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Parades PsychoEducation Trial - Statistical Analysis Plan

This document describes the statistical analyses undertaken for the primary comparisons between Group Psychoeducation and Group Peer Support as interventions for Bipolar disorder (as part of the NIHR funded PARADES programme RP-PG-0407-10389: led by the Spectrum Centre). The paper reporting the outcomes of the trial is currently under review and will be referenced here on publication.

Read the plan

Mapping the CNWL

Trust-wide initiatives for relatives of people with mental health problems

A Commissioned Independent Review

This report is a CNWL commissioned independent review of some of the Trust wide initiatives provided or developed by the Trust in an attempt to map the services that carers currently receive or have access to, and the ways that these could be improved.

Read the report

Bipolar Disorder is a Two-Edged Sword: A qualitative study

Bipolar Disorder can have highly detrimental effects on the lives of people with the diagnosis and those who care about them. However, growing evidence suggests that aspects of bipolar experiences are also highly valued by some people.

This paper highlights the need to invite people to talk about positive aspects of bipolar experiences as well as the difficulties they face. This may help us to understand ambivalence to current treatment and to develop interventions that minimise the negative impacts, whilst recognising and potentially retaining some of the positives.

Read the article

Understanding Bipolar Disorder

Why some people experience extreme mood states and what can help

This report was commissioned by the British Psychological Society's Division of Clinical Psychology to provide a psychological perspective on the experience and treatment of Bipolar Disorder. This report represents the work of a large group of academics, researchers, professionals and service users lead by Professor Steven Jones, Dr Fiona Lobban and Anne Cooke. The report makes important recommendations for psychological treatments and delivery of psychologically informed care across clinical services.

Pendulum, the magazine of Bipolar UK, comments on the Understanding Bipolar Disorder report. Winter, 2010.

Pendulum Review of Understanding Bipolar

Self Appraisals of Internal States and Risk of Analogue Bipolar Symptoms in Student Samples

Evidence from Standardised Behavioural Observations and a Diary Study

Abstract:

An integrative cognitive model proposed that individuals vulnerable to bipolar disorder (BD) assign extreme personal meaning to internal states. This research investigated the utility of the Hypomanic Attitudes and Positive Predictions Inventory as a cognitive risk measure for BD. Study 1 (N = 64; mean age 21.8 years, 42 female) explored whether students at cognitive risk had more extreme changes in mood and both self-reported and observer-rated bipolar-relevant symptoms during an interview task following a mood induction. The risk group did not respond differentially to the mood induction, but they spoke faster and dominated the conversation more during the interview task, self-reported greater activation, depression and negative affect, and scored higher on hypomanic personality, reward sensitivity, and dysfunctional attitudes. When controlling for other established cognitive measures, activation was still higher in the cognitive risk group at trend, and depression and negative affect were significantly higher. Activation, depression, and negative affect were still significantly higher in the cognitive risk group when controlling for reward sensitivity. Study 2 (N = 30; mean age 19.93 years, 21 female) complemented the experimental study with a 7 days diary study of everyday mood and behaviour. The risk group reported higher negative affect and bipolar-relevant symptoms. These results are consistent with the role of extreme appraisals of internal state in vulnerability to BD.

Full reference

Dodd, A.L., Mansell, W., Beck, R.A., & Tai, S.J. (2013). Self Appraisals of Internal States and Risk of Analogue Bipolar Symptoms in Student Samples: Evidence from Standardised Behavioural Observations and a Diary Study. Cognitive Therapy and Research, 1-15.

Self Appraisals of Internal States and Risk of Analogue Bipolar Symptoms in Student Samples: Evidence from Standardised Behavioural Observations and a Diary Study

Download Self Appraisals of Internal States Paper

A Pilot Web Based Positive Parenting Intervention to Help Bipolar Parents to Improve Perceived Parenting Skills and Child Outcomes

Background:

Children of bipolar parents are at elevated risk for psychiatric disorders including bipolar disorder. Helping bipolar parents to optimize parenting skills may improve their children's mental health outcomes. Clear evidence exists for benefits of behavioural parenting programmes, including those for depressed mothers. However, no studies have explored web-based self-directed parenting interventions for bipolar parents.

