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14.5 How research needs to change There are a number of problems with the exclusive use of randomised controlled trials as the basis for evidence based practice (Pilgrim, 1997). Such methods provide useful information about doing the same thing (e.g. giving medication) to groups (e.g. people with a diagnosis of ‘bipolar disorder’). They are particularly suited to testing interventions which fit this ‘black box’ model, in which the treatment given is always the same, and in which groups of people with a diagnosis of bipolar disorder are regarded as being in all relevant respects identical. This type of research ignores individual variation. Studies, therefore, actively discount the experience of service users, are based on diagnostic groups which are of questionable validity, and when used to investigate talking therapies often involve testing a poor analogue of what will be possible in routine mental health services. The issue of funding for research is also important. Traditionally, drug companies have funded much research into ‘bipolar disorder’ (Bregin, 1983), which raises several important issues. Firstly, this research has often been based on the assumption that the tendency to experience extreme mood states is primarily a biological phenomenon. As this report has demonstrated, both this assumption and also the view that everyone who has a diagnosis of bipolar disorder needs to take medication long term, are increasingly being challenged. A second issue surrounding drug company funding is one of reliability and bias of findings. In recent years, concerns that studies funded by drug companies are more likely to report positively skewed findings have been supported by a number of studies (AlsNielsen et al., 2003; Bhandari et al., 2004). Although the National Institute for Health Research is beginning to fund drug studies independent from drug companies, there remains an urgent need for expansion of such alternative sources of funding. Given the inherent imbalance in research funding for biologically-based research (from drug companies) compared to other areas of research, the evidence presented in this report implies a need to focus more research funding on psychological approaches to extreme mood states. 14.6. How professional training needs to change Perhaps even more important than the availability of specific talking treatments is the need for all mental health workers to be aware of the information contained in this report. Many workers are unaware of the psychological perspective on extreme mood states, and are unfamiliar with the research described in this report. A fundamental message of this report is that extreme mood states are understandable in the same ways as ‘normal’ mood states, and can be approached in the same way. In the above introductory section, we noted that bipolar disorder is not an easy fit in services designed to work mainly with more persistent, rather than episodic problems. Similarly, counsellors and psychologists working in primary care or in secondary care psychological services often lack training in working with people with a diagnosis of bipolar disorder. Trusts must begin to roll out training, and to provide supervision and set-aside clinical time with alacrity. Making use of the information presented in this report, such training should not be focused primarily on specific skills but on attitudes and beliefs about what causes some people to experience extreme moods, and what can help. A culture change is needed in

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Understanding Bipolar Disorder

Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...

Understanding Bipolar Disorder  

This report was written by a working party of clinical psychologists who were chosen because of their particular expertise on the subject of...