Category Archives: Depression

Learn From the Founder of Mindful Awareness in Body-oriented Therapy (MABT)

By Cynthia Price

Cynthia Price, PhD MA LMT is a Research Associate Professor at the University of Washington in Seattle.  Shestudies Mindful Awareness in Body-oriented Therapy (MABT), an approach she developed to facilitate body/interoceptive awareness and related skills for self-care and emotion regulation.  She has clinical and research expertise working with people who are disconnected from their bodies due to trauma, chemical dependency, chronic pain or other life stressors.  Director of the non-profit Center for Mindful Body Awareness http://www.cmbaware.org/ she is involved in training clinicians in the MABT approach and implementing programs, particularly for underserved populations, to help make somatic awareness more available to more people.

Interoceptive awareness – the awareness of inner body sensations – is integral to mindfulness practice.  Most often, in mindfulness classes and practice, people engage in interoceptive awareness by attending to the sensation of their breathing or by engaging in a body scan.  Learning to become aware of how one feels inside is critical for gaining access to emotions, the link between emotions and physical sensations, and having an overall embodied sense-of-self.  Likewise, learning to integrate mindful attention to bodily experience in daily life can enhance regulation and self-care.

However, mindful attention to the body is not easy for everyone.  This tends to be particularly true for people who are unfamiliar with the practice, those who have high levels of stress, and those who may avoid awareness of their inner body sensations due to physical or emotional pain, for example those with a history of physical and/or sexual trauma. For some, individualized assistance in a safe therapeutic relationship is needed to develop interoceptive awareness as well as the capacity for sustained attention to internal experience. Mindful Awareness in Body-oriented Therapy (MABT) was developed to explicitly teach fundamental interoceptive awareness skills and to develop the capacity for sustained attention to interoceptive experience. The MABT approach grew out of Cynthia Price’s clinical work with people who were seeking emotional awareness and healing but were disconnected from their bodies. In more recent years, research findings highlight how helpful the MABT approach can be for reducing mental and physical health distress and for increasing emotion regulation.  As one research participant wrote about learning this approach:  “I tried meditating over the years and I was never able to concentrate. With MABT, I was able to slow my mind down and then follow what she (the therapist) was saying, concentrating on a body part, and what I was feeling and afterwards talking about that. Eventually, I learned to do that by myself. This is why I thought this approach was amazing because it taught me to meditate. Now I meditate every night. The difference is having someone lead me into learning how to do it first.’’ 

Join Cynthia Price and her colleagues for the Mindful Awareness in Body-oriented Therapy (MABT) professional training, April 28 – May 7, 2018 at Joshua Tree Retreat Center, Joshua Tree, CA. Mindful Awareness in Body-oriented Therapy (MABT) is an empirically validated 8-week intervention that combines manual, psychoeducation, and mindfulness approaches to teach interoceptive awareness and related practices for self-care and regulation.  To learn more, listen to the Liberated Body podcast in which Cynthia describes the MABT approach:  https://www.liberatedbody.com/podcast/cynthia-price-lbp-060

References:

  • Price, C. & Smith-DiJulio, K. (2016). Interoceptive Awareness is Important for Relapse Prevention: Perceptions of Women who Received Mindful Body Awareness in Substance Use Disorder Treatment. Journal of Addictions Nursing, 27 (1): 32-8. PMC4784109.
  • Price, C., Wells, E., Donovan, D., Rue, T.  (2012). Mindful Awareness in Body-oriented Therapy as an Adjunct to Women’s Substance Use Disorder Treatment:  A Pilot Feasibility Study.  Journal of Substance Abuse Treatment, 43: 94-107.
  • Price, C., Taibi, D., Smith Di-Julio, K., Voss, J. (2013). Developing Compassionate Self-Care Skills in Persons Living with HIV: a Pilot Study to Examine Mindful Awareness in Body-oriented Therapy Feasibility and Acceptability. International Journal of Therapeutic Massage and Bodywork, 6(2): 1-11.
  • Price, C., McBride, B., Hyerle, L., Kivlahan, D. (2007).  Body-oriented Psychotherapy for Female Veterans with PTSD Taking Prescription Analgesics for Chronic Pain: A Feasibility Study.  Alternative Therapies in Health and Medicine, 13(6):32-43.
  • Price C. (2005).  Body-Oriented Therapy in Recovery from Childhood Sexual Abuse:  An Efficacy Study.  Alternative Therapies in Health and Medicine, 11, (5): 46-57.

