MINDFULNESS

INTERVENTIONS FOR
BIPOLAR DISORDER
By: Emily Milord
Mindfulness in Clinical Social Work, Spring 2019
 Overview: What is Bipolar Disorder?
• Mood disorder
• Bipolar I, Bipolar II, Cyclothymic disorder & other bipolar
related disorders
• Bipolar I: manic episodes, and vast majority will
experience hypomanic and major depressive episodes
throughout their lifetime (DSM-5).
• Bipolar II: hypomanic episodes, and major depressive
episodes, but no mania.
 Mania vs. Hypomania vs. Depression
• Mania involves an elevated or irritable mood, reduced need
for sleep, pressured speech, inflated self esteem, reckless
behavior such as spending sprees (DSM-5).
• Can be accompanied by delusions and/or hallucinations
(i.e. psychotic features).
• Hypomania less severe version of mania, less impact on
functioning
• Depression (Can be accompanied by psychotic features).
• Mixed state
 Target Population
• Adults with Bipolar Disorder
ages 18+
• Average age of onset is
Age 25
• Adults with Bipolar 1 or
Bipolar II diagnoses
• With no current psychotic
symptoms ideally
Symptoms and Functional Consequences
• High suicide risk, at least 15% times of the general
population (DSM-5).
• BD may account for one-quarter of all completed suicides
(DSM-5).
• Lower socioeconomic status compared with the
general population (DSM-5).
• 30% show severe impairment in work role function
(DSM-5).
• Low self-esteem from job losses and social functioning
Are Mindfulness Interventions Appropriate for
Clients with Bipolar Disorder?
• Stressful life events are linked to the onset of mood disorders
• Mindfulness linked to reductions in stress (Lovas & Schuman-
Olivier, 2018).
• Mindfulness and psychosis may not mix, it could intensify
psychosis
• Other suspected issues: length of meditations difficult for people
with elevated mood, formal curriculum
• Let’s look at the research!
Applications of MBCT for Bipolar
Disorder
• Notice mood shifts and to accept them instead of avoid them
• may help to prevent the escalation of mood-activated patterns of unhelpful thinking.
• MBCT thought to be helpful for BD with cooccurring anxiety
• BD with cooccurring anxiety is linked to suicide attempts and poor overall outcomes(Williams et
al., 2008).
• Controlled trial of MBCT for BD for patients who are currently in between episode
anxiety symptoms, and have a history of suicidal ideation
• MBCT for 8 weeks
• Saw immediate relief in anxiety symptoms for those with anxiety
• Results: MBCT is effective for patients with BD who have suicidal ideation and anxiety
(Williams et al., 2008)
 Mindfulness Based Cognitive Therapy
(MBCT)
• Clinical trial: 12 group sessions weekly over 3 months
• Participants had symptoms of depression or mania, and
took medication.
• Learned to identify worsening mood through increasing
awareness to triggers, and through mindfulness to
sensations and thoughts.
• Mindful movement exercises, body scans
• Results: Depression scores significantly decreased following
MBCT treatment, mania did not decrease as a result of the
intervention
• Saw improvements in emotion regulation. Benefits
were maintained at 3-month follow-up (Deckersbach
et al. 2011).
 Dialectal Behavior Therapy (DBT) for Bipolar Disorder
• Originally developed for Borderline Personality Disorder (BPD) by Marsha Linehan,
(Van Dijk, 2009)
• Similar to BPD, clients with BD have trouble with emotion regulation, struggle with
relationships, and have turbulent moods and emotions.
• DBT can help manage overwhelming emotions in effective ways, handle distress
(Van Dijk, 2009).
• Use of psychoeducation, mood charting, developing skills, and radical acceptance
• Mindfulness exercises and meditation
DBT Skillset benefits for BD
• Core mindfulness skills
• Distress Tolerance Skills
• Emotional Regulation Skills
• Interpersonal Effectiveness Skills
 DBT Applications
• Help clients learn to recognize when they are in different emotional states
• Wise Mind vs. Emotion Mind vs. Reasoning Mind
• Emotion mind:
• Irrational thoughts, turbulent emotions, can lead to impulsive
decisions
• Wise Mind:
• Choosing to go for a walk when you feel like isolating yourself
• “Can you think of some examples of when you’ve acted in a way
that was satisfying in the short term but in the long run may have not
beneficial to you?”
• Reasoning Mind
• Bringing awareness to your thoughts - can help you act from wise mind,
rather than reacting from emotion mind (Van Dijk, 2009).
Which Mindfulness intervention is Best
for BD?
MBCT helpful for managing the course of the illness and
learning how to identify triggers and take action (such as call
psychiatrist to adjust medicine).
DBT helpful for managing symptoms within the mood episodes,
addressing interpersonal effectiveness, relationships, and
learning new skills such as distress tolerance.
• What they both have in common is psychoeducation, nonjudgmental
awareness of emotions, mindfulness meditation exercises
• Teaching people with BD formal curriculum of DBT or MBCT may help
them greatly during episodes, but it would be a challenge to engage
someone to learn it who is in mania.
 What people with BD have to say about
using mindfulness:
• Qualitative interviewing of clients who practiced Mindfulness over 18
months:
• Mindfulness practice more challenging when depressed
• Participants reported that with elevated mood it was possible to
establish decentred awareness by channeling energy and motivation
into formal practice (Chadwick, Kaur, Swelam, Ross, & Ellett, 2011).
• Self-Report Study of Benefits and Risks of Yoga for BD:
• Participants reported mostly positive emotional effects, reduced
anxiety, positive cognitive effects, or positive physical effects (e.g.,
weight loss, increased energy).
• 5 people reported instances increased agitation or manic symptoms
while doing yoga; 5 others experienced increased depression or
lethargy. (Uebelacker, Weinstock, & Kraines).
Overall Mindfulness Benefits for Bipolar Disorder
• Awareness to triggers and when an episode is
coming on
• Self-care to reduce their overall stress since
stress triggers mood episodes for people with BD
• Insight to their illness
• Improved interpersonal effectiveness and
relationships
• Awareness of symptoms can reduce impact of
the episode
• Improve cognitive functioning and attention
NASW Code of Ethics
Value: Dignity and Worth of the Person
• Ethical Principle: Social workers respect the inherent dignity and worth of the person.
• Value: Importance of Human Relationships
• Ethical Principle: Social workers recognize the central importance of human relationships.
1.02 Self-Determination
• Social workers respect and promote the right of clients to self-determination and assist clients in
their goals.
• Limit clients’ right to self-determination clients’ actions or potential actions pose a serious,
foreseeable, and imminent risk to themselves or others.
1.03 Informed Consent
 Final Thoughts
• Key Findings: MBCT and DBT both have promise
for relapse prevention and helping people with
Bipolar Disorder manage their symptoms

