Advance directives in bipolar disorder, a cognitive behavioural conceptualization

Mental Health Advance Directives (MHADs) are potentially useful for bipolar patients due to the episodic characteristic of their disease. An interest for the development of a Cognitive Behavioural Therapy (CBT) approach in the creation process of MHADs arises because of a lack of efficiency of the non-collaborative processes, the potential impact of psychopathology and the awareness of the illness in MHADs' content, the link between the patient's directives interest and the case manager's interest, and the lower interest reported by the potentially high MHADs beneficiary. The CBT intervention in the MHADs creation process that is proposed in this article is based on: the self-determination model for adherence, the cognitive representation of illness model, and the concordance model. The principles of the intervention were adapted from Motivational interviewing's (MI), emphasising personal choice and responsibility, and focusing on the patient's concerns about the treatment through Socratic dialogue. During the course of 2004, 20 advance directives written by patients (17 with bipolar disorder, 3 with schizoaffective disorder) have been collected following the described intervention. Therefore, this intervention seems to be relevant for patients with bipolar disorder.