 

 

Navigating Aortic Valve Replacement (AVR) Surgery with mPEAK and Mindfulness

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Read this very personal story from a recent mPEAK participant and Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

By William R. Matthews, MA, LPC

Medical literature contains numerous references proclaiming the benefits of meditation and mindfulness on cardiovascular health and pain management. But to me, these were merely academic case studies, as I had not personally known anyone who had successfully used mindfulness to manage through a major medical procedure. That is, until August 17, 2016, when I had aortic valve replacement surgery.

I need to back up a moment. In March of 2016 I participated in the three-day mPEAK intensive that included six weekly one-hour conference call follow-ups. For me the follow-up sessions were critical for integrating the didactic and practice sessions taught in the three-day into a consistent meditative practice. mPEAK was my first hands-on experience with mindfulness. At that point in time, I had been aware for several years that I had a bicuspid aortic valve that would “eventually” need replacement (in fact it kept me from fully participating in the five-mile mindful walk that is part of the program), but there had been no discussion of surgery with my primary physician or cardiologist. Two months after returning from mPEAK, my new primary care physician sent me for an ultrasound of my heart. The results indicated significant blockage of the aortic valve, and that started the ball rolling for surgery “as soon as possible.”

When a date for surgery was set, I emailed mPEAK ccf9e-headshot2program director, Peter Kirchmer, asking if he could provide me with additional mindfulness resources on pain management, since that seemed to be a big concern connected to surgeries. In response, Pete wrote “Forget about additional resources. You have everything you need already. Just continue developing the skills you already have.” Wise counsel indeed. So I loaded up my iPod with all the meditation files mPEAK had made available to us on its website, added John Kabat-Zinn’s Mindfulness Meditation for Pain Relief, and a few other meditations. I played these every evening before bed, in the waiting lounges of airports, and in my office sharing them with my clients. Ultimately, my iPod was headed with me to the hospital.

The night before surgery I slept soundly without the benefit of any sleep aid other than my meditation-filled iPod. I arrived at the hospital at 5:40 AM surgery day and was taken back to pre-op shortly thereafter. The nurse remarked that my blood pressure showed no signs of anticipatory anxiety.  I too was surprised at how calm I was considering someone was about to cut my chest open and mess with my heart. I told the nurse about my mindful preparation and she asked a lot of questions of interest to learn more. A brief chat with a family member, a friend and a short prayer from the rector of my church was all I remember before waking up almost six hours later.

I awoke in recovery to see the same three faces that I had left there that morning. After a few minutes I was taken to cardiac ICU. A nurse and a member of the physical therapy team armed with a pillow were waiting for me. The PT announced that she was there to help me get into bed by “leaning into my pain and clutching the pillow” as my incisions were on the right side along with two chest tubes. Even in my post-anesthesia fog, my mind went immediately to a body scan, noting that my left side was incision- and tube-free. I also made a mental note that at home my bedroom is set up so that I can only get into bed from my left side. I got up off the gurney without assistance walked around the end of the hospital bed, sat down and got into bed on the left side of the bed without assistance (with minimal pain) and said, “I think I’ll do it this way instead.” The PT could only respond, “I guess that way’s OK too.”

The nurse waiting her turn with me announced that she was there to help me with pain management. She advised, “The key to pain management is staying ahead of the pain.” I interpreted that to mean don’t wait until the pain gets bad, keep taking your medication. At that point my mind recalled an activity from mPEAK where we were asked to insert a hand up to mid-forearm into a bucket of ice water and keep it there until the pain started to hurt. Most people removed their hands from the buckets in under a minute. The teachers explained that a large part of managing pain is changing our relationship to the pain. After sharing techniques and mindsets for doing so, we were given the opportunity to try immersing our hands into the ice water again. Most everyone were able to keep their hands in the ice water for considerably longer the second time around. With this recollection I informed the nurse of my plan – to measure my pain on a scale from 0-5 every hour or so, and if the pain number was not any higher than the last “reading” I wouldn’t be asking for pain medication. I received medication for pain only twice: 1) shortly after arriving in the ICU and 2) later that day when they removed the chest tubes. By the next morning, the day after surgery, I had discontinued all pain medication for the remainder of my hospital stay.

