Hostname: page-component-78c5997874-t5tsf Total loading time: 0 Render date: 2024-11-15T19:20:41.124Z Has data issue: false hasContentIssue false
  • English
  • Français

A qualitative exploration of how people with bipolar disorder consider risk-taking in everyday decisions

Published online by Cambridge University Press:  18 December 2020

Andrew Wah ,
Suzanne Hodge ,
Steven H. Jones  and
Guillermo Perez Algorta Open the ORCID record for Guillermo Perez Algorta [Opens in a new window]
Andrew Wah
Affiliation:
Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
Suzanne Hodge
Affiliation:
Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
Steven H. Jones
Affiliation:
Spectrum Centre for Mental Health Research, Lancaster University, Lancaster, UK
Guillermo Perez Algorta*
Affiliation:
Division of Health Research, Faculty of Health and Medicine, Lancaster University, Lancaster, UK
*
*Corresponding author. Email: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Background:

Difficulties with decision making and risk taking in individuals with bipolar disorder (BD) have been associated with mood episodes. However, there is limited information about these experiences during euthymia, the mood state where people with BD spent the majority of their time.

Aims:

To examine how individuals with BD consider risk in everyday decisions during their euthymic phase.

Method:

We conducted a qualitative study that used semi-structured audio recorded interviews. Eight euthymic participants with confirmed BD were interviewed, and we used interpretative phenomenological analysis to analyse the data.

Results:

We identified four themes. The first theme, ‘Who I really am’, involves the relationship between individual identity and risks taken. The second theme, ‘Taking back control of my life’, explored the relationship between risks taken as participants strove to keep control of their lives. The third theme, ‘Fear of the “what ifs”’, represents how the fear of negative consequences from taking risks impacts risk decisions. Finally, the fourth theme, ‘The role of family and friends’, highlights the important role that a supporting network can play in their lives in the context of taking risks.

Conclusions:

The study highlights aspects that can impact on an individual with BD’s consideration of risk during euthymia. Identity, control, fear and support all play a role when a person considers risk in their decision-making process, and they should be taken into consideration when exploring risk with individuals with BD in clinical settings, and inform the design of future interventions.

Keywords

bipolar disorderdecision makingqualitativerisk taking
Type
Main
Information
Behavioural and Cognitive Psychotherapy , Volume 49 , Issue 3 , May 2021 , pp. 314 - 327
Copyright
© British Association for Behavioural and Cognitive Psychotherapies 2020

