The one knock on Russell's study was that her inclusion criteria relied solely on the patient's own self-reporting of their wellness. Researchers tend to be sticklers for quantifiable data, and a very recent study published in Clinical Psychology and Psychotherapy (abstract here) addressed that concern.
The researchers found 33 Canadians with bipolar who qualified as "high functioning" according to a number of rating scales, then interviewed the patients individually or in focus groups. The authors of the study openly acknowledged Dr Russell's work, which they cited as the only previous qualitative study that has examined stay well strategies by those with bipolar. (Pause for a brief second to consider the implications of that statement.)
To no one's surprise, the patients in the study identified very similar stay well strategies to those in Dr Russell's study, which the authors broke down into six key areas, namely:
- Sleep, rest, diet and exercise
- Ongoing monitoring
- Reflective and meditative practices;
- Understanding bipolar and educating others
- Connecting with others
- Enacting a plan.
Sleep, rest, diet and exercise
According to one patient in the study: "I make sure that I get to bed by 10:30–11:00 every night. And a routine is really important." The researchers also identified "waking rest" such as lying down or watching TV, which "enabled people to meet social and work responsibilities."
Sleep and rest are tied into diet and exercise, as all have to do with maintaining a sense of mental alertness. One patient reported that she avoids heavy foods when she's down; another that "being active really works for me." As the authors observed: "These strategies are inexpensive, within one’s control and reflect common sense."
According to the authors: "Participants described the importance of learning to pay close attention to their moods and involvement in activities, in order to judge when to make changes." Thus, "individuals would spread tasks out over the week, cancel social engagements if necessary and maintain some unscheduled time."
As one patient described it:
To me it’s an ongoing basis where it’s like a ship that’s always righting itself, you know. Or when you’re driving, you’re sort of correcting as you’re trying to drive in a straight line. So those were the things that I see, and then I make minor adjustments and hopefully I don’t have to make major adjustments because I’ve been always making these corrections.
Reflective and meditative practices
These ranged from yoga to praying to journaling. One patient's Tai Chi practice, combined with self-monitoring strategies fostered a "zone of stability" that allowed her to manage her illness well, despite experiencing symptoms.
Understanding bipolar and educating others
The successful patients in the study engaged in a variety of practices, from reading to attending support groups to charting their cycles to learning new skills from practical talking therapies such as CBT. In addition, the patients shared what they learned with family and friends, which in turn enabled them to become more supportive. As one patient explained:
I think my husband is really important because he will notice a depressive episode coming on before I will and he can tell by my body language. He says I walk differently. I carry myself differently and there is a look in my forehead and my eyebrows. He picks it out before I do. . . . He makes me aware of it and [then] I will just become more diligent about exercise, eating right, more sleep, and trying to . . . I guess, reassign priorities.
Connecting with others
Successful patients reached out in various ways, from contacting friends to finding formal support venues to volunteering to seeking professional help. As the authors explained, these activities are not unique to people with bipolar; rather the difference is the impact that these social interactions had on maintaining wellness especially during times of stress.
Enacting a plan
The patients in the study acknowledged the likelihood of things going wrong, and accordingly they had various arrangements in place, ranging from WRAP plans to informal understandings with friends and family.
The authors expressed the hope that once clinicians became aware of these stay well skills, they could tailor their therapies accordingly. But the successful patients in both Dr Russell's study and this one did not wait for their clinicians to become enlightened. Yes, they did learn from their clinicians. But, more important, they figured things out themselves.
Trust me, "Knowledge is Necessity" is not just a title to a blog; it's a way of life.