This path may seem non-obvious, you might have had no idea about it before, or it might be in some drawer labeled “hippies.” However, a series of studies proves its effectiveness in treating bipolar disorder and describes it as another tool in managing the illness.
In this post, I will talk about the effects of mindfulness practice (based on research results) and share my own experiences with it.
The First Book
After a few years of treatment with a new doctor and about 3 years of behavioral therapy, the doctor recommended my first book. I asked for literature that might help me cope with the illness. The book was The Mindful Way Workbook [1].
The book is an 8-week course in MBCT – Mindfulness-Based Cognitive Therapy. “Mindfulness” refers to awareness, and “Cognitive” refers to cognitive functions, which are responsible for our perception of reality – processing, analyzing, and interpreting it. This means they influence our memory, concentration, decision-making, and problem-solving skills.
I wondered what all this had to do with bipolar disorder. I expected the doctor to recommend some manual on how to live with bipolar disorder. Indeed, the second book he recommended had such a message, but I’ll discuss that in the next post. Still, I decided to take on the challenge and complete the MBCT course.
The book provides reasons for practicing MBCT, but as a scientist, I am looking for confirmed evidence of its effectiveness in treating bipolar disorder. So, for the purpose of writing this post, I delved into the subject and used available scientific articles.
Behavioral Therapy
Behavioral therapy also focuses on cognitive functions, just like the MBCT course, but it does not rely on meditation. Instead, it involves recognizing emotions and thoughts and developing mechanisms for responding to them in a conscious, rational, and purposeful way. Thanks to this therapy, it is possible to detect early signs that hypomania (or mania) or depression might develop [2] and prevent relapses through conscious, preventative actions.
The effect of therapy that I appreciate the most is that I have come to accept “gray” moods and no longer eagerly wait for elevated moods. This helps me better manage situations, because fundamentally, I do not want to be in hypomania. Studies have shown that most patients prefer being in hypomania (or even mania) [3]. It’s also important to remember that being in hypomania is not beneficial, because sooner or later, there will be a rebound in the opposite direction (depression). The same happens in reverse, which is why taking antidepressants is not admitting failure but is often a preventive measure against hypomania.
MBCT is another step in behavioral therapy, where you develop deep awareness of your emotional state, accept it as it is, and allow it to naturally pass, preventing it from developing into chronic depression or mania.
Both tools are invaluable for people with bipolar disorder. Their use allows for flattening the mood “sinusoid,” which translates to more stable pharmacological treatment and an easier life for both the patient and their loved ones.
MBCT Course
MRI studies have shown that the activity of the medial prefrontal cortex (PFC) is lower in individuals with bipolar disorder compared to healthy individuals. However, after an 8-week MBCT course, this activity significantly increases in patients. The PFC is responsible for cognitive functions. Moreover, studies demonstrate improved emotional regulation and reduced anxiety after completing the course [2]. Thanks to neuroplasticity, changes are possible at any age.
Research results show that individuals with BD have a higher tendency for rumination [4], which is the attempt to find a solution to alleviate bad feelings by imagining what can be done about it [1]. This approach almost always leads to a self-perpetuating spiral and causes even deeper depression. In contrast, mastering mindfulness allows for consciously directing attention in a kind, curious, and accepting (non-judgmental) way, regardless of whether we are experiencing unpleasant or pleasant feelings. With appropriate practice, this approach helps eliminate aversion, or automatic avoidance of unpleasant experiences, which often intensifies discomfort.
In individuals with mood disorders (depression, bipolar disorder, etc.), improvement has been observed in the form of reduced disease relapses (episodes of mania, hypomania, depression) after an 8-week MBCT course, which has proven to be as effective as pharmacological treatment [5].
People with bipolar disorder also exhibit reward processing disorders, contributing to comorbid conditions like addictions. This is related to the activity of the neurotransmitter – dopamine, which I discussed in a previous post. Again, studies show that MBCT inhibits the response of these neurotransmitters [5].
How to Approach the Course
At the very beginning of the MBCT course, it is emphasized that one must be very disciplined in carrying it out. This means practicing the exercises (meditations) systematically 6 days a week. I decided to meet these requirements. However, due to various factors – mood (mostly), or other commitments – after a few weeks, I missed one or two sessions. At such times, I considered the course a failure and would stop it. I had such approaches (with high expectations) four times over the course of 3 years. Now, when I’m taking the course again, I try to have more self compassion. If I miss a session, I either extend the week by one or two days or skip the session. I try to achieve the desired effect hence allowing for small deviations. This will ensure I finish the course – perhaps not perfectly, but I will definitely benefit from it and continue practicing the appropriate meditations after it ends.
The course requires choosing a good time. It’s best to select a period of euthymia or mild depression. During such times, you are usually calmer and not burdening yourself with too many tasks. However, low motivation can be an obstacle. According to studies, people with bipolar disorder find it easier to complete the course during depressive states than during hypomania or mania [3].
What the Course Entails
The book is structured so that the first few chapters introduce some theory, which also serves as a motivator. Then, each week corresponds to one chapter. This includes specific exercises to be carried out that week, comments, an introduction, and spaces to write down experiences and perform a few exercises. Since the book is filled with statements and dialogues from other participants who have completed the course, it gives a sense of support and group work. All the meditations are guided, meaning recordings are available for download or streaming, with a pleasant voice leading you through the meditation. These are short meditations (5–10 minutes) as well as longer ones (40 minutes).