Prior to my surgery, my cardiologist and cardiac surgeon both agreed that I would need to go to a rehab facility “for at least a week” after being discharged from the hospital because I live alone. However, I created a dilemma for them because my recovery was so quick and complete. The discharge social worker advised me that I didn’t meet any medical criteria for rehab placement. She even had PT and OT evaluate me one more time in hopes of coming up with some reason to get me admitted, but neither could come up with a medical need. So I was discharged after 4-1/2 days, with my doctors agreeing that I could stay with a friend who lived within a mile of the hospital. I had a return visit to the cardiac surgeon four days afterward. At that appointment my cardiac surgeon said I was free to go back home and decide for myself when I would go back to work. I was back to work half-time three weeks after surgery and returned to full-time work the following week.

While I wouldn’t necessarily put AVR surgery in the category of a high performance activity, I am convinced that the skills and tools I learned from mPEAK, played a central role in my recovery.

William R. Matthews, MA, LPC is in private practice with the Great Lakes Psychology Group. Bill works out of GLPG’s office in Clinton Township, Michigan, where he counsels with children, adolescents and adults using family systems, EMDR, Mindfulness and sports psychology approaches. Bill is also a volunteer trainer and curriculum consultant for the University of Notre Dame’s Play Like a Champion Today educational program. Bill can be reached at bill.matt.GLPG@gmail.com.

Join Pete Kirchmer for the next mPEAK 3-Day Intensive March 11-13, 2017, UC San Diego Center for Mindfulness, San Diego, CA.

ccf9e-headshot2Pete Kirchmer is  the Program Director for the UCSD Center For Mindfulness mPEAK (Mindful, Performance Enhancement, Awareness & Knowledge) Program. Pete specializes in coaching his clients in applying the practice of mindfulness to making healthy lifestyle changes as well as improving performance in life, work and sport. For more information about Pete Kirchmer please visit his Mindfulness Based Health Coaching website.

Learning to Teach MBCT Practices Via the Web: Technology Supporting Teacher Development

By Zindel Segal, PhD and Sona Dimidjian, PhD

Online Training for Teaching Mindfulness In Your Clinical Practice

Z MindfulNoggin_email_adIt was February in 2010, Sona and I were at the end of the fourth day of teaching together a five-day intensive training in MBCT. We were sitting in the lodge of the meditation retreat center in Joshua Tree, California enjoying the beauty, silence, and spaciousness of our surroundings and beginning to engage a question raised by participants in that workshop, like many before them and many to come: how do I carry all that I have learned back into my daily life and work setting? It is a common reaction among participants who have taken MBCT clinical workshops. It usually surfaces towards the end of the training and is expressed in questions such as ‘what comes next?’ or ‘how can I support my learning?’. As we reflected on these questions, we realized that some of the searching arose from the very natural apprehension about returning to solo practice after days of instructed group learning and returning to the hustle and bustle of daily life after engaging deeply the practices of MBCT in a retreat setting. At the same time, however, we also heard in these questions a desire for more support, guidance and community in their intention to integrate the skills and practices they had learned over the week. We began to wonder about ways in which we could support such intentions, building on what we could provide during in person workshops. How could we best support practitioners as they worked to strengthen the experiential and content learning that comes with personal practice and clinical implementation?

mmb-enroll-imgThe issue resurfaced in an interesting way, during our collaboration to develop an online version of Mindfulness Based Cognitive Therapy. We evaluated this digital version of MBCT – called Mindful Mood Balance – in a quasi-experimental open trial with 100 recovered depressed patients at Kaiser-Permanente Colorado and got promising results, Sona Dimidjian, S. Beck, A. Felder, J. Boggs, J. Gallop, R. & Segal. Z. (in press). Web-based Mindfulness-Based Cognitive Therapy for reducing residual depressive symptoms: An open trial and quasi-experimental comparison to propensity score matched controls. Behaviour Research and Therapy. We are continuing this work on extending MBCT for patients with a recently funded, larger definitive, randomized trial that we will conduct with recovered depressed patients reporting residual depressive symptoms (R01 – MH102229). As we developed Mindful Mood Balance, we began to realize that it was one way we might respond to the questions that were raised at the Joshua Tree retreat center in 2010. Mindful Mood Balance was built to teach patients explicitly some of the core skills of MBCT, but it also might be a valuable resource for clinicians who want to get the “feel” of the MBCT curriculum as it unfolds over time and who might benefit from the structure of an 8-week program in supporting their own practice of the core elements of MBCT. With this knowledge in mind, we also began to imagine other ways in which we could offer training to clinicians on some of the more subtle and challenging aspects of delivering MBCT. We built a program that taught therapists the detailed use of one of the core MBCT skills, the three minute breathing space, which they could use with their clients. We didn’t see either of these offerings as a replacement for in person training, but as another option in the array of treatment/ training resources, with distinct advantages of being able to learn from one’s home on one’s own schedule. .

