcare practitioners. Some also found it useful to share what they had learned with family member and friends.
Not surprisingly connecting with others was an important strategy for many patients, although finding a balance between solitary and social time was important. Connections included family and friends, seeking out professional support, and for some people, doing volunteer work.
Discussing the findings, the researchers emphasize the important of patients discovering the best coping strategy for themselves.
“The notion of an idiosyncratic narrative is not surprising given the complex pattern of interactions that are likely to moderate well-being in bipolar disorder,” Michalak et al conclude.
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By Andrew Czyzewski