Updates about ORBIT application

1. ORBIT in 6:40

2. 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

3. • 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

4. • 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)

5. 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

6. 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

7. Pilot study results
• 30 late stage (> 6 episodes) completed
pre questionnaires
• 16 completed post questionnaires

8. • 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

9. 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."

10. 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

11. 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:
Mindfulness
Self-compassion
Strengths focused