Internet Psychotherapy for Bipolar Disorder in Primary Care

Bipolar Disorder Clinical Trial

Official title:

Internet Psychotherapy for Treating Bipolar Disorder in Primary Care

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02448108
• Other study ID #: 00085129000
• Secondary ID: R34MH107541
• Status: Completed
• Phase: N/A
• Start date: March 1, 2017
• Est. completion date: September 30, 2019

Study information

• Verified date: January 2020
• Source: University of Pittsburgh
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial 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.

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.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 47
• Est. completion date: September 30, 2019
• Est. primary completion date: April 30, 2019
• Accepts healthy volunteers: No
• Gender: All
• Age group: 18 Years to 99 Years

Eligibility

Inclusion Criteria:

• 18 years and older;

• meet DSM 5 criteria for bipolar disorder I, II or Other Specified Bipolar and Related Disorder;

• using the SCID 5;

• score > or = to 9 on Patient Health Questionnaire-9 or score > or = 155 on Internal State Scale;

• receiving care from a Primary Care Physician in a designated study site;

• access to broadband Internet connection and telephone; and

• ability to read and speak English.

Exclusion Criteria:

• Self-reported visual impairment that would prevent completion of study procedures;

• Psychotic disorder, substance use disorder or current manic episode, which would deem participation in the study either inappropriate or dangerous;

• currently receiving specialty mental health services for bipolar disorder from a psychiatrist or therapist;

• planning to leave Primary Care Practice within next 3 months; and

• active suicidal ideation.

Related Conditions & MeSH terms

• Bipolar Disorder

Intervention

Behavioral:
• i-IPSRT
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.

Other:
• Written Psychoeducation
Written material about the importance of social rhythm regularity to mood stability in bipolar disorder

Locations

Country	Name	City	State
United States	University of Pittsburgh Medical Center	Pittsburgh	Pennsylvania

Sponsors (3)

Lead Sponsor	Collaborator
University of Pittsburgh	National Institute of Mental Health (NIMH), Northwestern University

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Client-Satisfaction Questionnaire	measure of client satisfaction	Up to Week 12
Primary	Social Rhythm Metric (measure of lifestyle regularity)	measure of lifestyle regularity	Up to 12 weeks
Primary	Supportive Accountability Questionnaire	assesses level of perceived accountability to another person for treatment participation	Up to Week 12
Secondary	Quick Inventory of Depressive Symptoms	measure of depressive symptoms	up to 12 weeks
Secondary	Internal State Scale	measure of mood symptoms	up to 12 weeks
Secondary	Short Form-12	measure of overall health status	up to 12 weeks
Secondary	Functional Assessment Short Test	assessment of impairment in functioning	up to 12 weeks