Mindfulness as a treatment for Bipolar disorder
Mindfulness has become an increasingly popular in recent years. Research has found mindfulness based therapy to be successful as part of a treatment for depression (Hofmann et al., 2010). This is of particular interest for the treatment for bipolar disorder, where treating depressive symptoms has to be carefully managed to avoid an increase in manic symptoms. This article will outline the main points relating to bipolar disorder, mindfulness, mindfulness based cognitive therapy, and six studies which have looked specifically at MBCT and its effectiveness as a treatment for bipolar disorder.
Bipolar disorder is one of the top 10 most disabling conditions in the world (Kupfer, 2005). It effects an estimated 1 percent of the population in its classic manic-depressive form (Weissman et al., 1996), also known as the bipolar I subtype. An additional 2 percent of the population suffer from other subtypes and related disorders (Kupfer, 2005). The pathogenesis of the disorder remains a subject of study, with genetic factors possibly contributing to bipolar risk (Fears et al., 2014). In 1995, the estimated cost of the disorder in the US alone was $45 billion per annum (Wyatt et al., 1995). On average, one-fifth of individuals with bipolar die by suicide (Jamison, 1996). It “may account for one-quarter of all completed suicides” (Diagnostic and Statistical Manual of Mental Disorders ???, 2013, p131). Episodes of hypomanic and depressive mood and energy levels characterise bipolar and related disorders.
Bipolar I disorder is a “modern understanding of the classic manic-depressive” . Manic episodes are periods of over a week in which there is an abnormally elevated mood and energy levels that cause impairments in social and work life. These often include a decreased need for sleep, and sometimes feelings of euphoria. Hypomania is the milder occurrence of mania, lasting at least four consecutive days and not necessarily causing life impairments. Depressive episodes are periods of two weeks in which a depressed mood or loss of interest occurs. These periods also include the possibility of weight loss, insomnia, fatigue, feelings of worthlessness, diminished ability to think, or thoughts of death.
The primary treatment for bipolar is mood stabilisers, often lithium, although recently anti-convulsants have proved successful to flatten the extreme emotions. Anti-psychotic medication is used to control manic episodes. Anti-depressant medication is used to control the depressive episodes; however anti-depressants can trigger and increase manic episodes . In extreme cases, electroconvulsive therapy is the preferred option (Dierckx et al., 2012). A combination of medication and psychotherapy, usually, has the best results.
Mindfulness, in short, is an awareness of, and a presence in, the now. It derives from the Buddhist meditation practice, involving a focus on the breath, the body, and sensations. In so doing, the practitioner practices self-regulation. In maintaining a focus of attention on the now, they develop a conscious awareness of their thoughts and thought patterns. The practice proposes that there are two distinct kinds of thinking; self-reference in the now and self-reference across time, a theory supported by fMRI studies (Farb et al., 2007).