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adida, M., Jollant, F., Clark, L., Besnier, N., Guillaume, S., Kaladjian, A., … & Courtet, P. (2011). Trait-related decision-making impairment in the three phases of bipolar disorder. Biological Psychiatry, 70, 357–365. doi: 10.1016/j.biopsych.2011.01.018 CrossRefGoogle ScholarPubMed
Akers, N., Lobban, F., Hilton, C., Panagaki, K., & Jones, S. H. (2019). Measuring social and occupational functioning of people with bipolar disorder: a systematic review. Clinical Psychology Reviews, 74, 101782.CrossRefGoogle ScholarPubMed
Alexander, L. F., Oliver, A., Burdine, L. K., Tang, Y., & Dunlop, B. W. (2017). Reported maladaptive decision-making in unipolar and bipolar depression and its change with treatment. Psychiatry Research, 257, 386–392. doi: 10.1016/j.psychres.2017.08.004 CrossRefGoogle ScholarPubMed
American Psychiatric Association (APA) (2013). Diagnostic and Statistical Manual of Mental Disorders (5th edn). Arlington, VA: APA.Google Scholar
Burdick, K. E., Braga, R. J., Gopin, C. B., & Malhotra, A. K. (2014). Dopaminergic influences on emotional decision making in euthymic bipolar patients. Neuropsychopharmacology, 39, 274–282. doi: 10.1038/npp.2013.177 CrossRefGoogle ScholarPubMed
Cáceda, R., Nemeroff, C. B., & Harvey, P. D. (2014). Toward an understanding of decision making in severe mental illness. Journal of Neuropsychiatry and Clinical Neurosciences, 26, 196–213. doi: 10.1176/appi.neuropsych.12110268 CrossRefGoogle ScholarPubMed
Dias, V. V., Brissos, S., Frey, B. N., & Kapczinski, F. (2008). Insight, quality of life and cognitive functioning in euthymic patients with bipolar disorder. Journal of Affective Disorders, 110, 75–83. doi: https://doi.org/10.1016/j.jad.2008.01.010 CrossRefGoogle ScholarPubMed
Folstad, S., & Mansell, W. (2019). ‘The Button Question’: a mixed-methods study of whether patients want to keep or remove bipolar disorder and the reasons for their decision. Journal Of Affective Disorders, 245, 708–715. doi: 10.1016/j.jad.2018.11.025 CrossRefGoogle ScholarPubMed
Fredman, S. J., Baucom, D. H., Boeding, S. E., & Miklowitz, D. J. (2015). Relatives’ emotional involvement moderates the effects of family therapy for bipolar disorder. Journal of Consulting and Clinical Psychology, 83, 81–91. doi: 10.1037/a0037713 CrossRefGoogle ScholarPubMed
Galletta, A. (2013). Mastering the Semi-Structured Interview and Beyond: From Research Design to Analysis and Publication. New York: New York University Press.CrossRefGoogle Scholar
Goodell, L. S., Stage, V. C., & Cooke, N. K. (2016). Practical qualitative research strategies: training interviewers and coders. Journal of Nutrition Education and Behavior, 48, 578–585. doi: 10.1016/j.jneb.2016.06.001 CrossRefGoogle ScholarPubMed
Holmes, M. K., Bearden, C. E., Barguil, M., Fonseca, M., Monkul, E. S., Nery, F. G., … & Glahn, D. C. (2009). Conceptualizing impulsivity and risk taking in bipolar disorder: importance of history of alcohol abuse. Bipolar Disorders, 11, 33–40. doi: 10.1111/j.1399-5618.2008.00657.x CrossRefGoogle Scholar
Inder, M. L., Crowe, M. T., Joyce, P. R., Moor, S., Carter, J. D., & Luty, S. E. (2010). ‘I really don’t know whether it is still there’: ambivalent acceptance of a diagnosis of bipolar disorder. Psychiatric Quarterly, 81, 157–165. doi: 10.1007/s11126-010-9125-3 CrossRefGoogle Scholar
Inder, M. L., Crowe, M. T., Moor, S., Luty, S. E., Carter, J. D., & Joyce, P. R. (2008). ‘I actually don’t know who I am’: the impact of bipolar disorder on the development of self. Psychiatry: Interpersonal and Biological Processes, 71, 123–133. doi: 10.1521/psyc.2008.71.2.123 CrossRefGoogle Scholar
