Internet Psychotherapy for Bipolar Disorder in Primary Care

Over a third of individuals with bipolar spectrum disorders (BP) are treated exclusively in
primary care settings, and yet, primary care providers (PCPs) are ill-equipped to manage this
complex and disabling illness. Medications, which can be prescribed by PCPs, hasten recovery
from illness and improve long-term course of illness for those with BP, but relapse and
residual symptoms are common when individuals are treated with pharmacotherapy alone. Best
practices treatment for BP includes adjunctive, BP-specific psychotherapy as a key element of
effective care. And yet, evidence-based BP-specific psychotherapies that engage and modify
targets specific to BP are typically unavailable in primary care settings. Online
interventions have the potential to overcome barriers to accessing evidence-based
psychosocial treatments for BP in primary care. In other settings and with other populations,
effectiveness of online interventions improved when human support/coaching (clinical helpers;
CH) via text, email, and telephone was added to the intervention. Interpersonal and Social
Rhythm Therapy (IPSRT) is a BP-specific psychotherapy that uses a problem-solving approach to
help individuals regularize their social rhythms in order to entrain underlying disturbances
in circadian and sleep/wake regulation, factors that are increasingly recognized as playing
important roles in the pathogenesis of BP. Its primary behavioral target is regularity of
daily routines such as sleep/wake cycle and mealtimes. This construct is measured by the
validated Social Rhythm Metric (SRM). The current project seeks to develop and conduct
initial testing of an online version of IPSRT (i-IPSRT) for use in primary care. We will (1)
evaluate the feasibility and acceptability of supported and unsupported online psychotherapy
interventions for BP in primary care (i-IPSRT and i-IPSRT plus CH) compared to Control
Condition (CC), (2) examine whether i-IPSRT and i-IPSRT + CH engages its primary behavioral
target as measured by the SRM, and (3) explore the impact of i-IPSRT, i-IPSRT + CH, and CC on
symptoms and functioning over 12 weeks. Information from this study will inform a larger
trial to test the effectiveness of these approaches in primary care. The public health impact
of developing an effective, technology-enabled approach to delivering evidenced-based
psychotherapy that targets specific, modifiable, behaviors for BP in primary care settings is
substantial, offering the potential to reduce illness burden and improve outcomes for
individuals with this disabling disorder.

Inclusion Criteria:

- 18 years and older;

- meet DSM 5 criteria for bipolar disorder I, II or Other Specified Bipolar and Related
Disorder;

- using the SCID 5;

- score > or = to 9 on Patient Health Questionnaire-9 or score > or = 155 on Internal
State Scale;

- receiving care from a Primary Care Physician in a designated study site;

- access to broadband Internet connection and telephone; and

- ability to read and speak English.

Exclusion Criteria:

- Self-reported visual impairment that would prevent completion of study procedures;

- Psychotic disorder, substance use disorder or current manic episode, which would deem
participation in the study either inappropriate or dangerous;

- currently receiving specialty mental health services for bipolar disorder from a
psychiatrist or therapist;

- planning to leave Primary Care Practice within next 3 months; and

- active suicidal ideation.