AUSTRALIAN ROTARY HEALTH / IAN PARKER BIPOLAR FUND PhD SCHOLARSHIP: BIPOLAR DISORDER
TITLE OF PROJECT:
Assessing an Online Psychotherapy program for Bipolar Disorder.
SCHOLARSHIP APPLICANT AND SUPERVISOR DETAILS:
Name: Emma Gliddon
Proposed Commencement of PhD: February 2013
Proposed Department and Intitute: School of Medicine, Deakin University
Academic Qualifications: B.Aps[Psych], BSc[Hons]
Name: Professor Michael Berk
Department and Institute of Research: School of Medicine, Deakin University
Academic Qualifications: MBBCh, MMed[Psych] Cum Laude, PhD, FRANZCP
[Permission Granted for Letter of Recommendation of Emma Gliddon by Professor Michael Berk - see below]
To: Kelly Anne Martinez
Australian Rotary Health
RE: Support for Emma Gliddon: Ian Parker Scholarship
I provide unreserved support for Emma Gliddon’s Ian Parker Scholarship. This PhD project will examine the role of social support in the context of the development of an online self-help program for bipolar disorder, known as the MoodSwings program. Specifically, it will explore ways discussion board participation could mediate participant outcomes.
Emma has the potential to be an outstanding early career researcher who has already made impressive strides at an early state of her career. I supervised Emma during her Honours candidature (2012) and found her to be a diligent, organised, thorough reliable, honest and personable worker, capable of conducting world-class research. The quality of her written work in particular was outstanding. This is reinforced by her winning both the “Best Scientific Poster Award 2010″ for Barwon Health Research Week, and a “Highly Commended Poster Award” for ASPR in 2010, for the only two posters she has submitted.
Emma completed her Bachelor of Applied Science (Psychology), and an honours degree with Bachelor of Science (Honours), and scored an H1 with 82. Her honours thesis was titled “MoodSwings”: Usability and pilot testing of an Internet-based, adjunctive, psychosocial treatment program for bipolar disorder.” This gives her the technical expertise and experience in the domain of her PhD which further enhances the inevitability of the success of the proposed project.
I believe she has the potential to make a contribution of the highest quality and she has proven beyond doubt to be an outstanding young scientist. This prestigious grant would greatly facilitate Emma’s research goals. I consider Emma to be one of a rare group of individuals who have the full complement of skills required to be an outstanding independent researcher. She has the intellectual curiosity, insight, drive, stability, enthusiasm, initiative, interpersonal skills and writing ability that make her the complete package. Emma and the project have the strong support of both myself and the Deakin University Medical School. She is a great asset to our research unit and is integral to the project’s success. I strongly recommend that she be awarded the inaugural Ian Parker Fellowship
Prof. Michael Berk
Research Assistant [voluntary] – Barwon Health, Barwon Psychiatric Research Unit, 2009
During this time Emma assisted in data collection, maintaining participant record, and program support for the MoodSwings website. She worked with Ms Sue Lauder and Professor Michael berk. Her work on this project later became her honours project, which she studied for the duration of 2010.
Bachelor of Science [Honours] – The University of Melbourne 2010
For Emma’s honours year, she conducted two elevations of an uploaded version of the MoodSwing program [ known as MoodSwings 1.5 ]. This work was completed under the supervision of Professor Michael berk, Ms Sue Lauder and Associate Professor Seetal Dodd. The first of these elevations involved a usability study using a sample of convenience, and the second involved a pilot study using a sample of people with bipolar disorder. Throughout this study Emma co-ordinated all study participants, which involved recruitment from a waiting list, and conducting screening phone calls to confirm a diagnosis of bipolar disorder, as well as maintaining participant records and data collection. At the conclusion of the project, she analysed all study data and completed a 13,000 word thesis.