Joffe, R. T., MacQueen, G. M., Marriott, M., & Young, L. T. (2004). A prospective, longitudinal study of percentage of time spent ill in patients with bipolar I or bipolar II disorders. Bipolar Disorders, 6, 62–66. doi: 10.1046/j.1399-5618.2003.00091.x CrossRefGoogle ScholarPubMed
Jones, S. H., Smith, G., Mulligan, L. D., Lobban, F., Law, H., Dunn, G., … & Morrison, A. P. (2015). Recovery-focused cognitive-behavioural therapy for recent-onset bipolar disorder: randomised controlled pilot trial. British Journal of Psychiatry, 206, 58–66. doi: 10.1192/bjp.bp.113.141259 CrossRefGoogle ScholarPubMed
Khalsa, H. M. K., Salvatore, P., Hennen, J., Baethge, C., Tohen, M., & Baldessarini, R. J. (2008). Suicidal events and accidents in 216 first-episode bipolar I disorder patients: predictive factors. Journal of Affective Disorders, 106, 179–184. doi: 10.1016/j.jad.2007.05.027 CrossRefGoogle ScholarPubMed
Lobban, F., Taylor, K., Murray, C., & Jones, S. (2012). Bipolar disorder is a two-edged sword: a qualitative study to understand the positive edge. Journal of Affective Disorders, 141, 204–212. doi: 10.1016/j.jad.2012.03.001 CrossRefGoogle ScholarPubMed
MacQueen, G. M., Young, L. T., & Joffe, R. T. (2001). A review of psychosocial outcome in patients with bipolar disorder. Acta Psychiatrica Scandinavica, 103, 163–170. doi: 10.1034/j.1600-0447.2001.00059.x CrossRefGoogle ScholarPubMed
Martino, D. J., Strejilevich, S. A., Torralva, T., & Manes, F. (2011). Decision making in euthymic bipolar I and bipolar II disorders. Psychological Medicine, 41, 1319–1327. doi: 10.1017/S0033291710001832 CrossRefGoogle ScholarPubMed
Meyer, T. D., & Hautzinger, M. (2012). Cognitive behaviour therapy and supportive therapy for bipolar disorders: relapse rates for treatment period and 2-year follow-up. Psychological Medicine, 42, 1429–1439. doi: 10.1017/S0033291711002522 CrossRefGoogle ScholarPubMed
Milkman, K. L., Chugh, D., & Bazerman, M. H. (2009). How can decision making be improved? Perspectives on Psychological Science, 4, 379–383.CrossRefGoogle ScholarPubMed
Miziou, S., Tsitsipa, E., Moysidou, S., Karavelas, V., Dimelis, D., Polyzoidou, V., & Fountoulakis, K. N. (2015). Psychosocial treatment and interventions for bipolar disorder: a systematic review. Annals of General Psychiatry, 14, 19. doi: 10.1186/s12991-015-0057-z CrossRefGoogle ScholarPubMed
Morton, E., Michalak, E. E., Hole, R., Buzwell, S., & Murray, G. (2018). ‘Taking back the reins’ – a qualitative study of the meaning and experience of self-management in bipolar disorder. Journal of Affective Disorders, 228, 160–165. doi: 10.1016/j.jad.2017.12.018 CrossRefGoogle ScholarPubMed
Murphy, F. C., Rubinsztein, J. S., Michael, A., Rogers, R. D., Robbins, T. W., Paykel, E. S., & Sahakian, B. J. (2001). Decision-making cognition in mania and depression. Psychological Medicine, 31. doi: 10.1017/s0033291701003804CrossRefGoogle Scholar
National Institute for Health and Clinical Excellence (NICE) (2014). Bipolar disorder (update): the management of bipolar disorder in adults, children and adolescents in primary and secondary care. In Clinical Guideline 185. London: NICE.Google Scholar
Olley, A., Malhi, G. S., Mitchell, P. B., Batchelor, J., Lagopoulos, J., & Austin, M.-P. V. (2005). When euthymia is just not good enough. Journal of Nervous and Mental Disease, 193, 323–330. doi: 10.1097/01.nmd.0000161684.35904.f4 CrossRefGoogle Scholar
Owen, R., Gooding, P., Dempsey, R., & Jones, S. (2017). The reciprocal relationship between bipolar disorder and social interaction: a qualitative investigation. Clinical Psychology & Psychotherapy, 24, 911–918. doi: 10.1002/cpp.2055 CrossRefGoogle ScholarPubMed
