Web therapy could be an option for bipolar disorder (Wired UK)


An online platform that helps
people with bipolar disorder self-administer therapy has proven to
be successful in a small trial, with 92 percent of participants saying they found
the content positive.

Nicholas Todd, a psychologist in clinical training at the NHS
Trust, has developed the site as part of a project he’s running
called Living with Bipolar.

In it, he asked 122 people to use a sort of e-learning
environment that uses audiovisual models and worksheets,
incorporating parts of cognitive behavioural therapy and
psycho-education known to be effective in bipolar patients. There’s
also a peer support forum, which is moderated by a member of Todd’s
research team, and motivational emails were periodically sent to
those on the trial.

“Service users were encouraged to access the intervention
flexibly and use it as and when they felt appropriate,” Todd told
Wired.co.uk. That’s because, as he presents in a paper on the platform, for patients “recovery is defined
as people living a fulfilling life alongside their condition”. As
such, it needs to fit in around them, their lifestyle and their
changing needs.

One participant comments: “….for me recovery is certainly not
about being symptom freeā€¦ it is about coping and having a
reasonable quality of life, being able to work productively and
enjoy things outside of work.”

Thus, Todd explains, “service users did not focus on a ‘cure’ as
their desired outcome but instead personally defined recovery goals
and improved quality of life.”

By the trial end, Todd found that on average, users who stayed
till the end completed 60 percent of the programme. Of the people
that completed the whole thing — 15 modules — 74 percent took
under three months to do so.

The platform took a year to develop, spent looking at the most
effective components of psychological therapy for bipolar disorder.
As this was narrowed down, the group carried out five focus groups
and tested it online via a consultancy group.

The system gets users to identify their own mood using an
established scale, the idea being they — and the system — can
track their own ups and downs. “Service users would then receive
information about the most appropriate modules, given their mood
symptoms,” says Todd.

The forum, he says, played a key role in the project’s success.
One participant commented, “…part of it [bipolar disorder] is
feeling very alone… you don’t get that and I do think that the
forum works extremely well with the intervention…” Todd explains
how participants used it to support each other not only through the
new intervention process, but through life events.

“A balance was struck between allowing participants to offload,
and posts which encourage or talk about acts of suicide, self-harm,
harm to others and are unhelpful to participants’ recovery.” A
total of 70 percent of the users signed up to the forum, and 1,927
posts on 130 topics were accumulated. “The participants who used
the forum tended to complete more modules, and all participants who
completed the entire programme used the forum, albeit in different

The idea behind the platform is to help bridge those periods
between appointments, or those appointments that a patient misses.
As with depression, health services can be known to administer
solely medication to help alleviate symptoms. More and more, the
NHS is striving to ensure psychological therapy is integrated
alongside a prescription for mood stabilisers, such as lithium.
“However, severe inequalities in access to psychological
interventions for bipolar disorder currently exist in the NHS,”
Todd says. “This intervention aims to increase access to
psychological intervention.”

Todd tells us the NHS is actively training more staff to deliver
psychological therapy, to plug the gap. For now, that initiative is
being piloted for severe mental health conditions. “This
intervention may fit as part of this initiative in giving service
users with bipolar disorder greater access to psychological

“Computerised interventions are not about replacing face-to-face
interventions, but giving someone another option to receive
psychological support. In fact, some people prefer accessing
psychological support in this way as it fits better with their

For one woman in particular the experience has been, in her
words, “life changing”.

She said: “I have encountered insights in the modules that have
significantly helped me to survive the blackest moments. I cannot
measure the value of this, as it has contributed to their
difference between life and death. My husband and I are sincerely
grateful for the immeasurable impact this has had on our

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15 August 2014 | 11:30 am – Source: wired.co.uk

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