Research Assistant [casual] – Deakin University, School of Information Systems, School of Information technology, 2010 – 2012
Between 2010 and 2012 Emma worked with three academics in two different schools at Deakin University. In the School of Information Systems, she worked with Dr John Lamp and Associate professor Annemieke Craig. With Dr lamp, she assisted in collecting data for a project on ERA journal ranking. With Associate Professor Craig, she assisted in data collection, data entry and data analysis for the Go Girls and Digital Divas programs, which aim to encourage participation in IT fields in girls and young women. Emma also helped to develop and maintain a number of large electronic libraries. In the School of Information Technology, she continued her work on the Go Girls project with Associate Professor Jo Coldwell-Neilson.
Research Assistant [casual] – University of Melbourne, Department of Psychiatry, 2011 – current
Following the completion of Emma’s honours in 2010, she was invited to continue working on the MoodSwings program, and commenced her position at the University of Melbourne. During this time, the MoodSwings program received funding from the National Institutes of Health and has become a collaborative project between the University of Melbourne and Stanford University in the United States.
During Emma’s time in this position, she has assisted in the development of the study design and methodology, editing and updating website content, preparing study protocol and related documentation including the Data Safety Monitoring Board [DSMB] Charter, liaising with a web developing company, and maintaining a database of potential study participants.
SUMMARY OF PROJECT [In plain English/lay language]
This PhD project will examine the role of discussion board participation within an online self-help program for bipolar disorder, known as the MoodSwings program. Specifically, it will explore ways discussion board participants could mediate participant outcomes.
Participant outcomes will be assessed using a combination of online self-report and phone assessments to measure mood symptoms, relapse, health care utilisation, social support, quality of life, functionality, and motivation for treatment over a 12-month period.
Discussion board participation will be assessed in two ways. Active participation will be measured using the number of posts submitted per user, and passive participation will be measured using both page views and duration of page views.
A total of 300 participants will be recruited for the MoodSwings program, with 100 randomly allocated to each of three groups. These groups are: discussion board only, discussion board plus psycho-education material, or discussion board, psycho-education material, and interactive psychosocial CBT based tools. Each group will have an independent discussion board, and all three discussion boards will be assessed during this project.
RESEARCH PROJECT PLAN, AIMS, POTENTIAL SIGNIFICANCE & BACKGROUND
Emma was required to list the specific aims of the project. If hypotheses are to be tested, they should be clearly stated. She was required to provide a description of how she selected the project and how the results from her study will improve the health of Australians.
Aims: The aims of this PhD project are to asses the relationship between motivation for treatment and discussion board engagement, to access of both active and passive engagement mediates positive outcomes on the assessment measures, and to identify commonly occurring discussion board themes and topics.
It is hypothesized that motivation will be positively correlated with discussion board engagement. Secondly, it is hypothesized that higher engagement, both active and passive, will be positively correlated with positive outcomes including program adherence.
Finally, it is hypothesized that the greatest number of active participants will be associated with a higher volume of submitted posts. A qualitative theme analysis will also be conducted to determine the most commonly occurring topics discussed in each of three groups. This analysis will help to identify any additional needs in the psycho-educational material available in the MoodSwings 2.0 program and inform future content of bipolar programs.
Potential significance: The results from this project will help us to better understand the potential benefits of online therapy for people with bipolar disorder, and specifically what role online discussion forums play in improving outcomes, which will inform future programs. Online therapy programs could potentially be of great benefit to those in rural, regional and remote ares of Australia, as they provide access to those who may not usually be able to attend face-to-face therapy. Also, as a large portion of the participants being recruited for this project will be Australian, the results of this project will be specifically relevant to Australians living with bipolar disorder, as well as their families and care-givers.
Project selection: Emma selected this project because of the huge potential of online therapy. She found the area to be very interesting, and her previous experience with the MoodSwings program in particular have been very positive. She personally feels that this area of research is of great public health importance and can be of great benefit to many people, and to be involved in the ongoing development of this program is very rewarding.
Background: In recent years the treatment of bipolar disorder has recognised the critical role of psychosocial factors in the development and maintenance of the disorder. [Colom and Vieta 2004]. and these factors are now targeted in treatment approaches. The high costs and finite resources associated with face-to-face therapies limit access for many, often those most in need [Andersson and Carlbring 2003]. However, Internet based treatment overcome many of these issues [Lauder, Chester et al. 2007]. Online therapies have produced broadly similar results to face-to-face treatments and have been applied to a wide range of mental health conditions [e.g. Titov, Andrews et al. 2008; Aydos, Titov et al. 2009; Proudfoot 2004; Andersson, Bergstrom et al. 2005].
