Is digital the future of relapse prevention in bipolar disorder?

Treatments for bipolar disorder are aimed at controlling symptoms and preventing relapses, which consist of mood swings between high-energy mania and depression. However, for about 75 per cent of people with bipolar disorder, relapses remain a feature in their lives.

Enhanced Relapse Prevention (ERP) is a psychological intervention intended to help people with bipolar disorder to recognise and manage mood changes in order to reduce the occurrence and severity of relapses. The key elements include identification of individual triggers and early warning signs for both mania and depression, alongside the development of coping strategies to manage mood changes in everyday life.

Researchers at Lancaster University, led by Professor Fiona Lobban, were awarded NIHR Research for Patient Benefit (RfPB) funding to run a trial looking at the feasibility and acceptability of an online approach to ERP.

ERP online: informative and interactive

The online tool created for this study was developed to be both informative and interactive, providing information to help understand bipolar disorder - the causes, treatments available and how they can be accessed - alongside videos of people talking about their experiences, coping strategies and warning signs. Participants were then also able to monitor and log their mood on a daily basis in a life chart to create a timeline to look back at, enabling them to identify patterns leading to a relapse.

Feedback about site was very positive, not least because an online approach enables access anytime from anywhere. The logistics of face to face sessions are often tricky, particularly for relatives and carers who may have full time jobs to fit around caring responsibilities.

In total 96 people took part in the trial and, when asked about the site, one of the participants said:

“It’s always available and also the information on there has been put together by the people who do know what they’re doing.” 

ERP online

How do you keep technology relevant in research?

Technology is always evolving and so inevitably after two years of follow up the ERP online tool created for this study looks a little out of date. This is a challenge for researchers using digital tools but Professor Lobban highlights that this isn’t always a negative:

“I don’t think it mattered that the tool was a bit out of date by the end of the study. Providing good quality information and signposting is always going to be helpful for people with long term conditions and we have demonstrated that this can be done easily with basic technology.

“The use of more advanced technology is really interesting but I think the challenge is how best to use it. There is a big difference between what we could do, what we should do and what people with mental health conditions want us to do with technology - it’s important we ask them.”

Patient and public involvement (PPI) was a key aspect of this project in enabling the team to understand what the needs of their participants were and develop the most appropriate tool to match.

Next steps

The full findings of this study are due to be published soon, and following the success of the project the team are now testing an online toolkit for parents and relatives of people with bipolar disorder and psychosis. The REACT trial is NIHR Health Technology Assessment (HTA) funded and it builds on the online ERP study by providing information for relatives alongside the option to be put in touch with trained supporters and others in the same situation in a chat room environment for peer to peer support.

If you are a relative of someone with bipolar disorder or psychosis (including schizophrenia) and want to find out more about taking part in the trial, please visit

The study was led by Professor Fiona Lobban at Cumbria Partnership NHS Foundation Trust (ref PB-PG-0211-10001).

If you’ve got a solution that could address unmet clinical need in mental health through medical technology you may be interested in applying for the 2018 NIHR Invention for Innovation (i4i) Challenge Award, open until 4 April.