Table 1 The CCC framework with interventions
Treatment obstacles identified | Potential interventions |
|---|---|
Capability | |
 Struggle to maintain identity | - Support social and professional functioning - Psychotherapy to challenge feelings of inadequacy |
 Meaningful employment | - Cognitive remediation - Potential pharmacology targeting cognitive impairments - Address residual depressive symptoms and side effects of medication - Career support services |
 Loss of relationships | - Family-focused therapy - Caregiver support - Social skills training - Interventions that address comorbidities - Earlier intervention |
 Unpredictable nature of disorder | - Access to care, medicine and psychotherapy services to improve symptom control |
Comfort | |
 Perception of diagnosis as indeterminate and unscientific | - Providers must acknowledge patient’s experience of misdiagnosis and heterogenous nature of bipolar disorder - More research focusing on biomarkers and risk factors for bipolar disorder - Robust psychoeducation - More time with providers |
 Social stigma—lack of public awareness and education | - Increase public education - Collaborative patient-clinician discussions to develop trust and acknowledge patient experiences |
 The trials of medication | - Evidence-based treatment - Clearer medication guidelines and mental health research for prescribers - Increased public education - Realistic and trusting patient-clinician collaborations about medication decisions |
Calm | |
 Dismissive doctors | - Increased time and better communication with providers - Holistic support from social workers and mental health support teams to cover limitations in clinician availability |
 Finding the right psychotherapist | - Improved support to navigate psychotherapy in clinic - Institutional changes to mental health care in the United States to reduce obstacles to treatment - Train more psychologists to cover shortages |
 Financial burden | - Early intervention prior to more severe outcomes and treatment costs - Employers and providers provide social service and insurance support - Increased local and federal support - Consider disparities in education, geography and income when providing financial support and assistance |