Can digital positive psychology interventions improve the quality of
life in bipolar disorder?
Abstract
Background Bipolar disorder (BD) is a severe mental illness
characterised by recurrent manic, hypomanic and depressive episodes
alternating with euthymic periods. The burden of BD is vast, and many
patients have unmet needs in their treatment. To better support patients
in their personal recovery and well-being, positive psychology
interventions (PPIs) have shown to be a promising tool. Recently, a
mobile application has been developed to offer PPIs: the WELLBE BD-app.
Aim The current study was designed to study the acceptability
of the WELLBE BD-app and evaluate the feasibility of the design for use
in a larger controlled trial (CT). We also studied the potential effects
on mental health. Method This pilot-study used a mixed-methods
quantitative and qualitative approach in which participants were
randomly assigned to an intervention- or a treatment-as-usual control
group, each with 20 participants with BD. The study sample consisted of
a seven weeks during intervention. To assess acceptability, we held
semi-structured interviews in the intervention group and collected log
data and questionnaire data on the actual use of the app and perceived
value of the accompanying exercises. Feasibility was determined by the
number of completers of the intervention in both the intervention and
control groups. Potential effects on mental health outcomes were
measured using an extensive set of pre and post-intervention
questionnaires. Results The intervention was fully completed by
52.7% (n = 11) of the participants and partly completed (1 to 4
modules) by 37.8% (n = 8). The post-test response rate was 73% in both
groups. On average, the exercises were rated with a value of 7.5 on a
scale of 1 to 10 ( SD = 1.2). Users found the application easy to
use, useful for people with BD, and to have an attractive design.
Problems with installation, technical problems, and lack of support were
barriers to using the app. Guidance by an expert by experience (in
videos before the exercises) was preferred by 80% of the participants
instead of guidance by a professional. Effects on mental health outcomes
were small and statistically non-significant, both between- and within
groups. Although we found no significant results in the quantitative
part of our study, the qualitative results show that people with BD
appreciated the content and design of the intervention. The minimal
effects on mental health may be partly explained by the small sample
size and the relatively high levels of mental health of the participants
at baseline. Conclusions and Implications for Practice Based on
this study a larger trial on the effects of the WELLBE-app appears
feasible and warranted. Next to minor modifications based on this pilot
study, to create optimal impact including patients with lower levels of
well-being is recommended and the guidance by experts or peers needs to
be considered.