Murray G, Leitan N D, Berk M, Thomas N, Michalak E, Berk L, Johnson S L, Jones S, Perich T, Allen N B, Kyrios Michael
Swinburne University, Melbourne, Australia.
Swinburne University, Melbourne, Australia.
J Affect Disord. 2015 Jun 1;178:46-51. doi: 10.1016/j.jad.2015.02.024. Epub 2015 Mar 5.
People in the late stage of bipolar disorder (BD) experience elevated relapse rates and poorer quality of life (QoL) compared with those in the early stages. Existing psychological interventions also appear less effective in this group. To address this need, we developed a new online mindfulness-based intervention targeting quality of life (QoL) in late stage BD. Here, we report on an open pilot trial of ORBIT (online, recovery-focused, bipolar individual therapy).
Inclusion criteria were: self-reported primary diagnosis of BD, six or more episodes of BD, under the care of a medical practitioner, access to the internet, proficient in English, 18-65 years of age. Primary outcome was change (baseline - post-treatment) on the Brief QoL.BD (Michalak and Murray, 2010). Secondary outcomes were depression, anxiety, and stress measured on the DASS scales (Lovibond and Lovibond, 1993).
Twenty-six people consented to participate (Age M=46.6 years, SD=12.9, and 75% female). Ten participants were lost to follow-up (38.5% attrition). Statistically significant improvement in QoL was found for the completers, t(15)=2.88, 95% CI:.89-5.98, p=.011, (Cohen׳s dz=.72, partial η(2)=.36), and the intent-to-treat sample t(25)=2.65, 95% CI:.47-3.76, (Cohen׳s dz=.52; partial η(2)=.22). A non-significant trend towards improvement was found on the DASS anxiety scale (p=.06) in both completer and intent-to-treat samples, but change on depression and stress did not approach significance.
This was an open trial with no comparison group, so measured improvements may not be due to specific elements of the intervention. Structured diagnostic assessments were not conducted, and interpretation of effectiveness was limited by substantial attrition.
Online delivery of mindfulness-based psychological therapy for late stage BD appears feasible and effective, and ORBIT warrants full development. Modifications suggested by the pilot study include increasing the 3 weeks duration of the intervention, adding cautions about the impact of extended meditations, and addition of coaching support/monitoring to optimise engagement.
与双相情感障碍（BD）早期患者相比，晚期患者的复发率更高，生活质量（QoL）更差。现有的心理干预措施在该群体中似乎效果也较差。为满足这一需求，我们开发了一种新的基于正念的在线干预措施，旨在改善BD晚期患者的生活质量。在此，我们报告了一项针对ORBIT（在线、以康复为重点的双相情感障碍个体治疗）的开放性试点试验。
纳入标准为：自我报告的BD原发性诊断、BD发作6次或更多次、在医生的照料下、能上网、精通英语、年龄在18 - 65岁之间。主要结局是简明生活质量量表（BD）（Michalak和Murray，2010年）上的变化（基线 - 治疗后）。次要结局是用抑郁、焦虑和压力量表（DASS）（Lovibond和Lovibond，1993年）测量的抑郁、焦虑和压力。
26人同意参与（年龄M = 46.6岁，标准差 = 12.9，75%为女性）。10名参与者失访（失访率38.5%）。完成者的生活质量有统计学意义的改善，t(15)=2.88，95%置信区间：.89 - 5.98，p =.011，（科恩d值 =.72，偏η² =.36），意向性分析样本t(25)=2.65，95%置信区间：.47 - 3.76，（科恩d值 =.52；偏η² =.22）。在完成者和意向性分析样本中，DASS焦虑量表上发现有非显著的改善趋势（p =.06），但抑郁和压力方面的变化未达到显著水平。
这是一项无对照组的开放性试验，因此所测得的改善可能并非归因于干预的特定要素。未进行结构化诊断评估，且有效性的解释受到大量失访的限制。
为BD晚期患者提供基于正念的在线心理治疗似乎可行且有效，ORBIT值得全面开发。试点研究提出的改进建议包括将干预时长增加3周、增加关于长时间冥想影响的警示，以及增加辅导支持/监测以优化参与度。
