Background: Although multiple qualitative studies have explored participants' experiences of
Behavioural activation (BA) for unipolar depression, none have investigated the experiences
of BA in people with bipolar depression. This is of particular interest because qualitative
studies concerning the experience of receiving therapy ...
Background: Although multiple qualitative studies have explored participants' experiences of
Behavioural activation (BA) for unipolar depression, none have investigated the experiences
of BA in people with bipolar depression. This is of particular interest because qualitative
studies concerning the experience of receiving therapy can help inform the theory of change
underpinning the intervention.
Aim: The purpose of this study was to explore the experiences and perspectives of individuals
with bipolar disorder who received a course of one-to-one BA for bipolar depression. We
sought to explore participants' experience of the effects of BA therapy, both proximally and
distally.
Method: Semi-structured interviews were conducted with nine individuals meeting research
diagnostic criteria for bipolar I or II disorder who had received up to 20 sessions of BA
adapted for bipolar depression. Thematic analysis using a framework approach was used to
explore and describe the experiences of participants.
Results: Participants' perspectives on the impact of therapy were categorized under four
subthemes: client behaviour inside and outside sessions, changes in clients' perspectives, the
impact on symptoms, and impact on life and functioning.
Conclusions: Participants’ accounts of the impact of therapy were broadly consistent with the
theory underpinning a behavioural approach. Participants described a central role for
perspective change, and particularly increased acceptance of the self and mood states, as
facilitating behavioural changes and more distal benefits. Process evaluations embedded in
future trials may include quantitative measures of key processes described by our participants,
as well as those clearly implied by the behavioural theory of depression.