The Three Minute Breathing Space Course, for example, teaches therapists how to deliver this practice, how to perform inquiry, how to make one’s own recordings and how to integrate the practice into daily life.

Therapists can also participate in a community of learners who are taking the course at the same time. Provided there is interest and benefit, our vision would be to build more contexts for learning responsive to what clinicians find challenging in delivering MBCT.

We have partnered with eLearning experts Brian and Traci Knudson in order to integrate clinical science and leading e-Learning technology, in courseware for health care professionals who want to enhance and enrich their clinical practice through delivering compassionate and effective mindfulness-based interventions. While it is still early days, we are curious to find out whether such modern / technological means can help support others in their use of these ancient / simple practices.

zindel_segal_120x1561Zindel Segal is one of the co-founders and developers (along with John Teasdale and Mark William) of Mindfulness-Based Cognitive Therapy (MBCT). Dr. Segal, along with Sarah Bowen and Steven Hickman, will be leading a 5-Day Professional Training Retreat in MBCT on February 15-20, 2015 at the EarthRise Retreat Center in Petaluma, California. Registration is now open for this experiential training event.

 

 

Hurrying up so we can slow down!

CharWilkinsBy Char Wilkins, MSW, LCSW
Mindfulness Teacher and Trainer

Well of course that makes sense! We leave work and drive too fast to get home so we can finally relax.  Between patients we scribble notes in the file, run to the bathroom, and make a phone call while slurping caffeine so that after the next patient we can catch our breath. We inhale lunch without looking at it while we order holiday gifts on online because we don’t want to waste time just eating.

“Deck the halls with boughs of holly,
tis the season of endless folly.”

It’s high season for too much and not enough, and Heart Hunger moves to the number one spot on Jan Chozen Bays’ list of Seven Hungers. As the holiday hype heightens and family drama, anxiety, depression and distress eating increase, we may feel anxious about our ability to respond to our patients’ escalating worries and fears about out of control holiday eating.  As clinicians, may find ourselves thinking that the problems that come with the season are just too much and that we don’t have what it takes to help those in our care with their overwhelming concerns.

holiday-foodDuring this holiday season of “food fests” at the office, with family and friends, in the media, schools and stores, we often suggest to our patients that they slow down when eating and savor the smells, tastes, textures and visual aspects of their food. But sniffing platters of food at the holiday office party isn’t going to happen. And slowing down with the very object that is their biggest “problem” can be daunting especially at this time of year.

We’re now in the throes of holiday madness sales, unrealistic expectations and personal history- a perfect recipe for reverting to the entrenched coping habit of eating foods that comfort or numb.  So even though it’s a season of huge over-indulgence, it can be a time during which small steps count.

Pausing can be one of those small steps. Rather than suggesting pausing before taking the first bite, suggest they pause before entering the room or building where the office party spread is on display.  Offer the idea of taking one minute to stay seated at their desk and feel the sensations in their feet in contact with the floor, or as they walk down the hall. Suggest sitting quietly for 60 seconds before getting out of the car to enter the house of a friend’s holiday brunch, aware of the feel of the steering wheel, or sounds inside or outside of the car, or the coming and going of the breath at the belly.  I call this “backing the movie up” far enough so that we can find a reasonable spot in which they might pause instead of hoping we can do it amidst the noise and pressure of the festive event. This way they begin building a slowing-down habit where and when it’s possible, rather than in the fray of things.

I try to take my own suggestion and see where in my day and my thinking I can slow down and pause. I try to “walk my talk” so that my practice becomes a skillful way of being with myself and others. I’d be interested to hear how you navigate the holiday food landscape mindfully (or not so mindfully!). Please share below your own observations and experiences, or perhaps the kinds of exercises of mindfulness practices you suggest to others.

