Meditation for Bipolar Disorder - Does It Work?
According to Fortune magazine, the meditation and mindfulness industries made over $1 billion in 2015. In fact, the popular mindfulness app Headspace has been downloaded over 6 million times. In recent years, the mainstream acceptance of meditation practices has become so common that critics have referred to it as the “McMindfulness” movement (Safran, 2014).
According to PsychologyToday.com, “meditation is a mental exercise that trains attention and awareness”. The earliest forms of meditation are based on Hindu Vendatism from over 3,000 years ago. Modern forms of meditation practiced in the West are based on the work of American Professor Jon Kabat-Zinn who popularized Mindfulness-Based Stress Reduction (MBSR) in the 1990s. Since that time, mindfulness has been shown to be effective in treating depression and anxiety in several scientific studies (Hoffman, 2017).
But what about a complex condition like bipolar disorder? Can something as simple as sitting still and focusing on the breath offer any relief?
Meditation for Treating Adults with Bipolar Disorder II: A Multi-city Study
The article Meditation for Treating Adults with Bipolar Disorder II: A Multi-city Study (Pandya, 2019) by Samta Pandya contributes to the research of mindfulness-based cognitive therapy (MBCT) as a therapeutic tool in the treatment of individuals with bipolar II disorder (BP-II). As Pandya states “some recent reviews on mindfulness and bipolar disorder have exhibited mixed results” (Pandya, 2019). A study in 2018 by Sanja Bojic and Rodrigo Becerra showed that when BP-II patients practiced meditation multiple times per week over a one-year period in conjunction with pharmaceutical therapies, there was a significant reduction of depression and symptoms of mania (Bjorc & Becerra, 2017).
However, subsequent studies and meta-analyses have not been as conclusive; with confounding variables such as “socio-demographic profile, symptom severity, and comorbidities” (Pandya, 2019) muddying the waters. Therefore, the purpose of Panda’s study was to generate more evidence as to the effect of meditation therapies on BP-II patients. In particular, Pandya focused on the effects of a customized meditation program on patients seeking treatment during a period of depression. She also attempted to identify the extent to which other demographic factors impacted the results of the meditation intervention.
An International Research Study on Meditation for BP-II
Pandya conducted her research in eight cities in Asia and Africa. In each city, four clinics identified patients with BP-II that would undergo the meditation regimen. A total of 622 patients were selected for the trial. Of these, 311 were randomly selected to receive the customized meditation therapy and 311 were assigned to a control group.
The researchers used the Bipolar Depression Rating Scale (BDRS) in a pre-intervention survey to assess the intensity of each patient’s depressive symptoms. In the BDSR, patients rate their symptoms on a scale from 0 to 3 (from low to high intensity). Symptoms reported include depressed mood, sleep disturbances, anhedonia, and feelings of worthlessness or helplessness among other factors. Each patient also was asked to provide background information about their demographics and social environment.
The intervention itself took place over 4 days with half-hour meditation sessions guided by a clinician each day. The meditation program included, to name a few techniques, “sitting still and contemplating something that brings joy”, “standing in the center position and contemplating by focusing on the place which is in between the eyebrows”, and lying motionless on the back while performing a muscle relaxation exercise. The 4-day intervention was then repeated 10 times over the course of 2 years.
While the intervention group received the customized meditation sessions, the control group received standard cognitive-behavioral therapy sessions. Then, the clinicians again administered the BDRS to both groups. The intervention group also answered questions about the extent of their meditation self-practice outside of the clinic.
Practice Makes…Better
Pandya sums up the research in the first line of her concluding discussion: “Results support the initial study hypothesis. The spiritual technique of meditation has a positive impact in terms of stabilizing moods of adults with BP-II” (Pandya, 2019). However, a closer look at the data homed in on a few specific findings that are most significant to the body of research regarding meditation as a treatment for BP-II.
To begin, the factor with the strongest link to improved post-intervention BDSR results was regular self-practice outside of the clinical intervention. Fifteen percent of the variance in the post-test was explained by this one factor alone (Pandya, 2019). Adding further weight to the benefit of meditation was the finding that when patients attended all 10 sessions over the 2-year period and regularly self-practiced, the severity of symptoms was reduced.
