Professor Michael Berk1, Dr Seetal Dodd1, Lesley Berk1, Sue Lauder1, Professor David Castle2, Monica Gilbert3, Carolynne Holdsworth3, Dr Jamie Chamberlain3, Professor Leon Pitterman4, Dr Britt Klein4, Dr David Austin4, Dr Andrea Chester5, Dr Greg Murray6
1 Department of Clinical and Biomedical Sciences, The University of Melbourne
2 St Vincent’s Hospital, The University of Melbourne
3 Collaborative Therapy Unit, Mental Health Research Institute
4 Department of General Practice, Monash University
5 Division of Psychology, RMIT University
6 Faculty Life and Social Sciences, Swinburne University
Beyond Blue Victorian Centre of Excellence
Project completion year
This project had two major objectives:
- to develop an online intervention for bipolar disorder
- to demonstrate that group-based intervention, on which the online program is based, is effective in treating bipolar disorder.
MoodSwings is an online intervention for bipolar disorder based on the Moodswings and Bipolar Therapy Group Project (MAPS). A series of sequential modules covers a range of psychological strategies for managing bipolar disorder in conjunction with medication.
The modules include understanding bipolar disorder; stress and triggers of illness; medication management; managing and monitoring early symptoms of depression, mania and hypomania; and developing plans to manage relapse. The sequence can be tailored to the type of bipolar illness, individualising the material. The site contains elements designed for developing a personal illness profile, key tools and a monitoring section to keep track of mood changes and triggers of illness. The personal profiles and monitoring sections are easily reviewed and updated. Automated reminder emails encourage participants to return to the site after a period of absence.
MoodSwings also contains a moderated discussion board for sharing experiences in a supportive environment. Site tours demonstrate key aspects of the site and how to navigate and make best use of it. Print buttons allow material to be printed and taken to service providers; help buttons allow email contact with the administrator.
To create the website, it was necessary to:
- design the structure and supporting software
- structure the website to allow continual iterative development
- train the moderator in web design software (WebGui)
- construct the site to allow evaluation of the intervention
- complete the content, including the interactive elements.
The website is based on the MAPS program, a pre-existing face-to-face group intervention based on consumer, carer and service provider focus groups and evidence from the literature. It involves 12, 90-minute group sessions, held weekly, followed by monthly booster sessions for three months.
Discussions about MoodSwings with consumers and service providers have been positive and collaborative national and international partners have been engaged.
The efficacy of the MAPS program was evaluated using a randomised controlled design comparing the program with a usual-treatment control group. All participants were monitored for relapse for nine months afterwards. The intervention group had a small number of relapses with depression, no manic relapses and, compared to the control group, a higher number of hypomanic relapses. This last finding may indicate that participants were better at recognising symptoms that had previously been dismissed as “normal”. For this reason, all relapses excluding hypomania were considered in the analysis, and there was a significant difference between the intervention and control groups (p = 0.02).
Implications for policy, practice and further research
Elements of the software can be activated or hidden, making it possible to create two arms of the MoodSwings site: an active intervention and an information-only arm. This key design element enables online evaluation of the project, which should be performed. The website can also keep track of how long participants spend on the site and what areas of the site they use. Using this is recommended to determine any dose effects of the site. Questionnaire data can be collected and downloaded directly to a statistical data package, saving time on data entry and minimising errors for future research projects.