Internet Psychotherapy for Bipolar Disorder in Primary Care
Condition: Bipolar Disorder
MeSH terms: Bipolar Disorder
Study type: Interventional

Summary: 
      The investigators will conduct a small pilot study to test the feasibility and acceptability
      of treating bipolar disorder (BP) in primary care with online psychotherapy delivered both
      with and without telephone, text, and email support from a clinical helper (CH). The ultimate
      goal of this work is to provide preliminary data needed to design a larger scale
      effectiveness study of online psychotherapy for treating BP in primary care.
    

Detailed description: 
      Over a third of individuals with bipolar spectrum disorders (BP) are treated exclusively in
      primary care settings, and yet, primary care providers (PCPs) are ill-equipped to manage this
      complex and disabling illness. Medications, which can be prescribed by PCPs, hasten recovery
      from illness and improve long-term course of illness for those with BP, but relapse and
      residual symptoms are common when individuals are treated with pharmacotherapy alone. Best
      practices treatment for BP includes adjunctive, BP-specific psychotherapy as a key element of
      effective care. And yet, evidence-based BP-specific psychotherapies that engage and modify
      targets specific to BP are typically unavailable in primary care settings. Online
      interventions have the potential to overcome barriers to accessing evidence-based
      psychosocial treatments for BP in primary care. In other settings and with other populations,
      effectiveness of online interventions improved when human support/coaching (clinical helpers;
      CH) via text, email, and telephone was added to the intervention. Interpersonal and Social
      Rhythm Therapy (IPSRT) is a BP-specific psychotherapy that uses a problem-solving approach to
      help individuals regularize their social rhythms in order to entrain underlying disturbances
      in circadian and sleep/wake regulation, factors that are increasingly recognized as playing
      important roles in the pathogenesis of BP. Its primary behavioral target is regularity of
      daily routines such as sleep/wake cycle and mealtimes. This construct is measured by the
      validated Social Rhythm Metric (SRM). The current project seeks to develop and conduct
      initial testing of an online version of IPSRT (i-IPSRT) for use in primary care. We will (1)
      evaluate the feasibility and acceptability of supported and unsupported online psychotherapy
      interventions for BP in primary care (i-IPSRT and i-IPSRT plus CH) compared to Control
      Condition (CC), (2) examine whether i-IPSRT and i-IPSRT + CH engages its primary behavioral
      target as measured by the SRM, and (3) explore the impact of i-IPSRT, i-IPSRT + CH, and CC on
      symptoms and functioning over 12 weeks. Information from this study will inform a larger
      trial to test the effectiveness of these approaches in primary care. The public health impact
      of developing an effective, technology-enabled approach to delivering evidenced-based
      psychotherapy that targets specific, modifiable, behaviors for BP in primary care settings is
      substantial, offering the potential to reduce illness burden and improve outcomes for
      individuals with this disabling disorder.
    

Intervention name(s): i-IPSRT; Written Psychoeducation
Intervention type(s): Behavioral; Other
Intervention description(s): internet IPSRT (a form of psychotherapy for individuals with bipolar disorder) will be offered via 12 specially-designed modules.
CH will have participated in a two day training about Bipolar Disorder and IPSRT.; Written material about the importance of social rhythm regularity to mood stability in bipolar disorder
Other intervention name(s): i-IPSRT + CH
Allocation: Randomized
Intervention model: Factorial Assignment
Masking: None (Open Label)
Primary purpose: Treatment