JMIR Publications

ABSTRACT

Background:

Bipolar II (BD-II) disorder is associated with significant burden, disability and mortality, yet there continues to be a dearth of evidence-based psychological interventions for this condition. Technology-mediated interventions incorporating self-management have untapped potential to help meet this need as an adjunct to usual clinical care.

Objective:

The objectives of this pilot study were to assess the feasibility, acceptability and clinical utility of a novel intervention for BD-II (Tailored Recovery-oriented Intervention for Bipolar II Experiences; TRIBE), in which mindfulness-based psychological content is delivered via an integrated web/smartphone platform. A focus of the study was evaluation of the dynamic usage patterns emerging from ecological momentary assessment and intervention to assist real-world application of mindfulness skills learnt from web-delivered modules.

Methods:

An open trial design using pre-test and post-test assessments with nested qualitative evaluation was used. Individuals (aged 18 to 65) with a diagnosis of BD-II were recruited worldwide and invited to use a prototype of the TRIBE intervention over a 3-week period. Data were collected via online questionnaires and phone interviews at baseline and 3-week follow-up.

Results:

A total of 18 participants completed baseline and follow-up assessments. Adherence rates (daily app use) were 65.6% across the 3-week study, with up to 88.9% of participants using the app synergistically alongside the web-based program. Despite technical challenges with the prototype intervention (from user, hardware and software standpoints), acceptability was adequate: The majority of participants rated the intervention positively in terms of the concept (companion app with website), content and credibility, and utility in supporting their management of BD. Evaluation using behavioural archetypes identified important use pathways and a provisional model to inform platform refinement. As hypothesised, depression scores significantly decreased post-intervention (Montgomery Asberg Depression Rating Scale baseline mean = 8.60 vs. follow-up mean = 6.16, t = 2.63, p = .01, d = .53, 95% CI = 0.52, 4.36).

Conclusions:

Our findings suggest that TRIBE is feasible and represents an appropriate and acceptable self-management program for BD-II. Preliminary efficacy results are promising and support full development of TRIBE informed by the present behavioural archetype analysis. Modifications suggested by the pilot study include increasing the duration of the intervention and increasing technical support.