Patient experiences of behavioral activation therapy for bipolar depression : a qualitative study

Abstract

Bipolar depression remains a significant, unresolved challenge in terms of effective treatment. Behavioural activation (BA) has emerged in recent years as a favourable therapeutic option for unipolar depression, both from the perspective of cost and efficacy. However, limited research exists on the feasibility of BA specifically for bipolar depression. Existing indications are promising, yet a deeper exploration of bipolar patients’ experiences and perceptions is required to advance BA as a therapeutic approach for this population. This study aimed to explore the experiences of individuals with bipolar disorder following BA treatment, with a particular focus on their perceptions of the therapy’s acceptability and change mechanisms. Qualitative semi-structured interviews were conducted with seven participants and analyzed using reflexive thematic analysis. Overall, participants reported satisfaction with BA, appreciating its simplicity, flexibility, and the concrete techniques they could apply independently after therapy. The therapeutic alliance was seen as crucial for engagement, with therapists viewed as trusted figures who provided support and encouragement. Homework was generally perceived as the main barrier to treatment, with participants finding it burdensome due to its considerable amount, frequency, and time-consuming nature. In line with BA’s rationale, participants primarily described therapy bringing about behavioral changes, although cognitive changes were also acknowledged. Gaining empowerment was widely reported, characterized by an increased sense of control and confidence in managing both their condition and daily life. Aligned with the goals of the intervention, therapy was seen as promoting more stable mood states in participants. This study contributes to the growing, though still limited, research on BA for bipolar depression, supporting the idea that BA is a feasible and potentially effective intervention for this population.