title: Online mindfulness-based intervention for late-stage bipolar disorder: pilot evidence for feasibility and effectiveness.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  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).
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors: Swinburne University, Melbourne, Australia. Electronic address: gwm@swin.edu.au.
authors: G
authors: G
authors: Murray
authors: Swinburne University, Melbourne, Australia.
authors: N D
authors: ND
authors: Leitan
authors: Deakin University, Melbourne, Australia; University of Melbourne, Melbourne, Australia.
authors: M
authors: M
authors: Berk
authors: Swinburne University, Melbourne, Australia.
authors: N
authors: N
authors: Thomas
authors: University of British Columbia, Vancouver, Canada.
authors: E
authors: E
authors: Michalak
authors: University of Melbourne, Melbourne, Australia.
authors: L
authors: L
authors: Berk
authors: University of California, Berkeley, Berkeley, USA.
authors: S L
authors: SL
authors: Johnson
authors: Lancaster University, Lancaster, UK.
authors: S
authors: S
authors: Jones
authors: University of New South Wales, Sydney, Australia.
authors: T
authors: T
authors: Perich
authors: University of Oregon, Eugene, USA.
authors: N B
authors: NB
authors: Allen
authors: Australian National University, Canberra, Australia.
authors: Michael
authors: M
authors: Kyrios
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001714:Bipolar Disorder / Q000175:diagnosis / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D064866:Mindfulness; D010865:Pilot Projects; D011613:Psychotherapy / Q000379:methods*; D011788:Quality of Life; D013813:Therapy, Computer-Assisted; D016896:Treatment Outcome
keywords: Bipolar disorder; Mindfulness; Online; Quality of life; Staging