Aims:

The aim of this research was to conduct a pilot study of a web-based parenting intervention based on the Triple P-Positive Parenting Programme.

Method:

Thirty-nine self-diagnosed bipolar parents were randomly allocated to the web-based intervention or a waiting list control condition. Parents reported on their index child (entry criterion age 4-10 years old). Perceived parenting behaviour and child behaviour problems (internalizing and externalizing) were assessed at inception and 10 weeks later (at course completion). Fifteen participants (4 control group and 11 intervention group) did not provide follow-up data.

Results:

Levels of child behaviour problems (parent rated; Strengths and Difficulties Questionnaire) were above clinical thresholds at baseline, and problematic perceived parenting (self-rated; Parenting Scale) was at similar levels to those in previous studies of children with clinically significant emotional and behavioural problems. Parents in the intervention group reported improvements in child behaviour problems and problematic perceived parenting compared to controls. Conclusions: A web-based positive parenting intervention may have benefits for bipolar parents and their children. Initial results support improvement in child behaviour and perceived parenting. A more definitive study addressing the limitations of the current work is now called for.

Full reference

Jones, S., Calam, R., Sanders, M., Diggle, P. J., Dempsey, R., & Sadhnani, V. (2013). A Pilot Web Based Positive Parenting Intervention to Help Bipolar Parents to Improve Perceived Parenting Skills and Child Outcomes. Behavioural and Cognitive Psychotherapy, FirstView 1-14.

A Pilot Web Based Positive Parenting Intervention to Help Bipolar Parents to Improve Perceived Parenting Skills and Child Outcomes

Download Positive Parenting Intervention Paper

A randomised controlled trial of recovery focused CBT for individuals with early bipolar disorder

Background:

There is increasing evidence for the effectiveness of structured psychological therapies for bipolar disorder. To date however there have been no psychological interventions specifically designed for individuals with early bipolar disorder. The primary objective of this trial is to establish the acceptability and feasibility of a new CBT based intervention (Recovery focused CBT; RfCBT) designed in collaboration with individuals with early bipolar disorder intended to improve clinical and personal recovery outcomes.

Methods and design:

This article describes a single blind randomised controlled trial to assess the feasibility and acceptability of RfCBT compared with treatment as usual. Participants will be recruited from across the North West of England from specialist mental health services and through primary care and self referral. The primary outcome of the study is the feasibility and acceptability of RfCBT as indicated by recruitment to target and retention to follow-up as well as absence of untoward incidents associated with RfCBT. We also intend to estimate the effect size of the impact of the intervention on recovery and mood outcomes and explore potential process measures (self appraisal, stigma, hope and self esteem).

Discussion:

This is the first trial of recovery informed CBT for early bipolar disorder and will therefore be of interest to researchers in this area as well as indicating the wider potential for evaluating approaches to the recovery informed treatment of recent onset severe mental illness in general.

Full reference

Jones, S., Mulligan, L., Law, H., Dunn, G., Welford, M., Smith, G., & Morrison, A. (2012). A randomised controlled trial of recovery focused CBT for individuals with early bipolar disorder. BMC Psychiatry, 12(1), 204.

A randomised controlled trial of recovery focused CBT for individuals with early bipolar disorder

Download Recovery focused CBT for individuals Review

Pragmatic randomised controlled trial of group psychoeducation versus group support in the maintenance of bipolar disorder

Background:

Non-didactically delivered curriculum based group psychoeducation has been shown to be more effective than both group support in a specialist mood disorder centre in Spain (with effects lasting up to five years), and treatment as usual in Australia. It is unclear whether the specific content and form of group psychoeducation is effective or the chance to meet and work collaboratively with other peers. The main objective of this trial is to determine whether curriculum based group psychoeducation is more clinically and cost effective than unstructured peer group support.

Methods/design:

Single blind two centre cluster randomised controlled trial of 21 sessions group psychoeducation versus 21 sessions group peer support in adults with bipolar 1 or 2 disorder, not in current episode but relapsed in the previous two years. Individual randomisation is to either group at each site. The groups are carefully matched for the number and type of therapists, length and frequency of the interventions and overall aim of the groups but differ in content and style of delivery. The primary outcome is time to next bipolar episode with measures of the therapeutic process, barriers and drivers to the effective delivery of the interventions and economic analysis. Follow up is for 96 weeks after randomisation.

