By Nicholas Todd, Psychologist in Clinical Training at Leeds Teaching Hospitals NHS Trust.
This article is part of our series: a day in the software life, in which we ask researchers from all disciplines to discuss the tools that make their research possible.
People with Bipolar Disorder often have problems gaining access to psychological therapy. Online interventions are an innovative solution to this accessibility problem and are recommended in clinical guidelines for mild to moderate anxiety and depression. These interventions provide round-the-clock, evidence based, self-directed support for a large number of people at a reduced cost to the NHS.
The Living with Bipolar project was funded by Mersey Care NHS Trust and led by myself under the supervision of Professor Fiona Lobban and Professor Steven Jones, from the Spectrum Centre for Mental Health Research, Lancaster University. It was the first randomised controlled trial of an online psychological intervention for Bipolar Disorder to find preliminary evidence that the web-based treatment approach is feasible and potentially effective.
Living with Bipolar is an online, interactive, recovery informed self-management intervention, broadly based on the principles of Cognitive Behavioural Therapy and Psycho-education. This intervention supports people as they learn more about their condition, increases their self-esteem and their knowledge of self-management techniques and increases their knowledge of practical and interpersonal skills to live a fulfilling life alongside their condition.
The intervention includes ten audio-visual interactive modules. These comprise of interactive worksheets and a mood checking tool, case studies and worked examples, the latter written by other service users with Bipolar Disorder. The intervention was supported by a peer forum moderated by a member of the research team, and participants also received regular motivational emails.
The randomised controlled trial compared 122 participants with a diagnosis of Bipolar Disorder. Participants were randomly assigned to either Treatment as Usual (TAU), or TAU plus the Living with Bipolar intervention. The trial ran for six months, with outcomes assessed three months in and at the end. Retention rates were high with 88% of participants in the intervention group and 92% of participants in the other group remaining in the trial. On average, participants engaged with 60% of the programme with 92% of participants finding the content effective and 81% who found the interface useful. A robust statistical analysis demonstrated medium treatment effect sizes for physical and psychological quality of life, wellbeing and recovery outcomes.
Participants found the intervention to be accessible, practical and recovery-focussed, with a flexible interface allowing participants to take responsibility for their own wellbeing. They said the peer support forum was very supportive and that it helped keep them engaged with the intervention. They also felt more confident about their condition and were more able to use mood management techniques and make the most out of services. Therapeutic gains included improved stability, being better able to access additional help from friends and family, less reliance on services and a greater willingness to turn to self-management.
A randomised controlled trial is now needed to assess the effectiveness of the Living with Bipolar intervention. It would investigate the validity of this approach for people in traditional NHS settings and who do not routinely access the internet for self-help, and the consideration of potential clinical risks would furthermore support the intervention.