Augmenting psychoeducation with a mobile intervention for bipolar disorder: A randomized controlled trial

Abstract

Background Psychosocial interventions for bipolar disorder are frequently unavailable and resource intensive. Mobile technology may improve access to evidence-based interventions and may increase their efficacy. We evaluated the feasibility, acceptability and efficacy of an augmentative mobile ecological momentary intervention targeting self-management of mood symptoms. Methods This was a randomized single-blind controlled trial with 82 consumers diagnosed with bipolar disorder who completed a four-session psychoeducational intervention and were assigned to 10 weeks of either: 1) mobile device delivered interactive intervention linking patient-reported mood states with personalized self-management strategies, or 2) paper-and-pencil mood monitoring. Participants were assessed at baseline, 6 weeks (mid-point), 12 weeks (post-treatment), and 24 weeks (follow up) with clinician-rated depression and mania scales and self-reported functioning. Results Retention at 12 weeks was 93% and both conditions were associated with high satisfaction. Compared to the paper-and-pencil condition, participants in the augmented mobile intervention condition showed significantly greater reductions in depressive symptoms at 6 and 12 weeks (Cohen's d for both were d=0.48). However, these effects were not maintained at 24-week follow up. Conditions did not differ significantly in the impact on manic symptoms or functional impairment. Limitations This was not a definitive trial and was not powered to detect moderators and mediators. Conclusions Automated mobile-phone intervention is feasible, acceptable, and may enhance the impact of brief psychoeducation on depressive symptoms in bipolar disorder. However, sustainment of gains from symptom self-management mobile interventions, once stopped, may be limited.

A systematic review of the psychometric properties, usability and clinical impacts of mobile mood-monitoring applications in young people

“…There is also evidence for usability (Bardram et al 2013). Participation rates are generally high across studies sampling adults, ranging from 65% (Depp et al 2015) to 88% , though Depp et al (2012) reported much higher completion rates for paper and pencil compared with app measures (82.9% v. 42.1%). Evidence also suggests that apps may help people with mental health problems to monitor triggers (Bardram et al 2013), that the capacity to convey experience can be therapeutic, and that apps could be a useful tool for improving patientclinician communication .…”

Engagement Strategies for Self-Monitoring Symptoms of Bipolar Disorder With Mobile and Wearable Technology: Protocol for a Randomized Controlled Trial (Preprint)

“…Our study app was simple in its design: users can log, review, and visualize their mood. This simplicity ensures study results will generalize to the wealth of mobile and wearable technology developed for BP [12][13][14][15][16][17][18][19], translating into better technology for individuals with BP to monitoring symptoms.…”

“…Increasingly, BP symptoms are being monitored passively through sensors on smartphones and wearable devices [12][13][14][15][16][17]. Smart-phone platforms MONARCA (MONitoring, treAtment and pRediCtion of bipolAr Disorder Episodes) [18] and PRIORI (Predicting Individual Outcomes for Rapid Intervention) [19] predict mood from patterns of speech and behavior from recorded calls, number of phone calls, and phone call duration.…”

Is a SIMPLe smartphone application capable of improving biological rhythms in bipolar disorder?

“…Nonetheless, some of the remaining questions that need to be solved regarding online interventions are the long-term engagement and the sustained effect of these approaches; especially, whether self-monitoring is modifying behaviour per se -as has been shown with other psychosocial interventions-or whether it is just a short-term Hawthorne like artefact (Colom et al, 2009;Depp et al, 2014;Hidalgo-Mazzei et al, 2015a;McCambridge et al, 2014;Torous et al, 2016). For instance, Depp et al evaluated an add-on psychoeducation program using a mobile intervention.…”

“…For instance, Depp et al evaluated an add-on psychoeducation program using a mobile intervention. The authors reported an initial improvement at 6 and 8 months regarding depressive symptoms in the active group but unfortunately the effect did not remain significant after 24-months follow-up (Depp et al, 2014). However, there is still an ongoing discussion about the duration that these interventions should have, as well as the best methods to retain patients in long-term online interventions (Morrison et al, 2012).…”