Kim Wright

Introduction: Bipolar Disorder (BD) is a complex and often chronic mood disorder that can cause significant distress and disruption to everyday life. The condition often requires lifelong treatment and self‐management. Caffeine is a lifestyle behaviour that could be useful in self‐management alongside traditional treatments, but further research is needed to explore the relationship between this lifestyle behaviour and its potential significance on affective state. Methods: Individuals with BD ( N = 20) took part in qualitative semi‐structured interviews, engaging in discussion about their personal experiences of caffeine consumption in relation to BD mood symptoms. Interviews were analysed using Interpretative Phenomenological Analysis (IPA). Results: Analysis revealed the superordinate theme ‘it's a balancing act’ was present in the majority of the transcripts, describing the caffeine‐bipolar relationship. This superordinate theme comprised themes specifically linked to lower mood states, ‘little helper’ and ‘nothing works’ and others linked to higher mood states ‘increased manic‐ness’ and ‘can't recall/concentrate’, in addition to themes around habitual caffeine consumption ‘habit/routine’ and planned use of caffeine ‘strategic routine’. Conclusion: The complexities of the caffeine‐bipolar relationship are highlighted. Participants indicated that caffeine requires a very delicate balancing act, having the potential to be both helpful and harmful. Findings emphasise the importance of increasing knowledge surrounding caffeine use for both patients with BD and clinical professionals.

Background: Between major affective episodes some people with bipolar disorder experience persistent low mood or mood instability. Here we report an initial evaluation of the STABILISE programme (ISRCTN19416314; registration date 01.02.23), an adaptation of individual behavioural therapy that includes concepts and techniques addressing emotion regulation designed to support people experiencing these inter-episode symptoms. This study aimed to evaluate the safety, feasibility and acceptability of the intervention and to explore whether the pattern of clinical change had potential for the intervention to be of benefit. Twelve individuals with inter-episode bipolar symptoms received the STABILISE therapy in a randomised, multiple baseline case series. Participants were randomly assigned to wait 3, 4 or 5 weeks before commencing treatment, which comprised up to 22 sessions up to 7 months. Measures of symptoms, mood lability, recovery and quality of life were completed at intake, pre-therapy, and post therapy. Participants completed weekly measures of affective symptoms over the baseline and therapy periods, and for three weeks after. Results: All 12 participants completed the therapy programme and reported high levels of satisfaction overall. No adverse events were judged to be therapy related. There was one instance of reliable deterioration on one outcome measure. Across all parameters of clinical change 9 of the 12 participants showed an overall pattern of improvement and none showed a pattern of deterioration overall. Conclusions: This study provides preliminary support for the feasibility, acceptability, safety, and clinical potential of the STABILISE therapy. Further investigation of these aspects in a larger sample and within a randomised controlled trial design is required.

Background/Objectives: Our understanding of mood instability as a clinically important feature of many psychiatric conditions has been increasing over the last decade, but there remains a lack of clarity around the optimal ways to calculate mood instability in real time. We conducted a systematic review in order to describe the statistical methods used in studies investigating mood instability that collected mood data using ESM (Experience Sampling Methodology). Results: From a total of 229 papers, we found 15 discrete statistical methods were used a total of 319 times. In 76 (33%) studies, more than one statistical method was used, and 39 (17%) studies employed distinct statistical methods for particular aspects of affect dynamics. Conclusions: Based on our findings, we recommend standardisation of statistical methods to strengthen future research on mood instability and ultimately support better clinical outcomes for individuals with mood difficulties.

Background: In between episodes of (hypo) mania and major depression, people with bipolar disorder can experience ongoing low mood or mood instability, and these may also be present as part of cyclothymic disorder. This is a phase II evaluation of an adapted form of behavioural therapy (STABILISE) for inter-episode bipolar symptoms. The study aims to establish the feasibility and acceptability of the therapy and research procedures, including an economic component, to inform a future definitive trial. Methods: Patients will be randomised 1:1 to either Treatment as Usual (control arm) or Treatment as Usual plus STABILISE intervention (intervention arm). Follow up points will be at 14, 30 and 52 weeks post eligibility confirmation, with 30 weeks as the primary end point. We aim to recruit 60 individuals meeting diagnostic criteria for a Bipolar Spectrum Disorder, and reporting ongoing bipolar symptoms (low mood or mood instability) outside of a manic or severe depressive episode. Feasibility and acceptability will be examined through recruitment and retention rates, completion rates for the candidate primary outcome measures (PHQ9, ALS-SF, QoL.BD and BRQ) and feedback from participants on their experience of study participation and therapy. Proceeding to a definitive trial will be indicated if the following criteria are met: (i) trial participation is deemed, or can be made, sufficiently safe; (ii) recruitment rate indicates that larger-scale recruitment would be feasible (recruitment rate of at least two participants per month within at least one site, with mitigation plan if overall target sample size not met); (iii) for candidate primary outcome measure follow up data is available at 30 weeks from at least 75% of participants, or from between 55 and 74% with clear plan for improvement. Discussion: This study is a randomised, controlled feasibility trial that builds on an initial case series of the STABILISE approach. The findings will be used to establish whether a future, definitive trial is feasible and to refine the research procedures and therapy protocol. Trial registration: ISRCTN18207465. Registered 13th March 2024, https://www.isrctn.com/ISRCTN18207465 .

