Recovery focused group therapy: Exploring a new treatment for adults with experience of bipolar disorder

This recovery focused group therapy will be delivered as an adjunct to existing treatment (pharmacological and/ or psychological). The intervention is informed by Acceptance Based Behavioral Therapy (AABT), motivational interviewing (MI) and consumer feedback. ABBT integrates CBT with principles and strategies from Acceptance and Commitment Therapy (ACT; Hayes, Strosahl & Wilson, 2012), dialectical behavior therapy (DBT; Linehan, 1993) and mindfulness-based cognitive therapy (MBCT; Segal, Williams & Teasdale, 2002) to address processes implicated in Generalised Anxiety Disorder (GAD; Roemer & Orsillo, 2009). According to this approach, GAD is maintained by an interplay between a) problematic ways of relating to internal experiences (e.g. restricted/ biased attention; critical, negative and fearful stance); b) rigid strategies aimed at experiential avoidance (i.e. efforts to alter the form, frequency and/ or intensity of internal events; Hayes, Wilson, Gifford, Follette & Strosahl, 1996) and c) subsequent ‘behavioral constriction’ (narrowing or avoidance of meaningful/ valued action; Roemer & Orsillo, 2009). This model of ABBT is particularly relevant to the current trial, since as with anxiety, Bipolar Disorder and substance use are also characterized by problematic reactions to internal events (Jones & Day, 2008; Jones, Mansell & Waaller, 2006; Johnson et al. 2008), experiential avoidance and behavioural constriction (Aldao et al., 2010; Spinhoven et al., 2014). The current intervention is designed to promote awareness of (i) how participants respond to experiences related to mood, anxiety and substance use, with a particular emphasis on the role of urges (to avoid, approach and/ or protect) and (ii) the relationship between these responses and valued living. The overarching focus will be on using this awareness to promote increased engagement in meaningful action. Sessions will consist of guided discovery, information provision and exercises (e.g. self-monitoring, mindfulness, awareness of thoughts, feelings and urges). Written material will be used to consolidate key concepts and allow participants to document ‘take home points’ of particular relevance to their own experience. The structure and content of written material will be finalised in collaboration with consumers. Dosage and administration The intervention will comprise eight sessions of face-to-face group therapy, of between 1.5 to 2 hours (plus a 15-30 minute mid-session break) delivered across 8 weeks. All sessions will be led by the same Clinical Psychologist (>10 years experience in research and mental health settings) and co-facilitated by the same Registered Psychologist (>5 years experience, masters level training). Sessions will be held in a community based private psychology clinic located on the Central Coast, NSW. Treatment Integrity Adherence to treatment protocol will be assessed via clinician ratings and separate independent objective rating of audio recorded therapy sessions. At the end of each session, the clinician will complete a rating scale specifically designed for the current study. Audio recordings will be rated using a corresponding fidelity scale specifically designed for the current study (i.e. to assess adherence to and competence in approaches to promote awareness, explore experiential avoidance, facilitate engagement in meaningful action; together with evidence based skills/ strategies for BPSD, anxiety and/ or substance use). This scale will be informed by published recommendations (e.g. Plumb & Roger, 2010; McHugh et al., 2009) and existing fidelity measures applied to ‘third wave’ interventions (e.g. Schimmell-Bristow, Bricker & Comstock, 2012). As we are unsure of how this scale will perform, we may also utilise at least one established instrument for assessing fidelity to CBT (e.g. Cognitive Therapy Scale – revised version). All sessions will be rated by an independent assessor masked to study protocol. To maximise masking, the independent researcher will be located off-site. A 20% sample will be re-rated by a second, independent masked-rater for inter-rater reliability.