An important element of some of these programs has been the use of online discussion boards. research has shown that message boards can provide a certain level of anonymity that may encourage users to express themselves more freely [Suler, 2004], and often result in higher levels of self disclosure among thos with stigmatizing mental health conditions [Barak et al. 2009]. The mechanisms by which online discussion boards can improve outcomes are unclear; however it may be that they improve perceived social support, which is a known influencing factor in illness development [Martin, et al. 2011]. There is a paucity of research into the possible benefits of online discussion environments on social support and participant outcomes, especially in the context of mental health.
In a systemic review, Griffiths et.al  found a number of Internet support groups helped to reduce depressive symptoms among participants with a range of medical conditions. Improvements in outcomes among discussion board users have also been shown in an online therapy program for social phobia [Titov, Andrews et.al 2008]. Active participation through frequent posting on discussion board has been found to be an important factor in student learning, while passive participation of reading posts had no impact on learning outcomes [Palmer, Holt et al. 2008]. The impact of active or passive participation on discussion boards in online psychotherapy has not yet been investigated within the context of online intervention programs for participants with mental health issues. The psychosocial benefits of active participation in online forums have, however, been measured among women with breast cancer [Rodgers & Chen, 2005]. This study in psychological distress and improvements in stress management among those who actively posted on an online support forum. Passive participation, however, was not assessed [Rodgers & Chen, 2005].
Few studies have assessed the use of Internet-based therapies in the treatment of bipolar disorder [Barnes, Harvet et al. 2007; Proudfoot; Parker et al. 2007; Barnes, Hadzi-Pavlovic et al. 2008; Simpson, Barnes et al. 2009; Todd, Solis-Trapala et al.2012; Lauder, berk et al. 2007]. While most final results are yet to be published, initial results showed improvements in perceived illness control and preceived stigma, as well as reduced levels of anxiety and depression across all treatment groups [Proudfoot, Parker et al 2012].
The first online psychosocial intervention for bipolar disorder to incorporate moderated discussion boards is the MoodSwings program [Lauder, Berk et al. 2007].
This program was developed in Australia, and is based on a successful face-to-face group based program called MAPS [Castle, Berk et al. 2007; castle; White et al. 2010], which combines the approaches of both CBT and psycho-education. While the previous MoodSwings program included discussion boards, each board was only allocated a maximum of 6 participants, resulting in relatively low levels of active participation. Further investigation is required to determine if higher numbers will result in more regular and in-depth discussion.
The objective of the proposed project is to assess if the extent of engagement with the online discussion boards provided withing the MoodSwings 2.0 program is related to positive outcomes, and what role motivation for treatment plays in this relationship.
Research Plan: This study is a 3-arm randomised controlled trial with a recruitment target off 300. Participants will be allocated to one of these groups: discussion board only, discussion board plus psycho-education material, or discussion board, psycho-education material, and interactive psychosocial CBT based tools. All participants will have access to one of three discussion boards [boards are allocated per group], with a maximum of 100 participants allocated to each discussion board. Active discussion board participation will be measured by the the number of posts submitted per user, while passive participation will be assessed using page views and duration of page views.
Participant involvement in discussion board will be explored as a mediator of changes to mood symptoms, relapse, health care utilisation, social support, quality of life, functionality, and motivation for treatment over a 12-month period. Assessments will be completed at baseline as well as 3, 6, 9 and 12 months follow up.
NEW MOODSWINGS WEBSITE NOW AVAILABLE: APRIL 2014
MoodSwings is an online self help program for Bipolar Disorder.
An invitation to participate if you are:
* Between the ages of 21 and 65
* Have a diagnosis of bipolar disorder
You are invited to participate in this research study to see how effective the MoodSwings website is at improving the well- being of people with bipolar disorder.
Please visit: www.moodswings.net.au