Dr. Jamie Livingston presents findings from a CREST.BD study evaluating a theatrical performance as an intervention for reducing mental illness stigma. Dr. Livingston describes details of the research design and the preliminary findings from the study's two target audiences, healthcare providers and people living with bipolar disorder. Originally presented at the Mental Health Commission of Canada's Together Against Stigma conference in Ottawa, Ontario on June 5th, 2012. Victoria Maxwell also performed her one woman stage play 'That's Just Crazy Talk' a theatrical performance which is the focus of this research.

1. Portraying Life Lived with Bipolar Disorder:
Evaluation of a Contact-
Based Theatrical
Performance
Jamie Livingston, Ph.D.
Erin Michalak, Ph.D.
Sagar Parikh, M.D., F.R.C.P.C.
Victoria, Maxwell, B.F.A.
Vytas Velyvis, M.A.
Sharon Hou, B.A.

2. Intervention
• 1-hour theatrical performance.
• Designed and delivered by Victoria Maxwell, a woman who
lives with bipolar disorder.
• Uses dramatic narrative to portray life lived with bipolar
disorder and stigma.
• Performed to a mixed audience in Vancouver and Toronto,
Canada.

3. Design
People with Bipolar Healthcare Service
Disorder Providers
T1 (Pre) DMISS, ISMI DMISS, MICA-4
Intervention Intervention
DMISS, ISMI DMISS, MICA-4
T2 (Post) Process Evaluation Process Evaluation
DMISS , ISMI DMIS, MICA-4
T3 (3 months)
Qualitative Qualitative
Interview Interview
DMISS: Day’s Mental Illness Stigma Scale (Day et al., 2007)
MICA: Mental Illness: Clinicians’ Attitudes Scale – Version 4 (Kassam et al., 2010)
ISMI: Internalized Stigma of Mental Illness (Ritsher et al., 2003)

4. Sample Items
• DMISS (7-point scale, 28 items, 7 subscales and total score)
– I don’t think it is possible to have a normal
relationship with someone with bipolar disorder.
• MICA-4 (6-point scale, 16 items, total score only)
– Working in the mental health field is just as
respectable as other fields of health and social care.
• ISMI (4-point scale, 29 items, 5 subscales and total score)
– I feel out of place in the world because I have a
mental illness.

5. Participants
People Service
with BD Providers
(N = 80) (N = 84)
Gender, % women 84% 71%
Years of age, M (SD) 42.4 (12.2) 40.2 (12.9)
Performance location
Vancouver 70% 64%
Toronto 30% 36%
Seen Victoria Maxwell
16% 24%
perform before, % yes

7. Learned something new?

8. Emotional impact on you?

9. Could this performance change public
acceptance of bipolar disorder?

10. Summary: Evaluation
The intervention was perceived positively by the
large majority of audience members.

12. Change in Attitude among People with
Bipolar Disorder: DMISS
T1 T2
DMISS (α=0.88) M SD N M SD N Repeated t-test d
Treatability 2.48 1.16 80 2.33 1.19 80 t(79)=1.61, p>0.05 0.17
Relationship 3.22 1.23 80 3.00 1.22 80 t(79)=2.42, p<0.05 0.27
Hygiene 2.44 1.30 80 2.35 1.36 80 t(79)=0.98, p>0.05 0.11
Anxiety 1.97 0.99 80 1.97 0.99 80 t(79)=0.03, p>0.05 0.00
Visibility 3.57 0.80 80 3.68 0.85 80 t(79)=-1.10, p>0.05 0.14
Recovery 3.59 1.87 80 3.58 1.95 80 t(79)=0.69, p>0.05 0.07
Professional 3.18 1.52 80 2.99 1.53 80 t(79)=1.39, p>0.05 0.15
efficacy
TOTAL 2.79 0.74 80 2.70 0.80 80 t(79)=1.76, p>0.05 0.19
DMISS: Day’s Mental Illness Stigma Scale (Day et al., 2007)

13. Change in Attitude among People with
Bipolar Disorder: ISMI
T1 T2
ISMI (α=0.94) N SD N M SD N Repeated t-test d
Alienation 2.35 0.70 78 2.23 0.77 78 t(77)=2.61, p<0.05 0.31
Stereotype 1.55 0.45 77 1.56 0.45 77 t(76)=-0.48, p>0.05 0.04
Discrimination 2.20 0.63 75 2.24 0.72 75 t(74)=-0.61, p>0.05 0.08
Withdrawal 2.04 0.68 79 2.05 0.75 79 t(78)=-0.32, p>0.05 0.02
Resistance 2.02 0.61 77 1.93 0.58 77 t(76)=1.14, p>0.05 0.14
TOTAL 2.01 0.49 75 1.98 0.55 75 t(74)=1.00, p>0.05 0.13
ISMI: Internalized Stigma of Mental Illness (Ritsher et al., 2003)

14. Summary: People with BD
The intervention produced limited overall change in
attitudes among people who live with bipolar
disorder.
Small to medium effects were observed:
 Improved beliefs about the potential of having a
positive relationship with a person who has bipolar
disorder.
 Decreased subjective feelings of being devalued by
society as a result of bipolar disorder.

16. Change in Attitude among Healthcare
Providers: DMISS & MICA-4
T1 T2
DMISS (α=0.87) M SD N M SD N Repeated t-test d
Treatability 1.74 0.76 84 1.52 0.54 84 t(83)=2.94, p<0.01 0.32
Relationship 2.38 0.99 84 2.06 0.94 84 t(83)=4.35, p<0.001 0.48
Hygiene 1.93 0.99 84 1.67 0.87 84 t(83)=3.42, p<0.01 0.37
Anxiety 1.72 0.89 84 1.60 0.82 84 t(83)=2.14. p<0.05 0.24
Visibility 3.40 0.84 84 3.40 0.83 84 t(83)=0.01, p>0.05 0.00
Recovery 2.55 1.31 84 2.20 1.38 84 t(83)=2.44, p<0.05 0.27
Professional 2.74 1.35 85 2.53 1.32 85 t(83)=1.78, p>0.05 0.20
efficacy
TOTAL 2.26 0.63 84 2.07 0.61 84 t(83)=5.55, p<0.001 0.58
MICA-4 (α=0.66) 30.6 6.5 82 29.8 6.7 82 t(81)=1.56, p>0.05 0.17
DMISS: Day’s Mental Illness Stigma Scale (Day et al., 2007)
MICA: Mental Illness: Clinicians’ Attitudes Scale – Version 4 (Kassam et al., 2010)

17. Summary: Healthcare Providers
• The intervention produced medium to large effects.
• Statistically significant and pragmatically meaningful
improvements in attitudes among those who provide
healthcare services to people with bipolar disorder
were achieved.

18. Conclusion
 The study findings support the inclusion of
the creative arts and contact-based
approaches in strategies that seek to foster
positive attitudes among healthcare
providers toward people with bipolar
disorder.