At the first meditation and even for a few sessions afterward, I felt like I was doing something abnormal, funny, maybe even foolish. Don’t be discouraged by this – after a few sessions, it becomes normal, especially since you will notice results almost immediately!
Tangible Effects
I think everyone will experience the effects of such a course a bit differently, as they will apply the learned techniques to their own problems. I started to notice the space around me quite quickly, and I felt peace, comfort, and joy in simple things, as I focused all my attention on them. I stopped washing dishes with a furrowed forehead, worrying about something, reminiscing, or planning. Household chores became a rest for my mind. I began functioning in a mode from experience to experience and knew that now I was driving or cycling past the supermarket, rather than suddenly realizing I was somewhere else, and the whole trip flew by without me knowing what I was thinking about. And usually, I didn’t even realize what those thoughts were causing. Now I notice that my back or stomach is tense, I breathe harder, or I’m breathing faster.
Thanks to learning to notice signals in my body and name my feelings (psychological state), I have the chance to let them pass peacefully without deepening my emotions, and focusing on my breath helps soothe them. Because I have a keen insight into what’s going on inside me, I can correlate emotional states with specific events and/or make better choices for my health. For example, if I notice I’m excited and feel a buildup, I might choose not to buy something or not to go to the cinema. If I see that this might be due to a recent meeting with a large group of people, I might try to avoid such situations during that period.
It is not true to say that mindfulness allow you to control emotional states because it’s rather about observing them non-judgmentally, but at the same time, it magically restores balance or the baseline state. This reminds me of Heisenberg’s uncertainty principle in physics, which states that the observation of a state indicator can change that state.
All this translates not only into early detection and prevention of extreme states or even small disturbances but also significantly improves daily life, enhancing its quality.
Halfway through the course, I encountered a new term, “aversion,” and thought it didn’t apply to me. It turned out, however, that it accompanied me almost constantly. Until now, I couldn’t function without some “talker”; a movie or music in the background or a phone conversation. Cleaning, cooking, walking, exercising, or falling asleep always took place with background noise. They were meant to drown out unpleasant feelings. It got to the point where I felt panic when leaving the house to walk 500 meters to the train station, fear of falling asleep in silence, or anxiety when my tablet ran out of battery and I had to cook.
With all my might, I tried to drown out persistent negative, judgmental thoughts – shame, sadness, fear. Now, however, I actively seek silence and nourish myself with it. Taking a bath in silence and using it as therapy and rest is also suggested by the book Silence [6].
Motivation
Reading works [1, 6, 7] is a great motivator for completing the course because these books provide many examples of situations that happen to different people and logical, undeniable evidence. For me, motivation comes from wanting a better life and not accepting the explanation “… because I have bipolar disorder and that’s how it is.” But my biggest motivation comes from my loved ones, especially my husband, who lives with me daily and has to cope with my illness at times, bearing more of the cost than I do. I don’t want to be a burden to him, and I also want to be ready to support him. Just the fact that someone is making an effort is incredible support for the loved ones. Inactivity and staying in the illness can be compared to not changing lifestyle habits when dealing with coronary disease.
Summary
The foundation for treating bipolar disorder is medication (especially for BD type I), followed by behavioral therapy, and nowadays MBCT is increasingly becoming a standard addition to the treatment system. These three elements, when adopted correctly and in this order, yield incredible results. Using behavioral therapy alongside medication and adding the MBCT course might feel overwhelming. The inability to complete therapy due to poorly adjusted medications and a chaotic sate of the body can be demotivating. Having the best doctor in the area and the best therapist is a key condition for successful treatment. Unfortunately, such doctors and therapists are few (at least in Poland).
These three pillars are often built over many years, depending on the type of the illness, so one must be patient, surround themselves with supportive people, and take action.
– Agnieszka
*The information and comments in this post do not constitute medical advice. The author takes no responsibility for any use of them.
[1] J.Teasdale, M. Williams, Z. Segal. 2014. The Mindful Way Workbook: An 8-week Program to free yourself from depression.
[2] Victoria L Ives-Deliperi, Fleur Howells, Dan J. Stein, Ernesta M. Meintjes, Neil Horn. 2013. The effects of mindfulness-based cognitive therapy in patients with bipolar disorder: A controlled functional MRI investigation.
[3] Paul Chadwick, Hardeep Kaur, Maged Swelam, Susan Ross, Lyn Ellett. 2011. Experience of mindfulness in people with bipolar disorder: A qualitative study.
[4] David A Lovas, Zev Schuman-Olivier. 2018. Mindfulness-based cognitive therapy for bipolar disorder: A systematic review.
[5] Kuyken, W., Hayes, R., Barrett, B., Byng, R., Dalgleish, T., Kessler, D., Lewis, G., Watkins, E., Brejcha, C., Cardy, J., Causley, A., Cowderoy, S., Evans, A., Gradinger, F., Kaur, S., Lanham, P., Morant, N., Richards, J., Shah, P., Sutton, H., Vicary, R., Weaver, A., Wilks, J., Williams, M., Taylor, R.S., Byford, S., 2015. Effectiveness and cost-effectiveness of mindfulness-based cognitive therapy compared with maintenance anti-depressant treatment in the prevention of depressive relapse or recurrence (PREVENT): a randomised controlled trial
[6] Thich Nhat Hanh. 2015. Silence: The power of quiet in a world full of noise.
[7] J.Teasdale, M. Williams, Z. Segal, J. Kabat-Zinn. 2007. Mindful way through depression: Freeing yourself from chronic unhappiness