Elsevier

Journal of Affective Disorders

Volume 171, 15 January 2015, Pages 13-21
Journal of Affective Disorders

Research report
A randomized head to head trial of MoodSwings.net.au: An internet based self-help program for bipolar disorder

https://doi.org/10.1016/j.jad.2014.08.008Get rights and content

Abstract

Background

Adjunctive psychosocial interventions are efficacious in bipolar disorder, but their incorporation into routine management plans are often confounded by cost and access constraints. We report here a comparative evaluation of two online programs hosted on a single website (www.moodswings.net.au). A basic version, called MoodSwings (MS), contains psychoeducation material and asynchronous discussion boards; and a more interactive program, MoodSwings Plus (MS-Plus), combined the basic psychoeducation material and discussion boards with elements of Cognitive Behavioral Therapy. These programs were evaluated in a head-to-head study design.

Method

Participants with Bipolar I or II disorder (n=156) were randomized to receive either MoodSwings or MoodSwings-Plus. Outcomes included mood symptoms, the occurrence of relapse, functionality, Locus of Control, social support, quality of life and medication adherence.

Results

Participants in both groups showed baseline to endpoint reductions in mood symptoms and improvements in functionality, quality of life and medication adherence. The MoodSwings-Plus group showed a greater number of within-group changes on symptoms and functioning in depression and mania, quality of life and social support, across both poles of the illness. MoodSwings-Plus was superior to MoodSwings in improvement on symptoms of mania scores at 12 months (p=0.02) but not on the incidence of recurrence.

Limitations

The study did not have an attention control group and therefore could not demonstrate efficacy of the two active arms. There was notable (81%) attrition by 12 months from baseline.

Conclusion

This study suggests that both CBT and psychoeducation delivered online may have utility in the management of bipolar disorder. They are feasible, readily accepted, and associated with improvement.

Section snippets

Background

In the treatment of bipolar disorder (BD), adjunctive psychosocial approaches (Lauder et al., 2010) have shown utility in terms of improvements in medication adherence (Colom et al., 2009); prevention and delay of relapse (Colom et al., 2003, Castle et al., 2010) and enhanced social and occupation functioning and improved quality of life (Miklowitz, 2008). There is a strong evidence base for adjunctive psychosocial interventions in bipolar disorder (Reinares et al., 2014). Predominant

Methods

Persons aged 18–65 years with a diagnosis of bipolar disorder type I or II, confirmed using DSM-IV-TR (American Psychiatric Association, 2000) criteria via telephone clinical interview, were included. Participants needed access to an internet-enabled computer. The ability to register for the program successfully indicated a level of reading competence; in addition, potential participants were asked whether they had read and understood the plain language statement, and whether they had any

Outcome measures

Outcome measures were chosen to assess change in a wide variety of characteristics of bipolar illness. Measures had to be deliverable by an online format.

The Altman Self-Rating Mania Scale (Altman et al., 1997) is a 5 item scale on which manic symptoms for the previous week are rated from 0 to 4, with higher scores indicating greater symptom severity. At a cut-off score of ≥6 the scale has a sensitivity of 85% in being able to detect the presence of moderate manic symptoms and a specificity to

Procedure

Apart from relapse, all measures were administered at baseline, post-intervention (3 months) and at 6 and 12 month follow up. Questions regarding relapse and medication change were included at the end of the core content modules and at 3, 6 and 12 months. To reduce questionnaire burden, baseline questionnaires were staggered across the first three modules. These staggered questionnaires were administered prior to any content related to the assessment. Measures were administered online with data

Results

A total of 273 people registered their interest in participating in this trial. Of these, 158 agreed to be contacted by the researchers, and were screened by telephone: two were unsuitable, one due to lack of access to a computer, the other due to lack of time. The remaining 156 participants were randomized and received password protected secure access to their allocated program. Participants randomized to the MS group were not aware of the specifics regarding the extra program content

Discussion

This study compared two online interventions for bipolar disorder, one containing basic psychoeducation and asynchronous discussion boards and the other having these same elements with the addition of interactive CBT based tools. The components of both MS and MS-Plus contained the common shared elements found in face-to-face programs noted earlier. The primary hypothesis, that the MS-Plus group would show greater reductions in relapse rates to both depression and mania was not supported by

Limitations

The limitations of this study include the lack of an attention control which could determine the effectiveness of online interventions in the management of bipolar disorder. Consequently, the study compared two very similar internet interventions and found little significant difference between them. A further limitation was that this study attempted to assess MoodSwings in as naturalistic a setting as possible, imposing very few exclusion criteria. Bipolar disorder is a pleomorphic disorder

Conclusion

In summary, this study found that both versions of our online intervention were associated with improvements in symptoms and functionality for people with bipolar disorder. The MS-Plus program, which included an interactive CBT component, was superior to the MS program on mania scores at 12-months relative to baseline. This suggests that online interventions may have potential for the adjunctive management of bipolar disorder. Interestingly, the principal area of difference between the full

Role of funding source

MoodSwings was supported by Beyondblue, the Victorian Center of Excellence in Depression and Related Disorders. This funded the project design, development implementation and analysis. Assistance was also received by Eli Lilly for the statistical analysis.

Conflict of interest

Sue Lauder has received research support from Beyondblue and conference support from Sanofi Aventis.

Andrea Chester has received Funding from the Office of Learning and Teaching.

David J Castle has received Grant Monies Received From: Eli Lilly, Janssen Cilag, Roche, Allergen, Bristol-Myers Squibb, Pfizer, Lundbeck, Astra Zeneca, Hospira; Travel Support and Honoraria for Talks and Consultancy from Eli Lilly, Bristol-Myers Squibb, Astra Zeneca, Lundbeck, Janssen Cilag, Pfizer, Organon,

Acknowledgments

MB is supported by a NHMRC Senior Principal Research Fellowship 1059660. The authors also acknowledge the earlier contributions of Professor Greg Murray and Professor Leon Piterman AM.

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    Clinical Trial Registration: Australian New Zealand Clinical Trials Registry (ANZCTR) Number 12607000118404.

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