• MBCT is promising for long-term management of disorder,

and reductions in relapse.
• Mindfulness can reduce stress levels, and high stress levels
can lead to a mood episode.
• DBT may be effective in helping people manage their
symptoms during episodes and following them.
• Mindfulness a successful and appropriate adjunct to
other interventions for BD, medication, psychotherapy,
lifestyle choices.
 Resources
• Mindfulness for Bipolar Disorder
• Workbooks
• The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder by Sheri Van Dijk, MSW
• Mindfulness-Based Cognitive Therapy for Bipolar Disorder. By Deckersbach, Holzel, Eisner, Lazar, and
Nierenberg
• Mindfulness for Bipolar Disorder, How Mindfulness and Neuroscience can Help You Manage Your Symptoms.
By: William R. Marchand, MD
• Bipolar Disorder National Alliance on Mental Illness (NAMI)
• Book/Memoir: An Unquiet Mind (Kay Redfield Jamison, Johns Hopkins Professor of Psychiatry)
• Documentary: Stephen Fry “The Secret Life of a Manic Depressive”
• Bipolar News. Online research findings on bipolar disorder.
• www.bipolarnews.com
Books about Mindfulness:
• The Mindful Way Through Depression By Williams, Teasdale, Segal, and Kabat-Zinn.
• Wherever You Go, There You Are: Mindfulness Meditation in Everyday Life. By John Kabat-Zinn.
 References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
Jamison, K. (2000). Suicide and bipolar disorder. Journal of Clinical Psychiatry, 61(SUPPL. 9), 47-51.

Chadwick, P., Kaur, H., Swelam, M., Ross, S., & Ellett, L. (2011). Experience of mindfulness in people with bipolar disorder: A qualitative study. Psychotherapy
Research, 21(3), 277–285. https://doi-org.library.aurora.edu/10.1080/10503307.2011.565487

Deckersbach, T., Hölzel, B. K., Eisner, L. R., Stange, J. P., Peckham, A. D., Dougherty, D. D., … Nierenberg, A. A. (2011).
Mindfulness-based cognitive therapy for nonremitted patients with bipolar disorder.CNS neuroscience & therapeutics, 18(2), 133–141. doi:10.1111/j.1755-
5949.2011.00236.x

Lovas, D. A., & Schuman-Olivier, Z. (2018). Mindfulness-based cognitive therapy for bipolar disorder: A systematic review. Journal of Affective Disorders,
240, 247–261. https://doi-org.library.aurora.edu/10.1016/j.jad.2018.06.017

Pankowski, S., Adler, M., Andersson, G., Lindefors, N., & Svanborg, C. (2017). Group acceptance and commitment therapy (ACT) for bipolar disorder and
co-existing anxiety—An open pilot study. Cognitive Behaviour Therapy, 46(2), 114–128. https://doi-org.library.aurora.edu/10.1080/16506073.2016.1231218

Uebelacker, L. A., Weinstock, L. M., Kraines, M. A. (2014). Self-reported benefits and risk of yoga in individuals with bipolar disorder. Journal of Psychiatric
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Van Dijk, Sheri (2009). The Dialectical Behavior Therapy Skills Workbook for Bipolar Disorder: Using DBT to Regain Control of Your Emotions and Your Life
Oakland, CA, US: New Harbinger Publications, Inc.

Weber, B., Sala, L., Gex-Fabry, M., Docteur, A., Gorwood, P., Cordera, P., … Mirabel-Sarron, C. (2017). Self-Reported Long-Term Benefits of Mindfulness-
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org.library.aurora.edu/10.1089/acm.2016.0427

Williams, J. M. G., Alatiq, Y., Crane, C., Barnhofer, T., Fennell, M. J.,Duggan, D. S., et al. (2008). Mindfulness-based Cognitive Therapy (MBCT) in bipolar
disorder: preliminary evaluation of immediate effects on between-episode functioning. Journal of Affective Disorders, 107(1–3), 275–279.