The main goal in treating bipolar disorder is usually to lengthen time between episodes. While that is a good and necessary goal, it ignores a significant portion of the person’s life. Bipolar disorder does not just consist of having symptoms. It also consists of the responses to those symptoms and how a patient is able to cope in life. This is called psychosocial functioning. How a person functions in life is not always congruent with their symptoms, so it is important to treat both areas. Functional remediation has been found to have a long-lasting effect in helping people with bipolar disorder increase their psychosocial functioning.
When measuring psychosocial function, experts look at six areas using the Functioning Assessment Short Test (FAST).
1 Autonomy– Can you live alone and take care of yourself?
2 Occupational functioning– Can you hold down a full or part-time job and do so well?
3 Cognitive functioning– How good are you in areas like memory, attention, learning and problem solving?
4 Financial issues– Can you manage your own money and stick to a budget?
5 Interpersonal relationships– Do you have meaningful, satisfying relationships with friends and loved ones?
6 Leisure time– Are you physically active? Do you participate in interests or hobbies?
There are 24 items scored on the FAST, with each question rated on a 0-3 scale. The higher the score, the less functional the person is likely to be. People are considered high-functioning if they score well in most of these areas. Note that some medications for bipolar disorder can negatively affect cognitive functioning, and therefore increase the FAST score to an extent.
Functional remediation is essentially therapy to improve psychosocial functioning. It involves educating patients and their families about the effects of bipolar disorder on cognitive function and how it may impact their daily lives. It then provides strategies on how to manage and cope with these issues. It is done in 21 weekly sessions that last 90 minutes, usually in a group setting. There are also online versions.
There are three sessions involving just psychoeducation pertaining to bipolar disorder and functioning. Then there are two sessions focused on attention, followed by six sessions on memory and ways to improve it. Then there are five sessions on cognitive dysfunction. These focus on time management, problem solving, planning and establishing priorities. The remaining sessions focus on communication skills, interpersonal relationships, autonomy and stress management.
All sessions are based on real-world situations and how patients can implement them in their daily lives. There are group tasks, role-playing and even homework assignments.
Multiple studies have shown that functional remediation is beneficial to patients not just in the short-term, but for at least one year out. Most recently, Jose Sanchez-Moreno of the University of Barcelona and his team studied 99 patients to find the effectiveness of functional remediation. Thirty-three patients underwent functional remediation, 37 received only psychoeducation and the other 29 received treatment as usual (medication, for example).
Six months after completing the initial study, those who underwent functional remediation saw an improvement of 9 points on the FAST scale. Those who had psychoeducation improved by about two points and those who underwent treatment as usual stayed approximately the same. The improvement for the functional remediation group was still seen after twelve months.
Interestingly, the subjects in the study did not show any improvements in overall symptom severity, even with improved FAST scores. This shows that functioning can improve even when symptoms do not.
If you or a loved one are having problems with social functioning, it may be beneficial to try functional remediation. Keep in mind that it is not meant to be a substitute for medication, but rather to complement it.
Image credit: jinterwas