Discussion:

The trial has features of both an efficacy and an effectiveness trial design. For generalisability in England it is set in routine public mental health practice with a high degree of expert patient involvement.

Full reference

Morriss, R., Lobban, F., Jones, S., Riste, L., Peters, S., Roberts, C., Mayes, D. (2011). Pragmatic randomised controlled trial of group psychoeducation versus group support in the maintenance of bipolar disorder. BMC Psychiatry, 11(1), 114.

Pragmatic randomised controlled trial of group psychoeducation versus group support in the maintenance of bipolar disorder

Download Psychoeducation vs Group Support Review

Relatives Education And Coping Toolkit - REACT

Study protocol of a randomised controlled trial to assess the feasibility and effectiveness of a supported self management package for relatives of people with recent onset psychosis

Background

Mental health problems commonly begin in adolescence when the majority of people are living with family. This can be a frightening time for relatives who often have little knowledge of what is happening or how to manage it. The UK National Health Service has a commitment to support relatives in order to reduce their distress, but research studies have shown that this can lead to a better outcome for service users as well. Unfortunately, many relatives do not get the kind of support they need. We aim to evaluate the feasibility, acceptability and effectiveness of providing and supporting a Relatives' Education and Coping Toolkit (REACT) for relatives of people with recent onset psychosis.

Methods

The study is a randomised control trial. Trial Registration for Current Controlled Trials ISRCTN69299093. Relatives of people receiving treatment from the Early Intervention Service for psychosis are randomly allocated to receive either Treatment As Usual (TAU) or TAU plus the REACT intervention. The main aims of the study are to: (i) determine the acceptability of a supported self-management intervention; (ii) determine preference for type of support; (iii) assess the feasibility of the design; (iv) identify the barriers and solutions to offering support for self-management approaches within the NHS; (v) estimate the likely effect size of the impact of the intervention on outcome for relatives; (vi) gain detailed feedback about the barriers and solutions to using a self-management approach; (vii) describe the way in which the intervention is used. Outcomes will be assessed from baseline and at the 6-month follow-up.

Discussion

The intervention is compared to current treatment in a sample of participants highly representative of relatives in routine early intervention services across the UK. The intervention is protocolised, offered within routine practice by existing staff and extensive process data is being collected. Randomisation is independent; all assessments are made by blind raters. The limitations of the study are the lack of control over how the intervention is delivered, the short follow-up period, and the lack of assessment of service user outcomes. Despite these, the findings will inform future effectiveness trials and contribute to the growing evidence base for supported self-management interventions in mental health.

Full reference

Lobban, F., Glentworth, D., Wainwright, L., Pinfold, V., Chapman, L., Larkin, W., Haddock, G. (2011). Relatives Education And Coping Toolkit - REACT. Study protocol of a randomised controlled trial to assess the feasibility and effectiveness of a supported self-management package for relatives of people with recent onset psychosis. BMC Psychiatry, 11(1), 100.

Relatives Education And Coping Toolkit - REACT. Study protocol of a randomised controlled trial to assess the feasibility and effectiveness of a supported self management package for relatives of people with recent onset psychosis.

Download REACT Protocol Review

Online articles

  • People with depression and bipolar must have more choice

    An increasing number of people are trying to cope with depression and bipolar in the UK. However, we also have an over-reliance on drugs and waiting lists can be a year long for Cognitive Behavioural Therapy, which teaches people to approach unhelpful thoughts differently. This article by Professor Steve Jones explores the need for choice in treatments and greater access to the variety of therapies known to be helpful. [TheConversation.com, May 2013]

  • Preventing bipolar relapse with web therapy

    Michael, 29, from Cheshire, was diagnosed with bipolar disorder after experiencing his "most severe high" while travelling after university. A spell in hospital a few years ago led to weekly sessions of therapy for a year which helped him manage the impact mood has on his life. But research into web therapy being carried out at Lancaster University may hold the key to ensuring he does not relapse. [BBC News, May 2013]

  • For some academic researchers, mental illness can be an advantage

    The stigma attached to mental illness in a high-achieving university setting, where reliability, consistency and accuracy are prioritised, has often meant that academics with a mental illness choose never to disclose their diagnosis. But in what may be an emerging trend in university recruitment, Debbie Mayes was specifically appointed to her research position because of her experiences as a user of mental-health services, as well as her academic credentials. [The Guardian, 2009]

Questionnaires

The four questionnaires listed horizontally below can each be accessed by clicking on their titles, whereupon more information will shown. Within each description, their are links to both the article, (PDF of the article), and the actual questionnaire, (Word document).