Background: In between episodes of (hypo) mania and major depression, people with bipolar disorder can experience ongoing low mood or mood instability, and these may also be present as part of cyclothymic disorder. This is a phase II evaluation of an adapted form of behavioural therapy (STABILISE) for inter-episode bipolar symptoms. The study aims to establish the feasibility and acceptability of the therapy and research procedures, including an economic component, to inform a future definitive trial. Methods: Patients will be randomised 1:1 to either Treatment as Usual (control arm) or Treatment as Usual plus STABILISE intervention (intervention arm). Follow up points will be at 14, 30 and 52 weeks post eligibility confirmation, with 30 weeks as the primary end point. We aim to recruit 60 individuals meeting diagnostic criteria for a Bipolar Spectrum Disorder, and reporting ongoing bipolar symptoms (low mood or mood instability) outside of a manic or severe depressive episode. Feasibility and acceptability will be examined through recruitment and retention rates, completion rates for the candidate primary outcome measures (PHQ9, ALS-SF, QoL.BD and BRQ) and feedback from participants on their experience of study participation and therapy. Proceeding to a definitive trial will be indicated if the following criteria are met: i) trial participation is deemed, or can be made, sufficiently safe; ii) recruitment rate indicates that larger-scale recruitment would be feasible (recruitment rate of at least two participants per month within at least one site, with mitigation plan if overall target sample size not met); iii) for candidate primary outcome measure follow up data is available at 30 weeks from at least 75% of participants, or from between 55 and 74% with clear plan for improvement. Discussion: This study is a randomised, controlled feasibility trial that builds on an initial case series of the STABILISE approach. The findings will be used to establish whether a future, definitive trial is feasible and to refine the research procedures and therapy protocol. Trial Registration: ISRCTN18207465. Registered 13^th March 2024, https://www.isrctn.com/ISRCTN18207465. Protocol version: 1.2 30.8.24

The majority of research into the mental health benefits of blue space (outdoor places where water is a central feature) has focussed on the associations between neighbourhood exposure to these spaces and population‐level incidence of unipolar depression or anxiety disorder. There has been little exploration of the therapeutic use of blue space by those navigating bipolar, schizophrenia or other psychotic conditions. Knowledge arising from such an exploration could assist in the design and optimisation of nature‐based care for people with these conditions, as well as with self‐management. We conducted semi‐structured online and telephone interviews with 19 adults who self‐reported experience of these conditions. Interviews were conducted in the United Kingdom from August to December 2021. We describe four of the key interpretive themes identified via an in‐depth inductive thematic analysis of the interview transcripts to highlight how participants sought out moments of affective sanctuary through their blue encounters. Blue spaces were described as having the potential to reset the mind, emotions and body. This was in part due to their socially undemanding nature, and ability to provide respite from a socially stressful world. Participants described developing a blue identity, whereby a sense of attachment to and shared history with these places was articulated as well as incorporating blue spaces into self‐ and emotion‐regulation practices. Finally, participants described experiences of and recommendations for a therapeutic blue intervention. The role of biodiversity in contributing to the benefits of blue spaces was implied primarily in terms of perceived soundscapes, but also through visual observations. Synthesis and applications. Blue care for people with bipolar, schizophrenia or other psychotic conditions should consider the need that some individuals have for solitude and proximity to their home when they visit blue spaces, as well as individual differences in the features of blue space interactions that provide the greatest benefit. Read the free Plain Language Summary for this article on the Journal blog.

Objectives: Mindfulness therapy improves drinking outcomes arguably by attenuating negative mood–induced drinking, but this mechanism has not been demonstrated in hazardous community drinkers. To address this, three studies tested whether a key ingredient of mindfulness, breath counting, would attenuate the increase in motivation for alcohol produced by experimentally induced negative mood, in hazardous community drinkers. Method: In three studies, hazardous community drinkers were randomized to receive either a 6-min breath counting training or listen to a recited extract from a popular science book, before all participants received a negative mood induction. Motivation for alcohol was measured before and after listening to either the breath counting training or the control audio files, with a craving questionnaire in two online studies (n = 122 and n = 111), or an alcohol versus food picture choice task in a pub context in one in-person study (n = 62). Results: In Study 1, breath counting reduced alcohol craving. However, since the mood induction protocol did not increase craving, the effect of breath counting in reversing such increase could not be demonstrated. Online breath counting eliminated the increase in alcohol craving induced by negative mood (Study 2) and eliminated the stress-induced increase in alcohol picture choice in the pub environment (Study 3). Conclusions: Briefly trained breath counting attenuated negative mood–induced alcohol motivation in hazardous community drinkers. These results suggest that breath counting is a reliable and practical method for reducing the impact of negative emotional triggers on alcohol motivation. Preregistration: These studies are not preregistered.