Mobile Acceptance and Commitment Therapy in Bipolar Disorder: Microrandomized Trial

BACKGROUND: Mobile interventions promise to fill in gaps in care with their broad reach and flexible delivery. OBJECTIVE: Our goal was to investigate delivery of a mobile version of acceptance and commitment therapy (ACT) for individuals with bipolar disorder (BP). METHODS: Individuals with BP (n=30) participated in a 6-week microrandomized trial. Twice daily, participants logged symptoms in the app and were repeatedly randomized (or not) to receive an ACT intervention. Self-reported behavior and mood were measured as the energy devoted to moving toward valued domains or away from difficult emotions and with depressive d and manic m scores from the digital survey of mood in BP survey (digiBP). RESULTS: Participants completed an average of 66% of in-app assessments. Interventions did not significantly impact the average toward energy or away energy but did significantly increase the average manic score m (P=.008) and depressive score d (P=.02). This was driven by increased fidgeting and irritability and interventions focused on increasing awareness of internal experiences. CONCLUSIONS: The findings of the study do not support a larger study on the mobile ACT in BP but have significant implications for future studies seeking mobile therapy for individuals with BP. TRIAL REGISTRATION: ClinicalTrials.gov NCT04098497; https://clinicaltrials.gov/ct2/show/NCT04098497