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The
Life Goals Program is structured group psychotherapy for
individuals with manic-depressive (bipolar disorder)
developed by Dr. Mark Bauer MD and Linda McBride MSN. Dr. Bauer is currently on the full-time faculty of the
Department of Psychiatry and Human Behaviour of Brown
University, and on staff in the Mental Health and
Behavioural Sciences Services of the Department of Veterans
Affairs Medical Center Providence, Rhode Island, U.S. A.
Linda McBride is a Clinical Nurse Specialist in the
Mental Health and Behavioural Sciences Service of the
Providence Rhode Island Department of Veterans Affairs
Medical Center. The Life Goals Program was developed to assist individuals
with bipolar disorder to participate more effectively in the
management of their own illness.
Additionally, the Life Goals Program is designed to improve the social and work-related problems that often develop for
individuals with bipolar illness.
The Life Goals Program is available in book form, and has
recently been released in a second edition (Bauer MS,
McBride L. Structured Group Psychotherapy for Bipolar Disorder. The
Life Goals Program, 2nd Edition (New York,
Springer, 2003). In
addition, the first edition has been published in French (Aubrey
JM (trans). Thérapie
de Groupe pour le Trouble Bipolaire: Un Approche Structurée.
Geneva, Switzerland, Éditions Médecine et Hygiene, 2001.), and an
unpublished Spanish version is also available from Dr. Bauer.
Use
of the Life Goals Program in a Research Project based in a
community setting:
From its inception, the Life Goals Program was developed to
be ideally suited for implementation in community settings.
The group format allows a number of individuals to interact
with one group therapist, the instructions are simple, and
reading and writing tasks needed are not prohibitively
complex. Dr.
Martha Sajatovic MD, and Dr. Marilyn Davies PhD, both with
the Department of Psychiatry at Case |
Western Reserve University in Cleveland, Ohio,
U.S.A. have recently begun a research study which tests the
effects of the Life Goals Program on attitudes and
behaviours in taking medication among patients with bipolar
disorder. This project is supported by research grants from
the National Institute of Mental Health (P20 MH066054-01A1
and K23 MH065599-01A2) and from the Woodruff Foundation.
The goal of this research study is to examine how a
psychosocial intervention based upon a collaborative
treatment model affects treatment adherence (how closely an
individual sticks to his prescribed medication schedule).
This is a prospective, randomized, controlled study of the
effects on treatment adherence of adding a psychoeducational
intervention (The Life Goals Program) to the medical
management (Usual Care) of outpatients with bipolar disorder
who attend a community mental health clinic. The community
mental health clinic (NorthEast Ohio Health Services) is
located in a suburban setting and provides a diverse array
of specialized mental health services including counselling
for individuals and families as well as medication
management.
As of December 2003 there have been 76 patients recruited.
The randomisation ensures that half of the participants are
recruited to the psychotherapeutic intervention and half of
the participants are recruited to the “treatment as usual”
control arm. Preliminary
data analysis finds that the average age of patients
participating is 43.9 years, ethnic composition 34% African-
American, 66% Caucasian.
Substance abuse is very common in the patients
involved in the study, with 65% of individuals having either
current substance abuse, or a past history of substance
abuse. The study
investigators have hypothesized that the Life Goals group
will improve treatment adherence attitudes among individuals
with bipolar disorder. Preliminary findings form the first
group participants (see changes in treatment attitude
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scores on Figure 1) support this hypothesis, as patients involved in the
Life Goals intervention had significant improvement in
attitudes towards medication after three months (p<. 05).
Patients in usual care had no change in attitudes towards
medication. A
larger sample of study patients followed over the
anticipated 1- year study trajectory is needed to confirm
these preliminary findings.
Currently the study continues to actively enroll
participants. More preliminary results on the primary outcome measures of
adherence attitudes and adherence behaviours will be
available and analyzed in 2004.
Fig.
10
(Grafico, Didascalia: “Changes
in treatment attitudes as a result of psychosocial
intervention.
(Increase in attitude score indicates more positive
attitudes towards treatment)”
Traduzione:“I
cambiamenti dell’aderenza alla cura come risultato
dell’intervento psicosociale (il maggiore punteggio
attitudinale indica una migliore adesione alla cura) ”
Implementing
a research project in a community setting poses challenges
not generally found in academic settings.
These include large, often overwhelming caseloads of
clinic staff, and patient populations that tend to be more
severely ill, with more life/family instability, poverty and
comorbid substance use than that typically seen in pure
“academic” or university settings.
However, the data obtained from conducting research
in community settings most closely represents the “real
world”, and provides a practical base upon which to design
and develop interventions that will benefit the greatest
number of individuals. There has been a very positive
response from Life Goals participants.
Verbatim
comments from patients in the first group cohort include:
“This is an exciting project.
It really has potential! ”, “ The education part
really helps me…”.
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