ORBIT in 6:40

ORBIT

• Online, brief, recovery-focussed, mindfulness-based self-help intervention for late stage bipolar disorder

• Content

– Skills in living in the present moment to improve emotion regulation and sleep

– Clarifying personal values as a guide to action

– Encouraging self-acceptance and self-compassion through avoiding attachment to positive and negative self-evaluations

• Structure (4 weeks)

– Introduction: aims and structure of the intervention, clinical cautions

– Self-acceptance: developing self-acceptance and self-compassion in the context of ongoing symptoms)

– Mindfulness: self as awareness, mindfulness as a tool for emotion regulation and sleep improvement via disengaging from distressing thoughts, feelings, bodily sensations

– Values and Goals: identifying personal values as a guide to action, setting valued goals

• Support and engagement

– Trained online coach via email

• Maximising engagement, adherence and application

– Persuasive system design

– Experiential pedagogy (video, audio, images, prose, poetry)

• International recruitment (UK, Canada, US, Australia)

Development

• Designed and refined in consultation with researchers, clinicians and consumers

• Beta testing with researchers, clinicians and consumers in Canada and Australia (N = 15)

• Found acceptable with no adverse effects expected, modified to incorporate feedback about content and structure

Completed pilot study

• Open Phase II trial

• Dec 2013 – May 2014

• Participants

– Self-reported diagnosis and episode history

– Self-reported under care of mental health professional

– Anonymous participation

– Two roles: recipient of intervention, consultant on intervention

• Recruited through CREST.BD in Canada, social media

Pilot study results

• 30 late stage (> 6 episodes) completed pre questionnaires

• 16 completed post questionnaires

• Brief QoL.BD significantly improved at post-test (M = 3.55, SD = .71) compared with pre-test (M = 3.28, SD = .78), F(1,15) = 7.43, p = .016, partial eta-squared = .33

• Non-significant improvements in all 12 subscales of QoL.BD, DASS scales (Anxiety approached significance, F(1,14) = 4.36, p = .056, partial eta-squared = .24

Qualitative findings

• "I think the application of the interventions has been helpful. I have noted that when "present" I have been able to begin applying my values to my decision making“

• "I liked the images and some of the videos which presented the material in a light-hearted way“

• "I think that format was great. As I am often online anyway, this venue was both convenient and relevant".

• All 16 participants responded they would recommend the program to other people with bipolar disorder: – "absolutely! I think the material is quite beneficial and good. I

was already sharing some of the material and ideas with friends with similar issues."

Next steps

• Definitive randomised controlled trial against active control (psychoeducation)

• Test mechanisms of action:

– Improved emotion regulation

– Improved relationship to self

– Improved sleep

• NHMRC project grant under review

• MQ LOI under review

In terms of research, what are the most important findings from this project?

A brief, online, mindfulness-based intervention to improve QoL in late stage BD is feasible and warrants further investigation

In terms of KE, what are the most important learnings to share with CREST.BD network members?

People with BD, like the rest of the population, are interested in the power of newer psychological therapies:

MindfulnessSelf-compassionStrengths focused