Spectrum Centre Resources

Adam Sawczuk talks about the ERP Online study being conducted by the Spectrum Centre.

Watch Dr Bev Clack present the IBPI study in Lancaster in January 2013.

Steve also discusses the driving factors behind our focus on bipolar disorder and related issues.

Rita talks about her experiences of bipolar disorder, getting a diagnosis and why she works with the Spectrum Centre to promote research and the involvement of service users

Steve discusses the study which is exploring the impact of a recovery-focused intervention on the mood and other factors of interest for people with a diagnosis of bipolar disorder. You can find out more about the study here.

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.

Download the report (PDF)

Download the paper (PDF)

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.

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.

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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.

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.

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.

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.

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.

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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.

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).

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.

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.

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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.

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.

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.

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.

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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.

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 selfmanagement 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 6 month follow-up.

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-mangement interventions in mental health.

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.