Background and Aims: Mental Health Advance Directives (MHADs) are potentially useful for Bipolar patients due to the episodic characteristic of their disease. Interest for the development of a Cognitive Behavioural Therapy (CBT) approach in MHAD creation process arises due to a lack of efficiency of non collaborative process, potential impact of psychopathology and awareness of illness in MHADs content, link of patient's directives interest with the case manager interest, and the lower interest reported by the potentially high MHADs beneficiary. CBT intervention here proposed in MHAD creative process bases itself on: The self determination model for adherence, the cognitive representation of illness model and Concordance.
Methods: The principles of the intervention were adapted from Motivational interviewing's (MI) emphasising personal choice and responsibility, and focusing on patient's concerns about treatment through Socratic dialogue.
Results: During the course of 2004, 20 advance directives written by patients (17 with bipolar disorder, three with schizoaffective disorder) have been collected following the described intervention.
Conclusions: Despite the presented preliminary feasibility data of this cognitive collaborative approach focusing on MHAD, its effect remain to be demonstrated. Controlled prospective studies are needed.