Ruwan M Jayatunge M.D.
Bipolar Affective Disorder (BPAD) is a chronic and
disabling psychiatric disorder characterized by recurrent episodes of
mania/hypomania and depression (Van Dijk et al., 2013). In
BPAD psychosocial functioning and quality of life often remain impaired between
mood episodes (Ball et al., 2006; Becerra et al., 2013). Bipolar
Disorder presents in 1-4% of the world's population, carrying significant
financial and functional consequences (Stump & Eng, 2018). The long-term outcomes of bipolar disorder range from lasting remission to
chronic course or frequent recurrences requiring admissions (Uher et al.,
2018). Bipolar disorder is the sixth leading cause of disability
worldwide (Murray et al., 1996).
According to the American Psychiatric Association (2000) symptoms of bipolar disorder
include happiness and irritability, decreased need for sleep, racing thoughts,
excessive confidence, increased energy, psychomotor agitation, and willingness
to engage in reward-oriented behaviors without consideration of potential
negative consequences. There are two main types of bipolar disorders; bipolar I
and bipolar II. Bipolar I disorder is
defined by at least one lifetime manic episode, whereas bipolar II disorder is
defined by less severe hypomanic episodes along with depressive episodes (Johnson
et al., 2012).
Bipolar patients are more prone to heart and metabolic diseases
as well as a higher risk of suicide compared to the healthy population (Riveros
& Retamal, 2018). Yatham and colleagues (2018) state that approximately 6%‐7% of identified patients with BD dying by
suicide.
The co-occurrence of bipolar disorder and anxiety disorder is
associated with a worse prognosis (van der Veen et al., 2018). According to
Simon and team (2005) BPAD has high comorbidity with anxiety disorders which is
approximately 62%. Many individuals with bipolar disorder have cognitive difficulties
and are disorganized in their daily lives (Deckersbach et al., 2012).
Deficient emotion regulation is closely related to
Bipolar Affective Disorder (Rheenen et al., 2014). Emotion regulation involves a coherent
relationship with the self, specifically effective communication between body,
mind, and feelings and effective emotion regulation involves the ability to
accurately detect and evaluate cues related to physiological reactions to
stressful events, accompanied by appropriate regulation strategies that temper
and influence the emotional response
(Price &Hooven, 2018).
Emotional processing in bipolar disorder is impaired
(Howells et al., 2014). Wessa
and Linke( 2009) state that in
response to emotional stimuli bipolar patients show a dysfunction in a
ventral-limbic brain network including the amygdala, insula, striatum,
subgenual cingulate cortex, ventrolateral prefrontal cortex and orbitofrontal
cortex. They hypothesized that this imbalance between the two networks has
been proposed to underlie deficient emotion regulation in bipolar disorder.
BPAD has high relapse rate, morbidity and psychosocial
impairment that often persist despite pharmacotherapy, highlighting the need
for adjunctive psychosocial treatments (Reinares et al., 2014).
The management of BPAD is a
challenge. Treating bipolar depression is based on the
combination of mood stabilizers and psychotherapy (McMahon et al., 2016). Some
Psychiatrists recommend mindfulness based interventions for the patients who
are diagnosed with BPAD. According to these clinicians there are improvements
in cognitive functioning and emotional regulation, reduction in symptoms of
anxiety depression and mania symptoms following mindfulness interventions.
Dr. William Marchand, Professor of Psychiatry at the
University of Utah, has experience using mindfulness-based interventions (MBIs)
for bipolar spectrum conditions. He
states that anecdotally, individuals with these conditions report that they
find MBIs to be helpful in managing their illness. Further, he says that
scientific evidence is accumulating that MBIs may be effective adjunctive
treatments for bipolar disorders (personal communication, 2018).
Chu and team (2018) reported the effectiveness of
adjunct mindfulness-based intervention in treatment of bipolar disorder.
Mindfulness interventions are based on teaching patients to pay complete
attention to the present experience and act nonjudgmentally towards stressful
events. During this mental practice the meditator focuses his or her attention
on the sensations of the body. While the distractions (mental images, thoughts,
emotional or somatic states) arise the participant is taught to acknowledge
discursive thoughts and cultivate the state of awareness without immediate
reaction (Bulzacka et al., 2018). It is a moment-to-moment awareness with
qualities of kindness, curiosity, and acceptance.
Meditation practice has been found to promote well-being by fostering
cognitive and emotional processes (Boccia et al., 2015). Mindfulness based cognitive
therapy may improve emotional processing in bipolar disorder (Howells et al.,
2014). Mindfulness influences neural processes in
midline self-referential and lateralized somatosensory and executive networks
(Lee et al., 2017). According to Tang and Posner (2016) mindfulness meditation improves
emotion regulation. Stange and team (2011) surmise that mindfulness
intervention may be a treatment option
that can be used as an adjunct to medication to improve cognitive functioning
in bipolar disorder.
