Research report A web-based self-management intervention for Bipolar Disorder ‘Living with Bipolar’: A feasibility randomised controlled trial Nicholas J. Todd a,n , Steven H. Jones a , Anna Hart b , Fiona A. Lobban a a Spectrum Centre for Mental Health Research, Division of Health Research, School of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom b Combining Health Information, Computation & Statistics, Lancaster Medical School, Faculty of Health and Medicine, Lancaster University, Lancaster LA1 4YT, United Kingdom article info Article history: Received 17 February 2014 Received in revised form 15 July 2014 Accepted 16 July 2014 Available online 27 July 2014 Keywords: Bipolar Disorder Online Individual psychotherapy Randomised controlled trial Quality of life Recovery abstract Background: Bipolar Disorder (BD) is a severe mental health problem. Psychological interventions are recommended by the National Institute for Health and Care Excellence (NICE) but patients experience severe inequalities in access. This study assessed the feasibility and potential effectiveness of a recovery informed web-based self-management intervention for people with BD. Methods: An online randomised controlled trial (n ¼122) compared treatment as usual (TAU) plus the ‘Living with Bipolar’ (LWB) intervention with a waiting list control (WLC) group. Results: The study recruited to target and the retention rates were high. Participants engaged with the approach. Compared with the WLC, those receiving LWB showed the most robust improvement in psychological and physical domains of quality of life, wellbeing and recovery at the end of the intervention. Limitations: The trial was not definitive and requires further investigation. Conclusions: There is preliminary evidence that a web-based treatment approach in BD is feasible and potentially effective. Such interventions could form part of the Improving Access to Psychological Therapy (IAPT) initiative in severe mental health. & 2014 Elsevier B.V. All rights reserved. 1. Introduction Bipolar Disorder (BD) is characterised by recurrent periods of extreme mood including depression, mania and mixed affective states (Goodwin and Jamison, 2007). It has been identified in 2% of the population (Merikangas et al., 2007) and is estimated to cost England d5.2 billion per year (McCrone et al., 2008). Although BD is ranked by the World Health Organisation as one of the sixth most debilitating conditions (Murray and Lopez, 1997), outcome is highly variable and there are those who experience long periods of stability (Michalak et al., 2006). Psychological interventions for BD, recommended by the National Institute for Health and Care Excellence (NICE) (NICE, 2006a) have been shown to be effective at reducing relapse and hospital admis- sion and improving functioning (Morriss et al., 2007), but significant problems exist with overall delivery across the National Health Service (NHS) (Bird, 2006) and there is substantial inequality in access (Shapiro et al., 2003). Improving access to psychological intervention is a UK government priority currently recently extended into severe mental health (DOH, 2011), but this requires the devel- opment of new accessible interventions. Web-based self-management interventions have the potential to improve equality of access in cost-effective ways (DOH, 2005). Such interventions offer round the clock access and are aimed at fostering existing coping skills and empowering people to take control of their own condition (DOH, 2001). Computerised inter- ventions are recommended as an effective treatment in the NICE guidelines for mild to moderate anxiety and depression (NICE, 2006b). However, to date, only two trials have evaluated web based interventions for BD. ‘Beating Bipolar’ (Smith et al., 2011) and the ‘Bipolar Education Programme’ (Proudfoot et al., 2007) are web-based psycho-educational programmes. However, neither reported significant difference between active intervention and control groups (Smith et al., 2011; Proudfoot et al., 2012). Other approaches currently under development include ‘Online Relapse Prevention’ (Barnes et al., 2007); and ‘Mood Swings’ (Lauder and Castle, 2008). The growing interest in this area reflects the potential utility of developing effective web based interventions, but more work is needed to design approaches that significantly improve outcome for service users. Current web based approaches have focussed on reducing symptoms and relapse, and have controlled access to Contents lists available at ScienceDirect journal homepage: www.elsevier.com/locate/jad Journal of Affective Disorders http://dx.doi.org/10.1016/j.jad.2014.07.027 0165-0327/& 2014 Elsevier B.V. All rights reserved. n Corresponding author. E-mail address: nicholas.todd@nhs.net (N.J. Todd). Journal of Affective Disorders 169 (2014) 21–29