Geerling Bart, Kelders Saskia M, Stevens Anja W M M, Kupka Ralph W, Bohlmeijer Ernst T
Department of Psychology, Health and Technology, Centre for eHealth and Wellbeing Research, University of Twente, Enschede, Netherlands.
Centre for Bipolar Disorder, Dimence Mental Health Institute, Deventer, Netherlands.
JMIR Form Res. 2022 Sep 19;6(9):e39476. doi: 10.2196/39476.
Patients with bipolar disorder (BD) report lower quality of life and lower levels of well-being than the general population. Despite the growing availability of psychotherapeutic and self-management interventions, important unmet needs remain. These unmet needs are closely linked to positive psychology domains. Although a growing number of studies have evaluated the impact of positive psychology interventions (PPIs) on patients with severe mental illness in general, only few have addressed the application of positive psychology for BD.
This study aimed to gain insight into the opinions of patients with BD and health care professionals about (web-based) PPIs for BD and to develop and pilot-test an app containing PPIs specifically designed for patients with BD.
The study was conducted in accordance with the Center for eHealth and Disease Management road map principles and incorporated cocreation and designing for implementation. Data were collected using focus group discussions, questionnaires, rapid prototyping, and web-based feedback on a prototype from the participants. In total, 3 focus groups were conducted with 62% (8/13) of patients with BD and 38% (5/13) of professionals. The collected data were used to develop a smartphone app containing short PPIs. The content was based on PPIs for which a solid base of evidence is available. Finally, a pilot test was conducted to test the app.
Focus groups revealed that PPIs as part of the current BD treatment can potentially meet the following needs: offering hope, increasing self-esteem, expressing feelings, acceptance, and preventing social isolation. Some patients expressed concern that PPIs may provoke a manic or hypomanic episode by increasing positive affect. The pilot of the app showed that the PPIs are moderately to highly valued by the participants. There were no adverse effects such as increase in manic or hypomanic symptoms.
With the systematic use of user involvement (patients and professionals) in all steps of the development process, we were able to create an app that can potentially fulfill some of the current unmet needs in the treatment of BD. We reached consensus among consumers and professionals about the potential benefits of PPIs to address the unmet needs of patients with BD. The use of PPI for BD is intriguing and can be usefully explored in further studies. We emphasize that more evaluation studies (quantitative and qualitative) that are focused on the effect of PPIs in the treatment of BD should be conducted. In addition, to establish the working mechanisms in BD, explorative, qualitative, designed studies are required to reveal whether PPIs can address unmet needs in BD.
双相情感障碍（BD）患者报告的生活质量和幸福感水平低于普通人群。尽管心理治疗和自我管理干预措施越来越容易获得，但仍存在重要的未满足需求。这些未满足需求与积极心理学领域密切相关。虽然越来越多的研究评估了积极心理学干预（PPI）对一般严重精神疾病患者的影响，但只有少数研究涉及积极心理学在双相情感障碍中的应用。
本研究旨在深入了解双相情感障碍患者和医疗保健专业人员对双相情感障碍（基于网络的）PPI的看法，并开发和试点测试一款专门为双相情感障碍患者设计的包含PPI的应用程序。
该研究按照电子健康与疾病管理中心路线图原则进行，并纳入了共同创造和为实施而设计的理念。通过焦点小组讨论、问卷调查、快速原型制作以及参与者对原型的基于网络的反馈来收集数据。总共进行了3个焦点小组讨论，其中双相情感障碍患者占62%（8/13），专业人员占38%（5/13）。收集到的数据用于开发一款包含简短PPI的智能手机应用程序。内容基于有充分证据基础的PPI。最后，进行了一次试点测试以测试该应用程序。
焦点小组表明，作为当前双相情感障碍治疗一部分的PPI可能满足以下需求：提供希望、增强自尊、表达情感、接纳以及预防社会隔离。一些患者担心PPI可能通过增加积极情绪引发躁狂或轻躁狂发作。该应用程序的试点表明，参与者对PPI的评价为中等至高。没有出现如躁狂或轻躁狂症状增加等不良影响。
通过在开发过程的所有步骤中系统地让用户（患者和专业人员）参与，我们能够创建一个有可能满足双相情感障碍治疗中当前一些未满足需求的应用程序。我们在消费者和专业人员之间就PPI解决双相情感障碍患者未满足需求的潜在益处达成了共识。双相情感障碍中PPI的应用很有趣，可在进一步研究中进行有益探索。我们强调应开展更多专注于PPI在双相情感障碍治疗中效果的评估研究（定量和定性）。此外，为了确定双相情感障碍中的作用机制，需要进行探索性、定性、设计性研究以揭示PPI是否能解决双相情感障碍中的未满足需求。