Palmier-Claus, J. E., Dodd, A., Tai, S., Emsley, R., & Mansell, W. (2016). Appraisals to affect: testing the integrative cognitive model of bipolar disorder. British Journal of Clinical Psychology, 55, 225–235. doi: 10.1111/bjc.12081 CrossRefGoogle ScholarPubMed
Pallant, J. F. (2000). Development and validation of a scale to measure perceived control of internal states. Journal of Personality Assessment, 75, 308–337.CrossRefGoogle ScholarPubMed
Pilgrim, D. (2013). Some implications of critical realism for mental health research. Social Theory & Health, 12, 1–21. doi: 10.1057/sth.2013.17 CrossRefGoogle Scholar
Reinharth, J., Braga, R., & Serper, M. (2017). Characterization of risk-taking in adults with bipolar spectrum disorders. Journal of Mental Disorders, 205, 580–584. doi: 10.1097/NMD.0000000000000680 CrossRefGoogle ScholarPubMed
Robertson, J. P., & Collinson, C. (2011). Positive risk taking: whose risk is it? An exploration in community outreach teams in adult mental health and learning disability services. Health, Risk & Society, 13, 147–164. doi: 10.1080/13698575.2011.556185 CrossRefGoogle Scholar
Samame, C., Martino, D. J., & Strejilevich, S. A. (2012). Social cognition in euthymic bipolar disorder: systematic review and meta-analytic approach. Acta Psychiatrica Scandinavica, 125, 266–280. doi: 10.1111/j.1600-0447.2011.01808.x CrossRefGoogle ScholarPubMed
Sheehan, D., Lecrubier, Y., Sheehan, K. H., Janavs, J., Weiller, E., Keskiner, A., … & Dunbar, G. (1997). The validity of the Mini International Neuropsychiatric Interview (MINI) according to the SCID-P and its reliability. European Psychiatry, 12, 232–241.CrossRefGoogle Scholar
Sicilia, A. C., Lukacs, J. N., Jones, S., & Perez Algorta, G. (2019). Decision-making and risk in bipolar disorder: a quantitative study using fuzzy trace theory. Psychology and Psychotherapy: Theory, Research and Practice. doi: 10.1111/papt.12215 CrossRefGoogle Scholar
Smith, J. A., Flowers, P., & Larkin, M. H. (2009). Interpretative Phenomenological Analysis: Theory, Method and Research. London, UK: Sage Google Scholar
Smith, J. A., & Osborn, M. (2015). Interpretative phenomenological analysis. In Smith, J. A. (ed), Qualitative Psychology: A Practical Guide to Research Methods (3rd edn). London, UK: Sage.Google Scholar
Smith, J. A., & Shinebourne, P. (2012). Interpretative phenomenological analysis. In APA Handbook of Research Methods in Psychology, Vol 2: Research designs: Quantitative, qualitative, neuropsychological, and biological (pp. 73). Washington, DC, USA: American Psychological Association.Google Scholar
Van Camp, L., van den Ameele, S., Sabbe, B. G. C., & Oldenburg, J. F. E. (2018). The longitudinal course of cognitive insight and mood in bipolar disorder. Psychiatry Research, 269, 9–12. doi: 10.1016/j.psychres.2018.08.063 CrossRefGoogle ScholarPubMed
Warwick, H., Mansell, W., Porter, C., & Tai, S. (2019). ‘What people diagnosed with bipolar disorder experience as distressing’: a meta-synthesis of qualitative research. Journal of Affective Disorders, 248, 108–130. doi: 10.1016/j.jad.2019.01.024 CrossRefGoogle ScholarPubMed
Willig, C. (2019). What can qualitative psychology contribute to psychological knowledge? Psychological Methods. doi: 10.1037/met0000218 CrossRefGoogle ScholarPubMed
Yechiam, E., Hayden, E. P., Bodkins, M., O’Donnell, B. F., & Hetrick, W. P. (2008). Decision making in bipolar disorder: a cognitive modeling approach. Psychiatry Research, 161, 142–152. doi: 10.1016/j.psychres.2007.07.00 CrossRefGoogle ScholarPubMed
Supplementary material: File

Wah et al. Supplementary Materials

Wah et al. Supplementary Materials

Download Wah et al. Supplementary Materials(File)
File 24.4 KB
Submit a response

Comments

No Comments have been published for this article.