Treatment Implications Psychoeducation and monitoring

The BAS theory claims that bipolar individuals are particularly susceptible to biobehavioural dysregulation, and therefore deliberate regulation of behaviour patterns may limit periods of vulnerability. Current therapy packages for bipolar affective disorder often adopt a diathesis-stress model (e.g., Lam et al., 1999; Scott, 2001) and teach clients the importance of having a balanced lifestyle and ensuring regularity of social routines in order to minimise sleep disruption, as keeping regular sleeping patterns and daily routines appears to be very important for bipolar patients (Wehr et al., 1987). Having knowledge of what may trigger an illness episode can lead to establishing a routine in daily living that avoids excessive stress and limits mood swings. Prediction, anticipation and prevention of any disruption in routine and sleep by stressors such as life events can be an important aspect in the psychosocial management of bipolar affective disorders.

Periods of BAS over- or underactivity would appear to constitute risky periods, despite the fact that clear symptoms of hypomania or depression may be absent at this stage. Therefore, a first step would be to monitor mood level in order to identify such periods. While mood and activity diary-keeping already form a part of existing therapy packages, the BAS theory suggests that monitoring should also take into account the status of BAS outputs such as level of motivation, optimism, physical restlessness and speed of thought. In fact, these are common prodromes of bipolar disorder, as measured by spontaneous self-report (Lam & Wong, 1997).

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