In the early 1990s Mark S. Bauer, MD, Linda McBride, MSN, and colleagues identified a variety of unmet needs and untapped opportunities in treating individuals with bipolar disorder. Specifically, it became clear that many individuals did not respond well to treatment not because of some putative disease factors, but because they had difficulty with managing their symptoms and participating in treatment. The sources of these difficulties were many, but it was clear that the traditional biomedical model, in which a skilled and altruistic clinician delivers treatment to a relatively passive and cooperative recipient, described only a minority of treatment scenarios—and that this was true not only for bipolar disorder and other mental health conditions, but also for medical disorders in general regardless of how apparent the biomedical cause. Purely biological treatments, without appropriate psychosocial supports, are either ineffective or impossible to implement. The “biopsychosocial” model was originally described by George Engel over 30 years ago, and has come to be increasingly reflected in a variety of care management strategies for medical illnesses.
The Life Goals approach was developed with the assumption that biology is not destiny; that is, the outcome of an individual’s illness depends not only on the biological (or psychological) factors associated with the illness itself, but also on the individual’s ability to manage those symptoms within their environment.
In order to provide optimal care, the content of Life Goals had to be augmented throughout the years, addressing in greater depth psychiatric comorbidities, in particular:
- anxiety and substance use disorders
- coping strategies for depression and suicide
- complications of mania and depression such as anger, irritability, and psychosis and cardiovascular risk and related physical wellness issues.
The development of the Life Goals self-guided workbook, Overcoming Bipolar Disorder, provided the opportunity to develop these additional topics more fully. The self-guided format lent itself easily to a modular approach through which an individual using the workbook could complete the core modules on goals, values, and illness management, and then select the specific modules relevant to him or her (e.g., more cognitive or behavioral work on depression and anxiety, help with smoking cessation or nutrition, strategies for dealing with psychosis). We have further expanded the utility of the program by adding more topics and creating a user-friendly website to guide the Life Goals provider and individual in customizing his or her program.