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Advance directives in bipolar disorder, a cognitive behavioural conceptualization
Yasser Khazaal1, Christèle Richard, Shona Matthieu-Darekar
1University Department of Adult Psychiatry, Lausanne, Switzerland. yasser.khazaal@chuv.ch
International Journal of Law and Psychiatry
|December 29, 2007
Summary
Cognitive Behavioural Therapy (CBT) enhances the creation of Mental Health Advance Directives (MHADs) for bipolar disorder patients. This collaborative approach improves directive content and patient engagement, addressing limitations of non-collaborative methods.
Area of Science:
- Psychiatry
- Psychology
- Mental Health Services
Background:
- Mental Health Advance Directives (MHADs) offer potential benefits for bipolar disorder patients due to the episodic nature of their illness.
- Non-collaborative MHAD creation processes often lack efficiency and may be impacted by psychopathology and illness awareness.
- Patient and case manager interest alignment and beneficiary engagement are key challenges in MHAD development.
Purpose of the Study:
- To develop and evaluate a Cognitive Behavioural Therapy (CBT) approach for creating Mental Health Advance Directives (MHADs).
- To address the limitations of non-collaborative MHAD processes and improve content and engagement for bipolar disorder patients.
Main Methods:
- The proposed CBT intervention integrates the self-determination model for adherence, the cognitive representation of illness model, and the concordance model.
- Intervention principles are adapted from Motivational Interviewing (MI), utilizing Socratic dialogue to focus on patient concerns and emphasize personal choice.
- Twenty advance directives were collected in 2004 from patients (17 with bipolar disorder, 3 with schizoaffective disorder) following the CBT intervention.
Main Results:
- The CBT-based intervention facilitated the creation of MHADs in patients with bipolar and schizoaffective disorders.
- The collaborative approach appears to enhance the content and relevance of the generated directives.
- The intervention demonstrated potential relevance for patients with bipolar disorder.
Conclusions:
- A CBT intervention, incorporating principles of self-determination, illness representation, and concordance, is a relevant approach for developing Mental Health Advance Directives.
- This collaborative method shows promise in improving the MHAD creation process for individuals with bipolar disorder.
- Further research is warranted to fully explore the efficacy and impact of CBT-guided MHAD development.
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