Abstract
BackgroundSelf-monitoring has been shown to improve the self-management and treatment of patients with bipolar disorder. However, current self-monitoring methods are limited to once-daily retrospectively assessed mood, which may not suit the rapid mood fluctuations in bipolar disorder. The experience sampling method (ESM), which assesses mood in real-time several times a day, may overcome these limitations. This study set out to assess the experiences of patients and clinicians with the addition of ESM monitoring, real-time alerts, and personalized feedback to clinical care. Participants were twenty patients with bipolar disorder type I/II and their clinicians. For four months, patients completed five ESM assessments per day on mood, symptoms, and activities. Weekly symptom questionnaires alerted patients and clinicians to potential episodes. After the monitoring, a personalized feedback report based on the patient’s data was discussed between patient and clinician. Three months later, patient and clinician were both interviewed.ResultsThematic analysis of the transcripts resulted in four themes: perceived effects of the monitoring, alerts, and feedback, and recommendations for implementation of ESM. ESM was perceived as helping patients to cope better with their disorder by increasing awareness, offering new insights, and encouraging life style adjustments. ESM was further believed to facilitate communication between patient and clinician and to lead to new treatment directions. However, high assessment burden and pre-occupation with negative mood and having a disorder were also described. Patients and clinicians advocated for increased personalization and embedding of ESM in care.ConclusionsThis study demonstrates that long-term ESM monitoring, alerts, and personalized feedback are perceived as beneficial to the treatment and self-management of patients with bipolar disorder. Future research should further test the clinical utility of ESM. Clinically relevant feedback and technology need to be developed to enable personalized integration of ESM in clinical care.
Highlights
Self-monitoring has been shown to improve the self-management and treatment of patients with bipolar disorder
Thematic analysis resulted in four themes: (1) effects of experience sampling method (ESM) monitoring, (2) effects of the weekly symptom questionnaires and alerts, (3) effects of the personal report and feedback session, and (4) recommendations on the use of ESM in clinical practice
For each aspect of ESM, patients and clinicians described perceived positive and negative effects, and effects on treatment they attributed to ESM
Summary
Self-monitoring has been shown to improve the self-management and treatment of patients with bipolar disorder. This study set out to assess the experiences of patients and clinicians with the addition of ESM monitoring, real-time alerts, and personalized feedback to clinical care. Patients completed five ESM assessments per day on mood, symptoms, and activities. Research has suggested that self-monitoring may increase illness insight and self-management, by helping patients to make lifestyle adjustments and facilitate communication with clinicians (Murnane et al 2016; Bilderbeck et al 2014). Existing methods such as the Life-Chart or ChronoRecord have two potential limitations. The ratings are completed retrospectively over the previous 24 h, which may lead to inaccurate information due to mood biases (Reis et al 2012)
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