(Char Wilkins, MSW, LCSW and her colleague Jan Chozen Bays, MD, author of Mindful Eating: A Guide to Rediscovering a Healthy and Joyful Relationship with Food  are co-leading an intensive 5-day Professional Training in a program called Mindful Eating, Conscious Living at the Joshua Tree Retreat Center in the high desert of Southern California March 10-15. See the website for more information.)

MBCT Ushers in the Next Era with Second Edition and Two Innovative Training Opportunities

Mindfulness-Based Cognitive Therapy for DepressionFew psychological interventions have engendered so much promise and delivered on that promise with such impressive clinical outcomes and research findings as Mindfulness-Based Cognitive Therapy (MBCT). The skillful “marriage” of cognitive behavioral therapy and mindfulness practice, MBCT has emerged as an effective treatment to prevent relapse in depression and is yielding good initial results in other settings and with other populations as well. With the imminent publication of the Second Edition of Mindfulness-Based Cognitive Therapy  (Guilford Publications), MBCT has entered it’s next generation, incorporating the ongoing work of co-founders Zindel Segal, Mark Williams and John Teasdale, with the input and efforts of numerous clinicians and researchers worldwide.

Zindel Segal, Ph.D.

Zindel Segal, Ph.D.

“Ten years have passed since the publication of Mindfulness Based Cognitive Therapy,” noted Zindel Segal recently, “and in that time there has been a productive engagement and interchange with clinicians and researchers who have offered and studied the program with their own patients.  Mark, John and I have been fortunate to be involved in some of these discussions and have learned from many ‘early adopters’ as well as from the increasing volume of empirical work that has evaluated and stretched MBCT to novel populations.  The second edition of MBCT gives us an opportunity to embed this ‘crowd sourced’ wisdom and feedback into an updated and expanded version of the book that offers a few refinements to the 8-week program and grapples, more generally, with the question of how the delivery of mindfulness based interventions can be optimized.”

“Kindness and compassion are the ground from which we practice, the ground from which we teach, and the ground that participants may then use in cultivating their own practice.”                 (From the Second Edition)

Perhaps most notable in the new edition is a chapter solely dedicated to the topic of compassion in MBCT. Segal reports that “an oft-repeated question I hear is ‘what is the role of compassion training in MBCT?’  This reflects perhaps the pervasive interest in bringing compassion to patients who are suffering, as well as an enthusiasm for newer protocols that feature compassion training as a central intervention.  The answer with respect to MBCT is not as straightforward as checking whether formal compassion or loving kindness is or is not taught within the 8 weeks.  It revolves around the deeper question of what exactly compassion means in a clinical context and how it can help address the vulnerability or illness perpetuating factors that keep people locked into symptoms and distress.”

FREE CHAPTER PREVIEW!
In advance of the release of the Second Edition of MBCT, Chapter 8, entitled “Pausing for Reflection: Kindness and Self-Compassion in MBCT” is available for free by emailing the UC San Diego Center for Mindfulness at mindfulness@ucsd.edu and requesting a copy.

Book purchasers get access to a companion Web page featuring downloadable audio recordings of the guided mindfulness practices (meditations and mindful movement), plus all of the reproducibles, ready to download and print in a convenient 8 1/2″ x 11″ size. A separate web page for use by clients features the audio recordings only.

As innovative as the MBCT program itself, the 5-day MBCT teacher training offered through the UC San Diego Center for Mindfulness is a “wonderful opportunity to experience the intricate interweaving of mindfulness practice and cognitive therapy skills in the delivery of the 8 week program,” said Segal. “Our days are long and incorporate elements of personal practice and clinical training all held within a retreat framework that clarifies intention, observation and self-compassion in the learning process.  If you are interested in learning the MBCT program ‘from the inside’ this is the best vehicle for doing so.”

For those who already have experience teaching MBCT or Mindfulness-Based Stress Reduction (MBSR) UCSD is now offering an Advanced Training for MBCT and MBSR Teachers taught by experienced teachers and trainers Susan Woods and Char Wilkins. Intended to focus upon universal principles for teaching mindfulness-based interventions. As such, the focus for this training is less about teaching to the structure of MBCT and/or MBSR and more about intentionally embodying mindful presence and strengthening the facilitation of mindful inquiry.

