Yes, to answer about 'Maintaining Factors'.
I must emphasise that this is about symptoms in general and is in no way
about Bipolar Disorder specifically.
Having said this I've been really interested reading this forum about the views about Bipolar. There seem to be two points of view - that it is so 'biological' that people just have to accept their situation, and those who believe that the outcomes
of Bipolar can be ameliorated by choices the individual can make in how they manage their lives and how they regard what happens to them in their daily lives.
Cos, I don't want to
breeze in with my naive theories and learning (but see my signature below) and tell you all how it is. But I am struck by how much of what is written on the forum does tie directly in to the cognitive-behavioural model of health. Those doubting this just consider how much you affect others/the world when you are asleep! Not very much - and what is missing when you are asleep... er conscious thought.
So this is the bit about maintaining factors and also inventories - all my own words
, not blagged off the net.....
‘Maintaining factors’ is the description in CBT given to the mechanisms that keep people in the situation of distress they are experiencing.
A common maintaining factor is an individual’s thought patterns. For example, negative automatic thoughts sustain depression - ‘I can’t face today so I’ll stay in bed, but staying in bed leaves me feeling useless (automatic thought = ‘I can’t even get out of bed so I must be really useless!’). So I really can’t face the day because I’m so useless and I will stay in bed.
Maintaining factors can provide a main starting point for therapeutic work. Making sense of the mechanisms of the client’s symptom maintenance can be seen as part of the collaborative educative process - the process of curiosity - of CBT, and understanding maintaining factors gives the client some choices in making changes. This empowerment is itself therapeutic.
Working with maintaining factors gives an opportunity to increase trust and rapport between therapist and client because the client feels their problems are being understood.
Addressing maintaining factors allows symptom reduction to occur, which allows the client to be more psychologically and physically available to work on issues they are concerned about.
An example of working with maintaining factors
A depressed client might give responses such as the following–
Thoughts: I’m useless, what’s the point in doing things, the phone call will be bad news. These are all ‘automatic thoughts’.
Feelings: I am tired of what’s happening (angry/frustrated), sad, lonely. These are all emotions.
Behaviours: I don’t get out of bed, I don’t answer the phone, I carry out acts that isolate me. These are all behavioural responses to emotions.
The therapist’s intervention is to draw these comments out in the form of a thoughts/feelings/behaviours triangle, and to deconstruct this picture the client portrays, for example, by asking the question:
‘As a client what do you get from the behaviour, for example, of not getting out of bed on the day?’
The client might reply:
’I don’t have to face up to things I can’t handle, but also I don’t think I feel any better for this, in fact I feel worse.’
The treatment protocol could make a switch at this point from a focus on affect to considering the behavioural aspect of the client’s situation, the ‘staying in bed’. The therapist might propose a ‘behavioural experiment’ that the client undertakes in the following week, before the next session:
‘What might be the effect of getting out of bed when you feel ‘depressed’?’
‘I wouldn’t feel so bad about myself – so useless – and it might
not be as bad as I thought it was going to be.’
Although this example is given in a very simplistic
form, it demonstrates the principle that understanding maintaining factors sustaining the client’s symptoms, i.e. feelings and behaviours, gives an effective entry point for the therapist to create choices for and relieve symptoms of the client.
It remains central to all forms of working in the CBT model that the process stays user-centred, and follows the client’s aims and goals rather than the therapist’s agenda in the situation.
Inventories are questionnaires that enable clients to give graded responses to specific questions about the symptoms they may be suffering, for example, depression or anxiety. This enables the client and therapist together to assess the severity of individual aspects of the client’s concerns, and to establish a benchmark for how much their issues are affecting them.
Inventories are helpful because they highlight the more important issues in a person’s symptoms and they also act as a measure of their change across sessions of treatment. Inventories also play an important role in research into mental health problems by giving ‘hard’ i.e. objective, information in controlled circumstances.
There are many specialised psychological/psychiatric inventories, amongst them the following commonly used examples:
Beck Depression Inventory
Beck Anxiety Inventory
HADS Inventory – Hospital Anxiety and Depression Scale. This is frequently used in NHS hospital admissions as a quick initial assessment tool.
DASS Inventory – Depression Anxiety Stress Scale. This is useful because it gives a measure of the stress the client/patient feels themselves to be under.
CORE IMS The CORE System (Clinical Outcomes for Routine Evaluation) has been designed in the UK for use in psychotherapy, counselling and other psychological therapies to measure outcome and provide for service audit, evaluation and performance management (to quote from the website homepage).
That's all folks! Back to my cave.