Online Support Tool to Prevent Relapse in Bipolar Disorder

 In Naturopathic News
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A recent study has shown an online resource as being particularly effective at preventing relapse in bipolar disorder patients. The online resource has been adapted from a previously developed manualized intervention tool used for point of contact care staff, called Enhanced Relapse Prevention (ERP). 1 ERPonline is an attempt to address a principle obstacle in delivering relapse prevention of any kind to the mental health community – that most need to be delivered face-to-face. The current study tests the feasibility and acceptability of using a web-based version of ERP.2

Characterizations of Bipolar Disorder

Bipolar disorder is a mood disorder characterized by manic, hypomanic, and major depressive episodes. A principle concern in the treatment and management of bipolar disorder is recurrence or relapse into manic or depressive states. Catching early early warning signs and initiating intervention strategies early on are mainstays in relapse prevention, however they are difficult to implement on an outpatient basis.3 Currently, around 50% of patients will experience a manic or depressive recurrence in year one of treatment, and around 70% by year four.4


ERPonline offers an inexpensive and easily accessible option for support after the initiation to treatment. ERP and ERPonline is a psychological approach which instructs individuals with bipolar to recognize and respond to early warning signs of relapse. It helps facilitate the identification of individual triggers and early warning signs for both mania and depression, as well as developing coping strategies to manage mood changes which occur as part of everyday life.

The Study

The study (of 96 participants) found that access to ERPonline was associated with improvement in belief about mood including increased monitoring of early warning signs compared to individuals who did not have access to the program. This could be a valuable and low-cost resource for individuals needing extra support for bipolar disorder, and other mood dysregulatory conditions.


  1. Lobban F, Taylor L, Chandler C, Tyler E, Kinderman P, Kolamunnage-Dona R, et al. Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial. Br J Psychiatry 2010 Jan;196(1):59-63
  2. Lobban F, Dodd AL, Sawczuk AP, et al. Assessing Feasibility and Acceptability of Web-Based Enhanced Relapse Prevention for Bipolar Disorder (ERPonline): A Randomized Controlled Trial. J Med Internet Res. 2017;19(3):e85.
  3. Merikangas KR, Jin R, He J, Kessler RC, Lee S, Sampson NA, et al. Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Arch Gen Psychiatry 2011 Mar;68(3):241-251
  4. Lobban F, Taylor L, Chandler C, et al. Enhanced relapse prevention for bipolar disorder by community mental health teams: cluster feasibility randomised trial. Br J Psychiatry. 2010;196(1):59-63.

Node Smith, associate editor for NDNR, is a fifth year naturopathic medical student at NUNM, where he has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine amongst the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend campout where naturopathic medicine and medical philosophy are experienced in nature. Three years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision. 

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