What Are Your Thoughts? We would love to hear your thoughts on the approach of explicitly teaching compassion and lovingkindness practice within mindfulness-based interventions like MBCT, versus the more implicit approach described by Segal et al in the new 2nd edition of the MBCT book (free pdf copy of the chapter available upon request at  mindfulness@ucsd.edu ). Please share your thoughts and opinions below.

Conference Recordings Offer Mindfulness-Based Tools for Educators, Counselors, and Parents

Over the last decade, an increasing number of parents, children, educators, clinicians and researchers have studied and experienced the wide-ranging benefits of bringing mindfulness practice to youth in educational, clinical, and community settings. To help develop best practices within this growing movement, the University of California San Diego’s School of Medicine and Center for Mindfulness, along with Stressed Teens, developed the Bridging the Hearts and Minds of Youth conference, which took place in February 2012.

The first-of-its-kind conference was designed to engage professionals in the ongoing discussion of the field as well as to assist their professional growth, all within the context of a thought-provoking, collegial and collaborative environment.

“We are excited about sharing the conference audio and videos of this dynamic gathering to those who weren’t able to attend, and thereby extend the discussion across the globe to people interested in this work in all its forms,” said Steven D. Hickman, PsyD, Director, UC San Diego Center for Mindfulness. “Our deepest hope is that our efforts will support and deepen the important work being done, and foster even more profound impact in years to come.”

Publisher More Than Sound recorded over 20 hours of presentations and workshops with thought leaders from various disciplines (clinicians, educators and researchers), including the following keynote addresses:

Rick Hanson, PhD
Neuropsychologist and Author
Managing the Caveman Brain in the 21st Century


Susan Kaiser-Greenland, JD

Author, Educator, Co-Founder, Inner Kids
The Mindful Child: Teaching the New ABCs of Attention, Balance and Compassion

Amishi Jha, PhD
Psychologist and Researcher
University of Miami
From Dazed and Distracted to Attentive and Calm: What the Neuroscience of Mindfulness Reveals

Pamela Seigle, MS
Executive Director, Courage & Renewal NE

Chip Wood, MSW
Author and Educator, Facilitator
Courage & Renewal Northeast

Courage in Schools: Connecting Hearts and Minds in the Adult Community

The following workshops and breakout sessions are also available:

Gina M. Biegel, MA, LMFT
Psychotherapist and Author, Founder, Stressed Teens Program
Mindfulness for Professionals Working with Adolescents: A Training in the Mindfulness-Based Stress Reduction Program for Teens (MBSR-T)

Randye Semple, PhD
Clinical Psychologist and Author
Mindfulness-Based Cognitive Therapy for Anxious Children
Introduction to Mindfulness-Based Cognitive Therapy for Children (MBCT-C)

Megan Cowan
Co-Founder and Executive Director of Programs, Mindful Schools
Integrating Mindfulness into the K5 Classroom: Lessons Learned From Teaching Over 13,000 Students

Gina M. Biegel, MA, LMFT
Race to Right Here Right Now: An Introduction for Utilizing and Disseminating Mindfulness with Adolescents

M. Lee Freedman, MD

Child and Adolescent Psychiatrist, Co-Founder, Mindfulness Toronto, Founder, Mindful Families and School
Mindful Parents: Resilient Children: Teaching Mindful Parenting Practice through Group and Individual Psychotherapy

Joe Klein, LPC, CSAC
Founder and President Inward Bound Mindfulness Education
Sex, Drugs, Facebook and Ice Cream

Sam Himelstein, PhD
Psychotherapist, Researcher, and Mindfulness Teacher
and
Chris McKenna

Mindfulness Teacher & Executive Director, Mind Body Awareness Project
Teaching Mindfulness to Urban & At-Risk Adolescents

Amy Saltzman, MD
Mindfulness Teacher & Holistic Physician, Creator and Director: Still Quiet Place, Co-founder and Director: Association for Mindfulness in Education
Still Quiet Place: Proven Practices for Teaching Children and Teens the Skills for Peace and Happiness

Amy Garrett, PhD
Research Scientist Stanford University
Brain Abnormalities Associated with Mood and Anxiety Disorders in Adolescents

Nimrod Sheinman, ND
Naturopathic physician and mind-body expert, Founder, Israel Center for Mind-Body Medicine, Founder, The Mindful Language Project
Bringing the Soul Back to School: Lessons Learned from over 15 Years of Teaching Mindfulness and Mind-Body Health in Israeli Schools

The audio recordings and videos are a useful resource for psychologists, counselors, educators, health professionals and parents who are working with children and teens. To purchase the audio or streaming conference videos of individual talks or the full conference, and to learn more about each talk, visit More Than Sound. Presenter biographies are available here. Sample video clips are available on More Than Sound’s YouTube channel.

