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Overcoming challenges in delivering integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder with co-morbid alcohol use: therapist perspectives

Published online by Cambridge University Press:  06 May 2020

Katherine Berry
Affiliation:
School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
Christine Barrowclough
Affiliation:
School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
Mike Fitsimmons
Affiliation:
School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
Rosalyn Hartwell
Affiliation:
School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
Claire Hilton
Affiliation:
Spectrum Centre for Mental Health Research, Institute for Health Research, Lancaster University, Lancaster, UK
Lisa Riste
Affiliation:
School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
Ian Wilson
Affiliation:
School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Sciences Centre, Manchester, UK
Steven Jones
Affiliation:
Spectrum Centre for Mental Health Research, Institute for Health Research, Lancaster University, Lancaster, UK
Corresponding

Abstract

Background:

Alcohol misuse is common in bipolar disorder and is associated with worse outcomes. A recent study evaluated integrated motivational interviewing and cognitive behavioural therapy for bipolar disorder and alcohol misuse with promising results in terms of the feasibility of delivering the therapy and the acceptability to participants.

Aims:

Here we present the experiences of the therapists and supervisors from the trial to identify the key challenges in working with this client group and how these might be overcome.

Method:

Four therapists and two supervisors participated in a focus group. Topic guides for the group were informed by a summary of challenges and obstacles that each therapist had completed at the end of therapy for each individual client. The audio recording of the focus group was transcribed and data were analysed using thematic analysis.

Results:

We identified five themes: addressing alcohol use versus other problems; impact of bipolar disorder on therapy; importance of avoidance and overcoming it; fine balance in relation to shame and normalising use; and ‘talking the talk’ versus ‘walking the walk’.

Conclusions:

Findings suggest that clients may be willing to explore motivations for using alcohol even if they are not ready to change their drinking, and they may want help with a range of mental health problems. Emotional and behavioural avoidance may be a key factor in maintaining alcohol use in this client group and therapists should be aware of a possible discrepancy between clients’ intentions to reduce misuse and their actual behaviour.

Type
Brief Clinical Report
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

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References

Bolton, J. M, Robinson, J., & Sareen, J. (2009). Self-medication of mood disorders with alcohol and drugs in the National Epidemiologic Survey on Alcohol and Related Conditions. Journal of Affective Disorders, 115, 367375.CrossRefGoogle ScholarPubMed
Braun, V., & Clarke, V. (2013). Successful Qualitative Research: A Practical Guide for Beginners. London, UK: SAGE Publications.Google Scholar
Brotchie, J., Hanes, J., Wendon, P., & Waller, G. (2006). Emotional avoidance among alcohol and opiate abusers: the role of schema-level cognitive processes. Behavioural and Cognitive Psychotherapy, 35, 231236.CrossRefGoogle Scholar
Jones, S., Riste, L., Barrowclough, C., Bartlett, P., Clements, C., Davies, L., Holland, F., Kapur, N., Lobban, F., Long, R., Morriss, R., Peter, S., Roberts, C., Camacho, E., Gregg, L., & Ntais, D. (2019). Reducing relapse and suicide in bipolar disorder: practical clinical approaches to identifying risk, reducing harm and engaging service users in planning and delivery of care the PARADES (Psychoeducation, Anxiety, Relapse, Advance Directive Evaluation and Suicidality) programme. Programme Grants for Applied Research, 6.Google Scholar
Miller, W. R., & Rollnick, S. (2012). Motivational Interviewing: Helping People Change (3rd edn). Guilford Press.Google Scholar
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