Dopke Cynthia A, McBride Alyssa, Babington Pamela, Jonathan Geneva K, Michaels Tania, Ryan Chloe, Duffecy Jennifer, Mohr David C, Goulding Evan H
Department of Psychiatry and Behavioral Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
General Pediatrics, Loma Linda Children's Hospital, Loma Linda, CA, United States.
JMIR Form Res. 2021 Mar 24;5(3):e25810. doi: 10.2196/25810.
Despite effective pharmacological treatment, bipolar disorder is a leading cause of disability due to recurrence of episodes, long episode durations, and persistence of interepisode symptoms. While adding psychotherapy to pharmacotherapy improves outcomes, the availability of adjunctive psychotherapy is limited. To extend the accessibility and functionality of psychotherapy for bipolar disorder, we developed LiveWell, a smartphone-based self-management intervention. Unfortunately, many mental health technology interventions suffer from high attrition rates, with users rapidly failing to maintain engagement with the intervention technology. Human support reduces this commonly observed engagement problem but does not consistently improve clinical and recovery outcomes. To facilitate ongoing efforts to develop human support for digital mental health technologies, this paper describes the design decisions, theoretical framework, content, mode, timing of delivery, and the training and supervision for coaching support of the LiveWell technology. This support includes clearly defined and structured roles that aim to encourage the use of the technology, self-management strategies, and communication with care providers. A clear division of labor is established between the coaching support roles and the intervention technology to allow lay personnel to serve as coaches and thereby maximize accessibility to the LiveWell intervention.
尽管有有效的药物治疗，但由于发作复发、发作持续时间长以及发作间期症状持续存在，双相情感障碍仍是导致残疾的主要原因。虽然在药物治疗的基础上增加心理治疗可改善治疗效果，但辅助心理治疗的可及性有限。为了扩大双相情感障碍心理治疗的可及性和功能，我们开发了LiveWell，这是一种基于智能手机的自我管理干预措施。不幸的是，许多心理健康技术干预措施的损耗率很高，用户很快就不再参与干预技术。人工支持可减少这种常见的参与问题，但并不能始终如一地改善临床和康复效果。为了推动为数字心理健康技术提供人工支持的持续努力，本文描述了LiveWell技术的设计决策、理论框架、内容、模式、提供时间以及辅导支持的培训和监督。这种支持包括明确界定和结构化的角色，旨在鼓励使用该技术、自我管理策略以及与护理提供者沟通。在辅导支持角色和干预技术之间建立了明确的分工，以使非专业人员能够担任辅导员，从而最大限度地提高LiveWell干预措施的可及性。