The UCSD Center for Mindfulness is planning the second annual Bridging Hearts & Minds conference, scheduled for February 1-3, 2013.

Mindfulness Interventions for Bipolar Depression

Dr. Marchand is an investigator at the George E. Wahlen Veterans Administration Medical Center in Salt Lake City, Utah and Assistant Professor of Psychiatry at the University of Utah.

Bipolar disorder is a severe psychiatric illness characterized by episodes of depression as well as periods of elevated mood, known as mania. This condition, previously known as manic-depressive illness, causes considerable suffering and disability. Furthermore, bipolar depression is often difficult to treat and associated with anxiety symptoms and an increased risk of suicide. Thus, additional treatment approaches are needed. Interventions that target anxiety and suicide risk, in addition to depression, could be particularly useful.

Mindfulness-based interventions have demonstrated effectiveness for symptoms of unipolar depression (major depression not associated with manic episodes) and anxiety. There is also evidence accumulating that these approaches may help reduce suicide risk. Therefore, I recently reviewed the literature to determine whether clinical trials of mindfulness-based approaches for bipolar depression are warranted. The results of that review were recently published in Depression Research and Treatment.

Several lines of evidence support studies of mindful-based interventions for bipolar depression. From a psychological perspective, bipolar depression appears to be associated with abnormal self-referential thinking, as has been established for unipolar illness. Further, ruminative analytical thinking about the self may contribute to symptom expression in both disorders. Thus, the practice of mindfulness would be expected to be beneficial for bipolar depression as a result of decreasing maladaptive self-focused thinking patterns. Similar mechanisms might also contribute to decreased suicide risk among those suffering from this condition.

Brain imaging studies also support clinical trials of mindfulness-based interventions for bipolar depression. Evidence links the function of the cortical midline structures with both emotional dysregulation and self-referential thinking in unipolar illness. Therefore, this brain region may mediate the relationship between aberrant self-referential thinking and negative emotion in major depression. Some evidence suggests that similar mechanisms may play a role in bipolar depression. Thus, while unipolar and bipolar depression are different psychiatric disorders, similar psychological and neurobiological mechanisms may underlie symptom expression in both conditions. This suggests that the response to mindfulness-based interventions may be similar across the disorders and provides a theoretical basis for the study of these approaches for bipolar depression.

A few studies (see references) have provided early evidence that mindfulness-based treatments may be useful for bipolar disorder. Moreover, diverse lines of investigation provide a conceptual background supporting continued clinical trials of mindfulness-based approaches for bipolar depression.

Please see Mindfulness Interventions for Bipolar Depression by William R. Marchand, MD for a free download of the complete review.

References:

P. Chadwick, H. Kaur, M. Swelam, S. Ross, and L. Ellett, “Experience of mindfulness in people with bipolar disorder: a qualitative study,” Psychotherapy Research, vol. 21, no. 3, pp. 277–285, 2011.

W. R. Marchand, J. N. Lee, C. Garn et al., “Aberrant emotional processing in posterior cortical midline structures in bipolar II depression,” Progress in Neuro-Psychopharmacology and Biological Psychiatry, vol. 35, no. 7, pp. 1729–1737, 1729.

W.R. Marchand, “Self-Referential Thinking, Suicide, and Function of the Cortical Midline Structures and Striatum in Mood Disorders: Possible Implications for Treatment Studies of Mindfulness-Based Interventions for Bipolar Depression,” Depression Research and Treatment, doi: 10.1155/2012/246725

B. Weber, F. Jermann, M. Gex-Fabry, A. Nallet, G. Bondolfi, and J. M. Aubry, “Mindfulness-based cognitive therapy for bipolar disorder: a feasibility trial,” European Psychiatry, vol. 25, no. 6, pp. 334–337, 2010.

J. M. G. Williams, Y. Alatiq, C. Crane et al., “Mindfulness- based cognitive therapy (MBCT) in bipolar disorder: preliminary evaluation of immediate effects on between-episode functioning,” Journal of Affective Disorders, vol. 107, no. 1–3, pp. 275–279, 2008.