Centre for Mental Health, Swinburne University of Technology.
Department of Psychiatry, University of British Columbia.
J Consult Clin Psychol. 2021 Oct;89(10):830-844. doi: 10.1037/ccp0000684.
Adjunctive psychological interventions improve outcomes in bipolar disorder (BD), but people in latter stages likely have different clinical needs. The objective here was to test the hypothesis that for people with ≥10 episodes of BD, a brief online mindfulness-based intervention (ORBIT 2.0) improves quality of life (QoL) relative to a Psychoeducation control. A rater-masked, pragmatic superiority randomized clinical trial compared ORBIT 2.0 with active control. Both interventions were 5-week coach-supported programs with treatment as usual continued. Inclusion criteria included age 18-65 years, confirmed diagnosis of BD, and history of ≥10 episodes. Measures were collected at baseline, postintervention, and 3- and 6-month follow-ups. The main outcome was QoL, measured on the Brief Quality of Life in Bipolar Disorder (Brief QoL.BD) at 5 weeks, using intention-to-treat analyses. Among N = 302 randomized participants, the primary hypothesis was not supported (Treatment × Time β = -0.69, 95% CI [-2.69, 1.31], p = .50). The main effect of Time was not significant in either condition, indicating no improvement in either group. Recruitment was feasible, the platform was safe, both interventions were highly acceptable, but usage was suboptimal. Post hoc analyses found both interventions effective for participants not in remission from depression at baseline. In people with late-stage BD, an online mindfulness-based intervention was not superior to psychoeducational control in improving QoL. Online delivery was found to be safe and acceptable. Future interventions may need to be higher intensity, address engagement challenges, and target more symptomatic individuals. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
附加心理干预可改善双相情感障碍 (BD) 的结局，但处于后期阶段的患者可能具有不同的临床需求。本研究旨在检验以下假设，即对于经历过≥10 次 BD 发作的患者，简短的在线正念干预 (ORBIT 2.0) 可改善生活质量 (QoL)，优于心理教育对照。一项设盲、实用优势随机临床试验比较了 ORBIT 2.0 与积极对照。两种干预措施均为 5 周教练支持的项目，同时继续进行常规治疗。纳入标准包括年龄 18-65 岁，确诊为 BD，且有≥10 次发作史。在基线、干预后以及 3 个月和 6 个月随访时收集测量数据。主要结局为 QoL，使用 5 周时的双相情感障碍简明生活质量量表 (Brief QoL.BD) 进行意向治疗分析。在 N = 302 名随机参与者中，主要假设未得到支持 (治疗×时间β = -0.69，95%CI [-2.69, 1.31]，p =.50)。在任何一种情况下，时间的主要效应均不显著，表明两组均未改善。招募是可行的，平台是安全的，两种干预措施都非常被接受，但使用率不理想。事后分析发现，基线时未从抑郁中缓解的参与者两种干预措施都有效。在晚期 BD 患者中，在线基于正念的干预措施在改善 QoL 方面并不优于心理教育对照。发现在线提供是安全且可接受的。未来的干预措施可能需要更高的强度，解决参与挑战，并针对更多有症状的个体。
