Online mindfulness-based intervention for late-stage bipolar disorder: pilot evidence for feasibility and effectiveness
Online mindfulness-based intervention for late-stage bipolar disorder: pilot evidence for feasibility and effectiveness
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DOI：
10.1016/j.jad.2015.02.024
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发表时间：
2015-06-01
影响因子：
6.6
通讯作者：
Kyrios, Michael
中科院分区：
文献类型：
--
作者：
Murray, G.;Leitan, N. D.;Kyrios, Michael
目的：与早期患者相比，晚期双相情感障碍（BD）患者的复发率较高，生活质量（QoL）较差。现有的心理干预在这一群体中也显得不那么有效。为了满足这一需求，我们开发了一种新的在线正念干预，针对晚期双相障碍患者的生活质量（QoL）。在这里，我们报告了一项开放的ORBIT（在线，康复为重点，双相个体治疗）试点试验。方法：纳入标准为：自我报告初步诊断为双相障碍，6次或6次以上双相障碍发作，在医生的护理下，可以上网，精通英语，18-65岁。主要结局是简要生活质量的变化（基线-治疗后）。次要结果为抑郁、焦虑和压力，采用DASS量表测量（Lavibond and Loydrond, 1993）。： 26人同意参与（年龄M=46.6岁，SD= 12.9, 75%为女性）。10名参与者失去随访（流失率38.5%）。完成者的生活质量有统计学意义的改善，t(15)=2.88, 95% CI: 0.89 -5.98, p = 0.011, (Cohen’s d(z)= 0.72，偏eta(2)= 0.36)，意向治疗样本t(25)=2.65, 95% CI:47-3.76, (Cohen’s d(z)= 0.52；部分埃塔(2)= 22)。在完成者和意向治疗样本中，DASS焦虑量表的改善趋势不显著（p=.06），但抑郁和压力的变化没有接近显著性。局限性：这是一项没有对照组的开放试验，因此测量到的改善可能不是由于干预的特定因素。没有进行结构化的诊断评估，对有效性的解释受到大量减员的限制。结论：基于正念的在线心理治疗晚期双相障碍是可行和有效的，轨道值得充分发展。试点研究建议的修改包括增加干预的3周持续时间，增加对延长冥想影响的警告，以及增加指导支持/监控以优化参与。(C) 2015 Elsevier B.V.版权所有
Objectives: 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 Mutt Secondary outcomes were depression, anxiety, and stress measured on the DASS scales (Lavibond and Loydrond, 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 d(z)=.72, partial eta(2)=.36), and the intent-to-treat sample t(25)=2.65, 95% CI:47-3.76, (Cohen's d(z)=.52; partial eta(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.Limitations: 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.Conclusion: 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. (C) 2015 Elsevier B.V. All rights reserved.