Web-based psychological self-help may aid bipolar patients

By Joanna Lyford, Senior medwireNews Reporter

A web-based self-management programme appears to be feasible and may be effective as an intervention for people with bipolar disorder.

In a randomised controlled trial, patients enrolled in the “Living with Bipolar” programme had a greater improvement in psychological and physical domains of quality of life, wellbeing and recovery than those receiving usual care.

The researchers say that the trial “was not definitive and requires further investigation” but note that such interventions could potentially help to improve access to psychological therapies.

“Web-based self-management interventions have the potential to improve equality of access in cost-effective ways”, write Nicholas Todd (Spectrum Centre for Mental Health Research, Lancaster University, UK) and co-authors in the Journal of Affective Disorders.

“Such interventions offer round the clock access and are aimed at fostering existing coping skills and empowering people to take control of their own condition.”

Todd’s group recruited 122 patients with a self-reported clinical diagnosis of bipolar disorder and randomised them to either the “Living with Bipolar” programme or to treatment as usual.

The “Living with Bipolar” programme is an online interactive recovery-informed self-management intervention, broadly based on the principles of cognitive behavioural therapy and psychoeducation. It comprises 10 interactive modules as well as worksheets, a mood checking tool, regular support emails and access to a forum and discussion boards.

Retention in the trial was high, with 88–92% of participants remaining at the end of the 6-month study period. The participant’s mean age was 43.4 years, 72% were female, 70% percent had bipolar I disorder, 76% were taking medication and 39% had accessed psychological support previously.

Although the study was not powered to demonstrate efficacy, analysis at 6 months showed that participants who accessed “Living with Bipolar” improved more than controls on most outcomes. Quality of life – in particular physical and psychological quality of life – recovery, perceived conflict, wellbeing, depression and social function all improved significantly more with the intervention than with usual care.

Interestingly, medication and service use generally declined during the trial period in the intervention group and increased with usual care.

Todd’s group says that the trial provides preliminary evidence that a web-based treatment approach in bipolar disorder is “feasible and potentially effective”.

They write: “This intervention could feasibly deliver an evidence-based psychological intervention to a large number of people with BD and has the potential to be part of the stepped care pathway in the [Improving Access to Psychological Therapy] initiative for severe mental health problems.”

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