Evaluation of an online relapse prevention program for bipolar disorder - An overview of the aims and methodology of a randomized controlled trial

Bipolar disorder is a chronic relapsing remitting illness affecting 1-2% of the general adult population. Awareness of the limitations of pharmacological treatment for this disorder has encouraged the development of psychological treatments and a large body of evidence now exists demonstrating the effectiveness of several types of psychosocial interventions in the treatment and prevention of relapse for bipolar disorder. Unfortunately, it is difficult for many individuals with bipolar disorder to access such programs due to financial constraints and restricted roll-out. One solution to this difficulty is to use Internet-based delivery of targeted psycho-education, cognitive behavior management and online medication monitoring to improve relapse prevention for those with bipolar disorder. The focus of this article is to discuss the aims and methodology of this unique, collaborative randomized control trial that evaluates the effectiveness of an Intemet-based disease management program (termed Recovery Road [RR]). The RR program incorporates both symptom monitoring with feedback, and targeted psychosocial treatment for adults with bipolar disorder delivered over a 12-month period. The overall aim was to determine whether this web-based adjunctive relapse prevention program can improve mental health outcomes. Upon successful enrolment, participants were automatically randomized into either the intervention (RR) or control group. The control group received some relevant information but did not include program components considered to be active parts of the experimental intervention. This article also describes a recruitment, enrolment and randomization process that maximizes the potential of the Internet for research and data collection purposes. At the time of writing full results were not yet available and, thus, were not reported in this article. Interim outcomes indicate that the online enrolment has been successful and participants are making full use of all online features of the active program included by the support facility. The difficulties with maintaining individuals on the control program are described and samples of typical anecdotal comments provided by participants to the research group via the support facility are presented.