Lauder Sue, Chester Andrea, Castle David, Dodd Seetal, Gliddon Emma, Berk Lesley, Chamberlain James, Klein Britt, Gilbert Monica, Austin David W, Berk Michael
The University of Melbourne, Department of Psychiatry, Royal Melbourne Hospital, Level 1 North, Main Block, Victoria 3050, Australia; DVC-Research and Innovation Portfolio & School of Health Sciences, and the Collaborative Research Network Federation University, Ballarat, Victoria, Australia.
RMIT University, Building 6, Level 5 Bowen Street, Melbourne 3000, Australia.
J Affect Disord. 2015 Jan 15;171:13-21. doi: 10.1016/j.jad.2014.08.008. Epub 2014 Sep 22.
Adjunctive psychosocial interventions are efficacious in bipolar disorder, but their incorporation into routine management plans are often confounded by cost and access constraints. We report here a comparative evaluation of two online programs hosted on a single website (www.moodswings.net.au). A basic version, called MoodSwings (MS), contains psychoeducation material and asynchronous discussion boards; and a more interactive program, MoodSwings Plus (MS-Plus), combined the basic psychoeducation material and discussion boards with elements of Cognitive Behavioral Therapy. These programs were evaluated in a head-to-head study design.
Participants with Bipolar I or II disorder (n=156) were randomized to receive either MoodSwings or MoodSwings-Plus. Outcomes included mood symptoms, the occurrence of relapse, functionality, Locus of Control, social support, quality of life and medication adherence.
Participants in both groups showed baseline to endpoint reductions in mood symptoms and improvements in functionality, quality of life and medication adherence. The MoodSwings-Plus group showed a greater number of within-group changes on symptoms and functioning in depression and mania, quality of life and social support, across both poles of the illness. MoodSwings-Plus was superior to MoodSwings in improvement on symptoms of mania scores at 12 months (p=0.02) but not on the incidence of recurrence.
The study did not have an attention control group and therefore could not demonstrate efficacy of the two active arms. There was notable (81%) attrition by 12 months from baseline.
This study suggests that both CBT and psychoeducation delivered online may have utility in the management of bipolar disorder. They are feasible, readily accepted, and associated with improvement.
辅助性心理社会干预在双相情感障碍中有效，但将其纳入常规管理计划常常因成本和可及性限制而受到困扰。我们在此报告对一个单一网站（www.moodswings.net.au）上托管的两个在线项目的比较评估。一个基础版本，称为情绪波动（MS），包含心理教育材料和异步讨论板；以及一个更具互动性的项目，情绪波动增强版（MS-Plus），将基础心理教育材料和讨论板与认知行为疗法的元素相结合。这些项目在一项直接比较的研究设计中进行了评估。
患有双相I型或II型障碍的参与者（n = 156）被随机分配接受情绪波动或情绪波动增强版。结果包括情绪症状、复发的发生、功能、控制点、社会支持、生活质量和药物依从性。
两组参与者从基线到终点情绪症状均有所减轻，功能、生活质量和药物依从性均有所改善。情绪波动增强版组在疾病的两个阶段，在抑郁和躁狂症状及功能、生活质量和社会支持方面的组内变化数量更多。情绪波动增强版在12个月时躁狂评分症状改善方面优于情绪波动（p = 0.02），但在复发发生率方面并非如此。
该研究没有注意力控制组，因此无法证明两个有效组的疗效。从基线到12个月有显著的（81%）损耗。
本研究表明，在线提供的认知行为疗法和心理教育在双相情感障碍的管理中可能都有用。它们是可行的，易于接受，并与改善相关。