Tab Content: (BRQ) Bipolar Recovery

BRQ - Bipolar Recovery Questionnaire

A quantitative measure of recovery experiences in bipolar disorder

The importance of personal recovery in mental health is increasing widely recognised. The BRQ, developed by the Spectrum Centre, assesses recovery experiences in individuals with a diagnosis of bipolar disorder to aid recovery informed developments in research and clinical practice.

This paper reports on the development of the Bipolar Recovery Questionnaire (BRQ):

Bipolar recovery questionnaire paper: Psychometric properties of a quantitative measure of recovery experiences in bipolar disorder

You can also download the Bipolar recovery questionnaire

Scoring note: All items are scored 0-100 based on where the participants places a cross of the respective 100mm line. Items 1,4,5,12,13,16,21,23,25,29,32,36 are all reverse scored. All other items are positively scored. All items are summed to provide the total recovery score.

Tab Content: EI Source of Inspiration Scale

EISI - External and Internal Sources of Inspiration Scale

Assessing how individuals appraise and respond emotionally to inspiration in Bipolar Disorder

EISI scores are significantly associated with behavioural tendencies that could have clinical significance, as both rumination and impulsiveness have been associated with worse clinical outcomes in BD

This paper reports on the development of the External and Internal Sources of Inspiration Scale (EISI):

Inspiration Paper

You can also download the Inspiration questionnaire only which includes scoring notes.

Tab Content: (HIQ) Hypomania Interpretation

HIQ - Hypomania Interpretations Questionnaire

Assessing positive self-dispositional appraisals in bipolar and behavioural high risk samples

The Hypomania Interpretations Questionnaire (HIQ) is designed to assess positive self-dispositional appraisals for hypomania-relevant experiences.

This paper reports on the development of the Hypomania Interpretations Questionnaire (HIQ):

HIQ article

You can also download the HIQ Questionnaire only.

Scoring of HIQ

For each question, items a. b. are positively scored. Ratings A-D correspond to scores of 1-4 for each item

For each question, item c. is score Yes = 1, No = 0

To calculate the total hypomanic appraisal score, sum items:
1a, 2b, 3a, 4b, 5a, 6a, 7a, 8a, 9b, 10b

To calculate the total normalising appraisal score, sum items:
1b, 2a, 3b, 4a, 5b, 6b, 7b, 8b, 9a, 10a

To calculate the total experience score, sum items:
1c, 2c, 3c, 4c, 5c, 6c, 7c, 8c, 9c, 10c

Tab Content: Interpretations of Depression

IDQ - Interpretations of Depression Questionnaire

Assessing the role of negative self-appraisal for depression-relevant experiences

The IDQ was developed for the purpose of a study exploring the role of negative self-appraisal for depression-relevant experiences as hypomanic personality is associated with elevated risk of depression as well as mania.

This paper reports on the development of the Interpretations of Depression Questionnaire (IDQ):

IDQ Interpretations questionnaire

You can also download the IDQ Questionnaire only.

Scoring of IDQ

For each question items a. b. are positively scored. Ratings A-D correspond to scores of 1-4 for each item

For each question item c. is score Yes = 1, No = 0

To calculate the total depressive appraisal score, sum items:
1b, 2b, 3a, 4a, 5a, 6a, 7a, 8a, 9a, 10a

To calculate the total normalising appraisal score, sum items:
1a, 2a, 3b, 4b, 5b, 6b, 7b, 8b, 9b, 10b

To calculate the total experience score, sum items:
1c, 2c, 3c, 4c, 5c, 6c, 7c, 8c, 9c, 10c