Q:  Reader Asks About Tom Whooten's Bipolar in Order Program

Dear Dr Phelps,

I was wondering if you have heard about the work of Tom Whooton and his Bipolar In Order workshops.  He wrote the book, "The Bipolar Advantage" but his work now includes so much more, it is constantly evolving.  It is one of many things including proper meds and therapy that has helped me.  I believe he provides excellent positive augmentation for recovery (for some!) ESPECIALLY because it is a well thought out peer run support program.  What do you think and why do you think most doctors and therapists are SOOOO skeptical?!!!
               

Dear Ms. S. --

Thank you for raising this question. I was aware of Tom Whooten's book, though I have not read it. Your question prompted me to look over the website he has developed, which explains some about the workshops he runs, and the book. On the basis of the quick look, I think we could be certain that there are at least some very useful ingredients in his material. If I am understanding correctly, he emphasizes acceptance and introspection (his terms), and for most people -- indeed whether they have bipolar disorder or not -- these are likely to be helpful.

Just as for a medication, I approach a technique such as these workshops looking for evidence that they are beneficial, and also looking for ways in which they might be harmful. In the case of the latter, because his approach seems to assume that people will be in treatment, and he is augmenting that treatment, and his technique does not seem to go directly against conventional treatments as far as I can determine in this brief look, I would say initially that he does not appear to be running a risk of harm. Therefore, as long as participants did not find participation too expensive (the book, for example, is quite inexpensive), then any benefits, even if they were relatively minimal, might indeed justify participation. In other words, if risks are near zero, there is less pressure to demonstrate that the benefits are substantial. I look at fish oil in the same way: although the evidence for benefit is rather slim (multiple studies, but few, perhaps only one, showing a degree of benefit that warrants clinical attention), the cost is relatively low and the evidence for risk seems minimal; indeed, there are other potential health benefits which are possible, such as a reduction in cardiovascular risk.

My only concern is that people might emphasize participation in his method rather than looking for one of the other bipolar-specific psychotherapies that have emerged recently that actually have some solid evidence for their efficacy. These include bipolar-specific cognitive behavioral therapy; interpersonal and social rhythm therapy; and family focused therapy -- further information on each being available on my website page about psychotherapy and bipolar disorder. Each of these methods has been tested against a placebo condition and found superior in short-, and in some cases long-term outcome.

To my knowledge, the Bipolar in Order workshops, and his book, have not been subjected to that kind of research approach. His method sounds good, but at the same time one should keep in mind one of the quotes he posts on his website:

          "However beautiful the strategy, you should occasionally look at the results."- Sir Winston Churchill

Nevertheless, from what I can see in the description of his approach I can imagine that for some people it would be tremendously helpful. As you point out, it also has the advantage of coming from the grassroots organizations which have worked for years to better the lives of people who suffer from bipolar disorder (The National Alliance for the Mentally Ill and the Depression and Bipolar Support Alliance). I have great respect for what these organizations have done, and are doing.

Therefore, I would not want to leave you with the impression that I am negative, overall, on the Bipolar in Order program. At the same time, just as with any treatment being offered, I think it deserves to be approached with some caution and an inclination to look for evidence of its effectiveness, as well as for any possible potential harm. This is especially warranted when someone is making money selling books or workshops. Mind you, the same caution should be applied to anything I am doing, as I also sell books and conduct workshops for which I receive honoraria.

Dr. Phelps