However, other factors also contributed to lower BDSR scores including country of origin, religion, gender, and marital status. Commenting on religious affiliation as a factor, Pandya says, “The characteristic of the intervention (meditation) was such that patients from Asian cities and Hindus and Buddhists were more responsive. This could be due to greater allegiance of meditation to their own belief patterns and systems” (Pandya, 2019). Indeed, meditation practice is not unfamiliar to many individuals in Asian countries. Understandably, westerners would be less familiar and possibly even less accepting of such a foreign spiritual practice. Pandya suggests addressing this challenge with “more culturally attuned meditation programmes” (Pandya, 2019).
In future research, more focus will need to be placed on controlling for variables of gender and marital status. Also, there is the consideration of time. The study was 2 years in length. The question remains as to the extent that the improvement was a result of regular meditation practice and to what extent it was a result of time as “a self-healing variable” (Pandya, 2019).
Further Research & Potential Applications
Meditation for Treating Adults with Bipolar Disorder II: A Multi-city Study was a noble attempt to add to the research data surrounding the use of meditation in the treatment of BP 11. Researchers must continue to explore options in the treatment of patients with this complex mental health challenge. The biopsychosocial framework for mental illnesses theorizes that mental health challenges such as BP II result from genetic (bio), cognitive (psycho), and sociological (social) components. While pharmacotherapy can be used to address the biological and neurological underpinnings of BP-II, meditation could be used to address some cognitive factors.
Pandya’s research contributes to the argument that a regimen of mindfulness practice can be of therapeutic benefit for individuals who suffer from depressive episodes or BP-II. Further research could be designed in a way to control for the factors of variance identified in this study including gender, relationship status, and religious or cultural background. If mindfulness practice really can bring significant relief to sufferers, then it would be helpful to identify the specific components of the practice that are therapeutic. Beyond this, clinicians could use data on the required regularity of self-practice when designing programs for patients.
Pandya alludes to the neurological effect of meditation on “brain regions that regulate attention control, affect, and emotions” (Pandya, 2019). It would also be interesting to learn how meditation can alter or reduce self-defeating cognitive patterns such as cognitive distortions and pessimistic attribution styles. The spiritual purpose of many historical forms of meditation is for the practitioner to achieve enlightenment. Further research needs to be done to understand how this spiritual goal relates to emotional regulation and cognition and whether the so-called mystical experience attained by some mindfulness practitioners can be stripped of its supernatural regalia and translated into a western clinical setting.
It is clear from this research that meditation practice is more than a “McMindfulness” quick fix for a diagnosis so complex as BP-II. However, as research leads to a greater understanding of the therapeutic effects of meditation and how they can be leveraged to support BP patients, clinicians can feel more confident prescribing formalized meditation interventions rather than offering the trepidatious suggestion heard in many a therapist’s office today that a patient “might try meditation”. Just as a general practitioner doctor confidently recommends cardiovascular exercise, so mental health practitioners could confidently recommend proven methods of mindfulness meditation to individuals to treat the psychological poles of BP-II.
For a discussion of some of the insights I have gained in my forays into mediation, visit my blog.
References:
Bojic, S., & Becerra, R. (2017). Mindfulness‐based treatment for Bipolar Disorder: A systematic review of the literature. Europe's Journal of Psychology, 13(3), 573–598. https://doi.org/10.5964/ejop.v13i3.1138
Hofmann, S. G., & Gómez, A. F. (2017). Mindfulness-based interventions for anxiety and depression. Psychiatric Clinics, 40(4), 739-749.
Meditation (2021). Psychology Today. Retrieved from: https://www.psychologytoday.com/us/basics/meditation
Pandya SP. Meditation for treating adults with bipolar disorder II: A multi‐city study. Clin Psychol Psychother. 2019;26:252–261. https://doi.org/10.1002/ cpp.2347
Safran JD (2014). "Straight Talk. Cutting through the spin on psychotherapy and mental health". Psychology Today.
